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目的评估单操作孔胸腔镜联合腹腔镜在McKeown食管癌根治术中的安全性及可行性。方法分析广西壮族自治区人民医院心胸外科2015年1月至2016年1月40例接受McKeown食管癌根治术的中下段食管癌患者资料,其中11例行单操作孔胸腔镜联合腹腔镜McKeown食管癌根治术(single-utility incision total endoscopy McKeown esophagectomy,s TEME),29例行三孔胸腔镜腹部开放McKeown食管癌根治术(three-port thoracoscope combined with laparotomy McKeown esophagectomy,t TLME),比较两组的术中情况、手术结果及术后并发症的发生率。结果两组在胸部手术时间、胸部术中出血量及胸部淋巴结清扫数量方面差异无统计学意义(P>0.05);sTEME组的腹部手术时间较t TLME组长(P<0.05),腹部术中出血量、术后24 h疼痛指数评分及术后住院时间优于t TLME组(P<0.05)。两组腹部淋巴结清扫数、术后重症监护时间、术后并发症发生率及术后6个月淋巴结复发转移情况差异无统计学意义(P>0.05)。结论单操作孔胸腔镜联合腹腔镜McKeown术治疗中下段食管癌可行,虽然会延长手术时间,但手术创伤小、住院时间短、近期效果满意。
Objective To assess the safety and feasibility of single-hole thoracoscope combined with laparoscopy in radical surgery of McKeown esophageal cancer. Methods The data of 40 patients with esophageal cancer who underwent radical resection of McKeown esophageal cancer from January 2015 to January 2016 in our hospital from January 2015 to January 2016 were retrospectively analyzed. Eleven patients underwent single-hole thoracoscope combined with laparoscopic McKeown esophagectomy (Three-port thoracoscope combined with laparotomy McKeown esophagectomy, t TLME) was performed in 29 patients underwent single-utility incision total endoscopy (McElee esophagectomy, s TEME) The situation, the surgical results and the incidence of postoperative complications. Results There was no significant difference between the two groups in the time of thoracic surgery, the amount of hemorrhage in thoracic surgery and the number of lymph nodes dissected in the thoracic cavity (P> 0.05). The abdominal operation time in sTEME group was longer than that in t TLME group (P <0.05) The amount of bleeding, postoperative pain score and postoperative hospital stay at 24 hours were better than t-TLME group (P <0.05). There were no significant differences in the number of lymph nodes dissection, postoperative intensive care time, incidence of postoperative complications and lymph node recurrence and metastasis at 6 months after operation (P> 0.05). Conclusions The single operation hole thoracoscope combined with laparoscopic McKeown surgery for the treatment of middle and lower esophageal cancer is feasible, although it will prolong the operation time, but less trauma, shorter hospital stay, the recent results are satisfactory.