摘要
目的：比较胸腔镜食管癌根治术与开放手术的纵隔淋巴结清扫情况，探讨胸腔镜手术的根治性及安全性。方法回顾性分析2009年6月至2011年6月间四川省肿瘤医院胸外科经左颈右胸上腹食管癌根治术治疗304例患者的临床资料。其中199例行传统开放三切口食管癌根治术（开放组），105例行胸腹腔镜三切口食管癌根治术（腔镜组），比较两组患者术中淋巴结清扫情况及围手术期并发症发生情况。结果腔镜组清扫纵隔淋巴结数目为（10．1±5．5）枚，明显少于开放组的（13．3±7．5）枚（P＜0．01）；但匹配术后病理分期后，各期腔镜组和开放组的胸内淋巴结清扫数目差异并无统计学意义（均P＞0．05）。开放组和腔镜组左喉返神经旁淋巴结平均清扫数分别为（2．7±0．2）枚和（1．4±0．2）枚，下段食管旁分别为（1．0±0．1）枚和（0．6±0．1）枚，病灶旁分别为（1．7±0．2）枚和（0．7±0．1）枚，差异均有统计学意义（均P＜0．01）；其他区域两组淋巴结清扫数目差异均无统计学意义（均P＞0．05）。腔镜组围手术期并发症发生率为28．6％（30/105），低于开放组的41．2％（82/199）（P＜0．05），但喉返神经麻痹发生率[12．4％（13/105）]明显高于开放组[2．5％（5/199），P＜0．01）。结论胸腔镜食管癌根治术安全可行。但在行胸腔镜纵隔淋巴结清扫时，应加强对喉返神经旁、下段食管旁和病灶旁淋巴结的清扫，并注意喉返神经的保护。
Objective To compare thoracoscopic esophagectomy with traditional esophagectomy in radical mediastinal lymphadenectomy for esophageal cancer , and to explore the feasibility and safety of thoracoscopic mediastinal lymphadenectomy for esophagectomy. Methods Clinical data associated with perioperation and mediastinal lymph nodes clearance of 304 patients undergoing radical operation of esophageal cancer via left neck-right chest-upper abdomen in our department from June 2009 to June 2011 were analyzed retrospectively. Among 304 cases, 199 received traditional open radical resection and 105 thoracoscopic esophagectomy. The intrathoracic mediastinal lymph node metastasis rate , extent of metastasis, time of operation, blood loss and complications between two groups were compared. Results All the 304 cases completed their operations successfully. A total of 3724 mediastinal lymph nodes were removed, mean 12.3±7.0 per case, including 1065 in thoracoscopic group, mean 10.1±5.5 per case, and 2659 in open group, mean 13.3 ±7.5 per case, whose difference was significant. But further analysis according to the postoperative pathologic staging showed no significant difference of above lymph nodes removed between two groups. Mediastinal lymph node metastasis was found in 126 patients with a rate of 41.4%, which was 35.6% and 44.7% in thoracoscopic and open groups respectively without significant difference （P〉0.05）. The left laryngeal recurrent nerve lymph node metastasis rate in open group and thoracoscopic group was 16.1% and 6.7% respectively , and the difference was significant （P〈0.05）. Differences of lymph node metastasis rate in other regions were not significant between the two groups. There were 365 positive lymph nodes , and the lymph node metastasis degree was 9.8%. which was 8.2% and 10.5% in thoracoscopic group and open group respectively （P〈0.05）, besides metastasis degree of open group was much higher in right laryngeal recurrent nerve and subcarinal lymph node region. The overall complication rate was 36.8%, which was 28.6% in thoracoscopic group and 41.2% in open group respectively with significant difference （P〈0.05）. There were no significant differences in operative time and blood loss between the two groups （both P〉0.05）. Conclusion Radical mediastinal lymphadenectomy with thoracoscopic esophagectomy is technically safe and feasible for early to moderate stage esophageal cancer with similar lymph nodes removed and lower complication morbidity. In the early period of carrying out thoracoscopic radical mediastinal lymphadenectomy, laryngeal recurrent nerve and subcarinal lymph node region should be identified to prevent incidental injury.
出处
《中华胃肠外科杂志》
CAS
CSCD
2014年第9期911-914,共4页
Chinese Journal of Gastrointestinal Surgery
关键词
食管肿瘤
胸腔镜
食管切除术
淋巴结清扫术
Esophageal neoplasms
Thoracoscopy
Esophagectomy
Lymph node dissection
