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目的:探讨应用胸腔镜联合腹腔镜手辅助在食管癌根治颈部吻合术中的疗效。方法:选取2011年7月至2015年5月入住我院的食管癌根治颈部吻合的患者64例,完全随机分为微创组(胸腔镜联合腹腔镜手辅助)34例、开放组(传统三切口)30例。比较两组围手术期临床资料及主要并发症情况。结果:微创组平均手术时间360±47min与开放组212±45min相比较差异具有统计学意义(P=0.03<0.05);微创组平均手术出血量180±18ml与开放组240±26ml间相比较差异具有统计学意义(P=0.02<0.05);微创组平均住院天数11±3d与开放组16±2d之间相比较差异具有统计学意义(P=0.04<0.05)。微创组平均清扫淋巴结12±3个与开放组13±2个间相比较差异不具有统计学意义(P=0.80>0.05);开放组术后出现乳糜胸1例(3.3%),微创组出现乳糜胸2例(5.9%);开放组术后出现吻合口瘘1例(3.3%),微创组出现吻合口瘘1例(2.9%),乳糜胸、吻合口瘘等并发症情况,两组相比较差异均无统计学意义。结论:胸腔镜联合腹腔镜手辅助在食管癌根治颈部吻合治疗食管癌安全可行经济,值得推广。
Objective: To investigate the effect of thoracoscope combined with laparoscopic hand assisted in the treatment of esophagectomy for cervical anastomosis. Methods: Totally 64 patients undergoing esophageal cancer radical neck anastomosis admitted to our hospital from July 2011 to May 2015 were randomly divided into minimally invasive group (thoracoscopic and laparoscopic hand-assisted) 34 cases, open group (traditional Three incision) 30 cases. Perioperative clinical data and major complications were compared between the two groups. Results: The average operative time in the minimally invasive group was significantly higher than that in the open group at 360 ± 47 min (P = 0.03 <0.05). The mean operative blood loss was 180 ± 18 ml in the minimally invasive group and 240 ± 26 ml in the open group The difference was statistically significant (P = 0.02 <0.05). The mean length of stay in the minimally invasive group was 11 ± 3d, which was significantly lower than that in the open group at 16 ± 2d (P = 0.04 <0.05). There was no significant difference in the average number of lymph nodes between the minimally invasive group (12 ± 3) and the open group (13 ± 2) (P = 0.80> 0.05). In the open group, chylothorax was found in 1 case (3.3% There were 2 cases of chylothorax (5.9%) in the open group, 1 case (3.3%) of the anastomotic leakage occurred in the open group, 1 case (2.9%) of the anastomotic leakage in the minimally invasive group, and the complications such as chylothorax and anastomotic fistula There was no significant difference between the two groups. Conclusions: Thoracoscopy combined with laparoscopic hand assisted in esophagectomy for the treatment of esophageal cancer is feasible and safe, which is worthy of promotion.