Comparison of laparoscope combined left thorax small incision and left thorax single-incision therapy for Siewert Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction
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摘要: 目的 探讨腹腔镜联合左胸小切口治疗SiewertⅡ/Ⅲ型食管胃结合部腺癌(AEG)在减少手术创伤同时安全、有效的充分切除肿瘤及淋巴结清扫的可行性。 方法 回顾分析2014年10月—2015年12月于林州市人民医院手术治疗的SiewertⅡ/Ⅲ型食管胃结合部腺癌患者193例的临床资料,其中58例行腹腔镜联合左胸小切口手术,135例行单一左胸切口手术治疗,分析2组患者手术时间、术中出血量、术后胸腔引流总量、胸腔引流带管时间、纵隔及腹腔淋巴结清扫数目,并进行统计学处理。 结果 腔镜组手术时间长于单左胸组,差异有统计学意义(P<0.05),而术中出血量、术后胸腔总引流量、术后住院时间、腹腔淋巴结清扫数目、VAS疼痛评分等方面,腔镜组均具有优势,差异有统计学意义(P<0.05);2组术后胸腔引流管引流时间、纵隔淋巴结清扫数目差异无统计学意义(P>0.05)。2组患者术后并发症的发生率均较低,腔镜组二次剖胸手术止血1例,2组各有1例患者术后发生轻度食管胃吻合口瘘,腔镜组发生肺部感染1例,单左胸组发生肺部感染5例,各组均无胸腹腔内、切口感染,无围手术期死亡。 结论 腹腔镜联合左胸小切口用于SiewertⅡ/Ⅲ型AEG的手术治疗具有创伤小、恢复快、切口疼痛轻、腹腔淋巴结清扫彻底、胸内食管胃吻合确切、瘤上切缘食管充分的优点,值得临床推广。Abstract: Objective To explore the feasibility of laparoscope combined left thorax small incision therapy in the treatment of Siewert Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction (AEG),and compared with the single-incision treatment in surgical trauma,safety and efficacy on tumor/lymph node dissection. Methods A retrospective analysis was done on 193 patients with Siewert Ⅱ/Ⅲ AEG in Linzhou city people's hospital from October,2014 to December,2015,including 58 cases of laparoscope combined left thorax small incision therapy and 135 cases of left thorax single-incision therapy.The operation time,intraoperative bleeding,total drainage volume,indwelling pleural catheter time,and mediastinal/celiac lymph node dissection number were compared and statistically analyzed. Results The laparoscope combined left thorax small incision treatment has a longer operation time(P<0.05).However,it has advantage on intraoperative bleeding,total drainage volume,postoperative hospitalization days,celiac lymph node dissection number,VAS pain score(P<0.05).No statistical significance was obtained in indwelling pleural catheter time and mediastinal lymph node dissection number(P>0.05).Low occurrence of postoperative implications and no perioperative period death were found in these cases. Conclusion Laparoscope combined left thorax small incision therapy in the treatment of Siewert Ⅱ/Ⅲ AEG is with the advantage of smaller wound,quicker postoperative recovery,less intraoperative pain,clearer celiac lymph node dissection,better esophagus-stomach anastomosis and more perservation of the esophagus at tumor upper margin,which is worthy of application.
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