微创McKeown与开式经右胸三切口食管癌切除术临床观察对比研究

doi:10.3969/j.issn.1007-3205.2019.12.008

摘要/Abstract

摘要： ［摘要］
目的观察微创McKeown术与开式经右胸三切口食管癌切除术治疗食管癌的效果及其对视觉模拟评分法(Visual Analogue Scale，VAS)评分、食管癌量表QLICP-ES评分的影响。
方法随机选择食管中上段癌患者90例，分观察组和对照组，每组45例。对照组采用开式经右胸三切口食管癌切除术，观察组采用经微创右胸上腹在颈三切口（McKeown）术，观察2组手术指标情况、术后并发症、术后疼痛评分及生命质量情况。
结果观察组手术时间、术中出血量、24 h引流量、引流时间及住院时间均短于或少于对照组，清扫淋巴结数目多于对照组（P＜0.05）。随着术后时间的延长，患者VAS评分逐渐下降，观察组术后6 h、24 h、36 h、72 h VAS评分显著低于对照组，其组间、时点间及组间与时点间交互作用差异均有统计学意义（P＜0.05）。观察组肺炎、肺不张、胸腔积液等并发症发生率显著低于对照组，但胃排空障碍发生率高于对照组（P＜0.05）。观察组术后3个月、术后6个月QLICP-ES评分均显著高于对照组（P＜0.05）。随访6个月，未发生缺失患者，观察组无复发患者，对照组复发1例。
结论微创McKeown术治疗食管癌效果好，手术时间短，术中出血量少，清扫淋巴结数量多，术后并发症少，且术后疼痛轻，患者生命质量高，故在临床上可广泛使用。

关键词: 食管肿瘤, 微创McKeown术, 传统开胸手术

Abstract: ［Abstract］ Objective〖HTSS〗To investigate the effect of minimally invasive McKeown operation and excision of esophageal cancer by open transposition of right chest with three incisions in the treatment of esophageal cancer and its influence on Visual Analogue Scale (VAS) and QLICP-ES scores.
〖WTHZ〗Methods〖HTSS〗Ninety cases of upper and middle esophageal cancer were randomly selected. They were divided into observation group and control group according to random number table method, 45 cases in each group. The control group underwent excision of esophageal cancer by open transposition of right chest with three incisions, while the observation group underwent minimally invasive right enteroventromedial-cervical incision(McKeown) operation. The surgical indicators, complications, pain scores and quality of life of the two groups were observed.
〖WTHZ〗Results〖HTSS〗The operation time, intraoperative bleeding volume, number of lymph nodes cleared, 24 hour drainage, drainage time and hospitalization time of the observation group were better than those of the control group(P＜0.05). With the extension of the postoperative time, the patient′s pain score gradually decreased, which is more meaningful than the difference of 6 h after surgery, the VAS scores of 6 h, 24 h, 36 h and 72 h were significantly lower than those of the control group, the difference between the establishment comparison, the time point comparison, and the establishment and the time point comparison are all of statistical significance(P＜0.05). Complications such as pneumonia, atelectasis and pleural effusion in the observation group were significantly less than those in the control group, but gastric emptying disorders were significantly higher than those in the control group(P＜0.05). The QLICP-ES scores in the observation group were significantly higher than those in the control group at 3 months and 6 months after operation (P＜0.05). Follow-up for 6 months showed that there were no missing patients, no recurrence in the observation group and 1 recurrence in the control group.
〖WTHZ〗Conclusion〖HTSS〗Minimally invasive McKeown operation has a good effect on esophagus, with short operation time, less bleeding, more lymph node dissection, fewer complications, less pain and higher quality of life. It can be widely used in clinic.

Key words: esophageal neoplasms, minimally invasive McKeown surgery, traditional thoracotomy

汪金钱，陈胜，陈四明，李胜平，汪方清，胡卫建*. 微创McKeown与开式经右胸三切口食管癌切除术临床观察对比研究[J]. 河北医科大学学报, doi: 10.3969/j.issn.1007-3205.2019.12.008.

WANG Jin-qian, CHEN Sheng, CHEN Si-ming, LI Sheng-ping, WANG Fang-qing, HU Wei-jian*. Clinical observation and comparative study of microinvasive McKeown and open Tri-incision oesophageal carcinoma with right throat#br#[J]. Journal of Hebei Medical University, doi: 10.3969/j.issn.1007-3205.2019.12.008.

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微创McKeown与开式经右胸三切口食管癌切除术临床观察对比研究

Clinical observation and comparative study of microinvasive McKeown and open Tri-incision oesophageal carcinoma with right throat#br#

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