电视胸腔镜下行食管癌手术胸部淋巴结清扫

Esophagectomy combined with radical lymphadenectomy by videothoracoscopy

目的探讨电视胸腔镜下行食管癌手术胸部淋巴结清扫的临床应用效果。方法对25例食管癌患者行电视胸腔镜下病灶切除、胸部淋巴结清扫(胸腔镜组),以同期22例行常规开胸手术者为对照(常规开胸组),对两组间胸部淋巴结清扫及围手术期情况进行比较。患者平均年龄55岁(34～73岁),肿瘤分期为T1～T3期,经右胸颈腹切口途径切除胸段食管,行食管胃左颈部吻合术。结果胸腔镜组和常规开胸组的胸部淋巴结平均切除数分别为(7.8±1.7)和(7.5±1.3)个/例,其中食管旁为(3.16±1.86)和(3.61±0.26)个/例,气管旁为(1.08±0.25)和(1.84±1.43)个/例,支气管旁为(1.21±0.87)和(1.03±0.89)个/例,隆突下为(2.04±1.02)和(1.39±0.76)个/例,下肺静脉旁为(2.47±1.65)和(1.97±1.47)个/例,两组比较差异无统计学意义(P>0.05),而胸部失血量分别为(130±83)和(350±135)ml,术后1d引流量分别为(280±132)和(350±149)ml,术后住院(10.9±2.5)和(14.6±1.7)d,平均费用(12386±1353)和(12526±1432)元/例,两组术中胸部失血量和术后住院时间比较,差异有统计学意义(t=6.83,5.87,P均<0.05)。结论电视胸腔镜下行食管癌切除、胸部淋巴结清扫可达到常规三切口开胸手术相同的效果,且有创伤小、出血少、疼痛轻、住院时间短、并发症少等优点。

Objective To explore the value of videothoracoscopy in the thoracoscopic mobilization of the thoracic esophagus combined with radical lymphadenectomy. Methods Between March 2002 and May 2003, thoracoscopic mobilization of the thoracic esophagus combined with radical lymphadenectomy was attempted in 25 patients (test group) and 22cases received routine open thoractomies (control group) . Mean age was 55 years (range 34—73).The cancers were T_1— T_3. Dissection of the thoracic esophagus was attempted via a right-sided approach, followed by a laparotomy and a cervical incision. Results The thoracoscopic procedure was successful in all patients. There was no post-operative death in two groups. Mean node harvest was (7.8±1.7) nodes for test group and (7.5±1.3)nodes for control group (P>0.05).Mean blood lo of the thoracic component was (130±83)ml for test group and(350±135)ml for control group(t=6.83,P<0.05). Median post-operative stay was (10.9±2.5)days for test group and (14.6±1.7)days for control group(t=5.87,P<0.05).Conclusion Videothoracoscopy could potentially provide an oncologically sound means for resecting the thoracic esophagus without the need for a thorcotomy. Radical thoracoscopic mobilization of the esophagus is feasible.