论文部分内容阅读
目的探讨传统手术与扩大根治手术治疗胸段食管鳞癌的临床疗效及安全性。方法回顾性分析2011年1月至2012年12月南京医科大学第一附属医院行根治性手术治疗148例胸段食管鳞癌患者的临床资料,所有患者手术前后均未行放化疗,根据是否清扫上纵隔淋巴结,分为传统手术组(103例)与扩大手术组(45例),比较两组患者的淋巴结清扫情况、总体生存时间、术后并发症发生率、住院时间及住院费用。结果扩大手术组清扫淋巴结数量大于传统手术组[(15.28±4.54)枚vs(12.06±4.86)枚,P<0.01],而扩大淋巴结清扫范围后,阳性淋巴结并未增多,两组差异无统计学意义(P>0.05)。传统手术组总体生存时间为(38.71±15.73)个月,中位生存期为39.1个月,1、2、3年的生存率分别为89.32%、78.64%和70.87%;而扩大手术组总体生存时间为(39.97±14.4)个月,中位生存期为40.6个月,1、2、3年的生存率分别为93.33%、82.22%和73.33%。两组生存时间、中位生存期和生存率比较差异均无统计学意义(P均>0.05)。COX多因素回归分析显示,淋巴结转移和肿瘤浸润深度是影响胸段食管鳞癌预后的独立危险因素(P均<0.01)。扩大手术组暂时性喉返神经损伤发生率高于传统手术组(22.22%vs 1.94%,P<0.01),其他并发症两组间差异无统计学意义(P均>0.05)。两组患者住院时间差异无统计学意义(P>0.05),但传统手术组患者住院费用显著低于扩大手术组(P<0.01)。结论两种手术方式对于胸段食管鳞癌临床疗效相当。传统手术创伤较小、住院费用较少,在临床治疗中具有一定的优势。
Objective To investigate the clinical efficacy and safety of traditional surgery and extended radical surgery in the treatment of thoracic esophageal squamous cell carcinoma. Methods The clinical data of 148 patients with thoracic esophageal squamous cell carcinoma underwent radical surgery from January 2011 to December 2012 in the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. All patients underwent radiotherapy and chemotherapy before and after surgery, The upper mediastinum lymph nodes were divided into two groups: conventional operation group (n = 103) and extended operation group (n = 45). The lymph node dissection, overall survival time, postoperative complication rate, hospital stay and hospitalization cost were compared between the two groups. Results The number of lymph nodes disseminated in the operation group was significantly larger than that in the conventional operation group (15.28 ± 4.54 vs 12.06 ± 4.86, P <0.01). However, there was no significant increase in the number of lymph nodes dissection Significance (P> 0.05). The overall survival time of the traditional operation group was (38.71 ± 15.73) months, the median survival time was 39.1 months, and the survival rates at 1, 2 and 3 years were 89.32%, 78.64% and 70.87% respectively. However, The time was (39.97 ± 14.4) months and the median survival time was 40.6 months. The survival rates at 1, 2 and 3 years were 93.33%, 82.22% and 73.33%, respectively. There was no significant difference in survival time, median survival and survival between the two groups (all P> 0.05). COX multivariate regression analysis showed that lymph node metastasis and tumor invasion depth were independent risk factors affecting the prognosis of thoracic esophageal squamous cell carcinoma (all P <0.01). The incidence of transient recurrent laryngeal nerve injury in the extended operation group was significantly higher than that in the conventional operation group (22.22% vs 1.94%, P <0.01). There was no significant difference in other complications between the two groups (all P> 0.05). There was no significant difference in hospitalization time between the two groups (P> 0.05), but the cost of hospitalization in the traditional surgery group was significantly lower than that in the extended surgery group (P <0.01). Conclusions The two surgical methods have similar clinical efficacy for thoracic esophageal squamous cell carcinoma. Traditional trauma surgery less hospitalization costs less, in clinical treatment has some advantages.