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目的分析并探讨微创术联用术前放化疗对晚期食管鳞癌(ESCC)的治疗效果。方法选取2012年1月至2014年1月徐州医学院附属医院收治的146例晚期ESCC患者作为研究对象,随机分为研究组和对照组,每组73例。研究组给予术前放化疗联用微创根治切除术,对照组实施单纯微创手术切除治疗。观察并比较两组治疗的临床疗效、并发症发生情况及远期随访结果。结果研究组完全缓解率(15.07%)和总有效率(79.45%)均显著高于单纯手术治疗的对照组的(4.11%)和(57.53%),差异有统计学意义(P<0.05)。两组患者的心脏并发症、肺部感染、吻合口瘘及声音嘶哑等并发症发生率比较差异无统计学意义(P>0.05)。术后2年随访发现,研究组患者的复发率(12.33%)、转移率(9.59%)和死亡率(19.18%)均明显低于对照组的30.14%、32.88%和35.62%,差异有统计学意义(P<0.05);研究组患者2年期生存率(80.82%)显著高于对照组(64.38%),差异有统计学意义(P<0.05)。结论术前放化疗联用微创根治手术对晚期ESCC有较好的临床疗效,未增加术后并发症,能够有效降低患者术后肿瘤复发和转移,提高患者生存率,值得进一步临床推广。
Objective To analyze and discuss the effect of minimally invasive surgery combined with preoperative radiochemotherapy on advanced esophageal squamous cell carcinoma (ESCC). Methods A total of 146 patients with advanced ESCC who were admitted to the Affiliated Hospital of Xuzhou Medical College from January 2012 to January 2014 were randomly divided into study group and control group, with 73 cases in each group. The study group was given preoperative radiochemotherapy combined with minimally invasive radical resection, while the control group was treated with minimally invasive surgical resection. The clinical efficacy, complications and long-term follow-up results of the two groups were observed and compared. Results The complete remission rate (15.07%) and total effective rate (79.45%) in the study group were significantly higher than those in the control group (4.11%) and (57.53%), respectively, with statistical significance (P <0.05). There were no significant differences in complication rates of cardiac complications, lung infections, anastomotic fistulas and hoarseness between the two groups (P> 0.05). The 2-year follow-up showed that the recurrence rate (12.33%), metastasis rate (9.59%) and mortality rate (19.18%) in the study group were significantly lower than those in the control group 30.14%, 32.88% and 35.62% (P <0.05). The 2-year survival rate (80.82%) in the study group was significantly higher than that in the control group (64.38%), the difference was statistically significant (P <0.05). Conclusions Preoperative chemoradiotherapy combined with minimally invasive radical operation has better clinical efficacy in advanced ESCC and no postoperative complications. It can effectively reduce postoperative tumor recurrence and metastasis and improve patient survival, which is worth further clinical promotion.