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目的探究左胸小切口手术治疗老年食管癌患者的临床疗效。方法选取2014年1月至2016年12月间安徽医科大学第一附属医院收治的50例老年食管癌患者,采用随机数表法分为观察组与对照组,每组25例。观察组患者采用左胸小切口手术,对照组采用右胸腹正中切口手术,比较两组患者手术相关指标,包括出血量、补血量、手术持续时间、术后胸腔引流量及视觉模拟评分法(VAS)等情况;检测术前及术后24h患者肺氧合指数;比较两组患者手术后2周并发症发生情况及术后1年和3年复发率。结果观察组患者手术期间出血量、补血量、手术持续时间、胸腔引流量和患者VAS评分均显著低于对照组,差异均有统计学意义(均P<0.05)。两组患者术后24h氧合指数(OI)与术前相比均显著下降,且观察组高于对照组,差异均有统计学意义(均P<0.05)。术后2周内,观察组患者并发症总发生率为48.0%(12例),1年内复发率为8.0%(2例),3年复发率为24.0%(6例),均显著低于对照组的76.0%(19例)、20.0%(5例)和52.0%(13例),差异均有统计学意义(均P<0.05)。结论左胸小切口手术治疗老年食管癌患者临床疗效显著,可明显提高患者肺氧合能力,减少肺部并发症的发生。
Objective To investigate the clinical effect of small left thoracotomy in the treatment of elderly patients with esophageal cancer. Methods Fifty elderly patients with esophageal cancer admitted to the First Affiliated Hospital of Anhui Medical University from January 2014 to December 2016 were randomly divided into observation group and control group with 25 cases in each group. The patients in the observation group were treated with small incision of the left chest and the control group with the right incision of the right chest and abdomen. The operation-related indexes including blood loss, blood volume, duration of operation, postoperative thoracic drainage and visual analogue scale were compared VAS) were measured. The oxygenation index (LAI) was measured before and 24 hours after operation. Complications of two weeks after operation and the recurrence rates at 1 year and 3 years after operation were compared between the two groups. Results The bleeding volume, blood volume, duration of operation, drainage of thoracic cavity and VAS score of patients in observation group were significantly lower than those in control group during operation (all P <0.05). Oxygenation index (OI) at 24 hours after operation was significantly lower than that before operation in both groups, and the difference between the two groups was statistically significant (all P <0.05). Within 2 weeks after operation, the overall complication rate in observation group was 48.0% (12 cases), the recurrence rate was 8.0% in 1 year (2 cases) and 3 years was 24.0% (6 cases), both of which were significantly lower than 76.0% (19 cases), 20.0% (5 cases) and 52.0% (13 cases) in the control group, the differences were statistically significant (all P <0.05). Conclusion Surgical treatment of senile esophageal cancer with left thoracic incision is significant, which can significantly improve pulmonary oxygenation and reduce the incidence of pulmonary complications.