目的 观察和比较胸腹腔镜联合手术治疗食管癌与传统食管癌根治术治疗食管癌的安全性、可行性和根治性及二者的临床疗效.方法 回顾性分析我院2010年1月至2011年7月收治的120例行食管癌根治术的患者.其中行胸腔镜、腹腔镜联合食管癌根治术的患者71例(腔镜组),行传统三切口开放性食管癌根治术的患者49例(开胸组).将两组患者的临床资料及疗效指标进行比较.结果 腔镜组和开胸组的总手术时间分别为( 276±16) min和(297±19) min(P＞0.05).术中总出血量分别为(218±34) ml和(298±37) ml,腔镜组明显少于开胸组(P＜0.01).术后第3天疼痛情况腔镜组少于开胸组,差异具有统计学意义(P＜0.01).术后腔镜组呼吸系统并发症的发生率为9.8％,开胸组为29.2％,两组差异具有统计学意义(P＜0.01).术后开胸组患者中有4例发生不完全性肠梗阻,而腔镜组无(P＜0.05).两组患者术后随访时间平均为( 15.3±2.1)个月,腔镜组的总复发率为7.8％,生存率为90.2％,开胸组分别为10.4％和88.3％,差异无统计学意义(P＞0.05).结论 胸腹腔镜联合手术治疗食管癌与传统食管癌根治术治疗食管癌相比,具有安全可靠,创伤小,并发症发病率低的优点,且疗效可靠,值得在临床推广使用.%Objective To compare the safety,feasibility,and efficacy of thoracoscopic and laparoscopic surgery with those of traditional esophagectomy for esophageal carcinoma.Methods The data on 120 patients with esophageal carcinoma who had been treated during January 2010 to July 2011 were retrospectively.71 patients received thoracoscopic and laparoscopic surgery ( TLS group ), while 49 patients received conventional open esophagectomy ( OE group ).The clinical data and the efficacy the procedure were compared between the two groups.Results The total surgical duration was ( 276 ± 16 ) min in TLS group and ( 297 ± 19 ) min in OE group ( P＞ 0.05 ); intraoperative blood loss was less in TLS group than in OE group [( 218 ± 34 )ml vs.( 298 ± 37 )ml,P＜ 0.01].The patients had lower pain level in TLS group than in OE group on day 3.( P ＜ 0.01 ).The rate of complications associated with respiratory system differed signficantly between TLS group and OE group ( 9.8％ vs.29.2％,P＜ 0.01 ).Four patients in OE group developed incomplete intestinal obstruction but no patients developed such disorder in TLS group ( P＜ 0.05 ).The mean follow-up duration was ( 15.3 ± 2.1 )mon in both goups.The total recurrence rate and the survival rate did not differed significartly between TLS group and OE group ( 7.8％ vs.10.4％ and 90.2％ vs.88.3％,P ＞ 0.05 ).Conclusions As compared with conventional open esophagectomy,thoracoscopic and laparoscopic surgery for esophageal carcinoma is safer and less invasive and has a lower rate of complications It is worth popularizing clinically.
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