手辅助电视胸腔镜食管癌切除术

Hand-Assisted Video Thoracscopic Surgery for Resection of Carcinoma of the Esophagus

目的 探讨手辅助电视胸腔镜(HVATS )食管癌切除术的方法和可行性。 方法 将5 0例食管癌患者分为研究组和对照组,各2 5例。研究组施行HO VATS食管癌切除术,对照组施行常规三切口开胸手术。比较两组患者术中淋巴结清扫情况和两组患者围手术期情况。 结果 研究组与对照组比较手术效果满意。研究组和对照组的食管旁淋巴结(枚)分别为(2 .92±0 .99)和(2 .96±0 .89) ,贲门旁淋巴结(枚)分别为(1.16±0 .6 9)和(1.0 8±0 .6 4 ) ,胃左动脉淋巴结(枚)分别为(2 .92±0 .76 )和(3.0 4±0 .6 8) ,清扫的淋巴结数目差异均无显著性(P >0 .0 5 ) ;纵隔淋巴结清扫(枚)分别为(6 .12±1.0 9)和(4.6 0±0 .91) ,差异有显著性(P <0 .0 5 )。胸部手术时间(min)分别为(5 1.2 4±4 .0 1)和(73.4 4±8.75 ) ,胸部失血量(mL)分别为(10 4 .2 0±13.89)和(191.2 1±2 4 .0 3) ,术后引流量(mL)第一天分别为(2 0 7.6±2 0 .0 6 )和(382 .0 0±2 5 .6 6 ) ,差异有极显著性(P <0 .0 1)。 结论 HVATS食管癌切除术能够达到常规三切口开胸手术相同的切除效果,且具有手术时间短、创伤小、出血少、疼痛轻、恢复快、并发症少等优点。

Objective To research the efficacy and operative method of hand assisted-video thoracscopic surgery(HVTS ) for resection of carcinoma of the esophagus. Methods 25 cases received hand assisted-video surgery (test group ). During the same period, 25 cases underwent routine open thoracotomies(control group). A cervical esophagogastrostomy was made. Results There were no operative mortality in two groups. The number of periesophageal dissected nodes was (2.92±0.99) in test group and ( 2.96 ± 0.89 ) in control group(P> 0.05 ). The number of parahiatal dissected nodes was(1.16±0.69) in test group and (1.08±0.64) for control group(P>0.05). The number of left gastric dissected nodes was (2.92± 0.76 ) in test group and (3.04±0.68) in control group(P>0.05). The number of mediastinal dissected nodes was (6.12±1.09) in test group and (4.60±0.91) in control group(P<0.05). The mean thoracic operating time was (51.24±4.01)min in test group and (73.44±8.75)min in control group. The mean thoracic operating blood loss was (104.20±13.89)mL in test group and (191.21±24.03)mL in control group. The mean chest tube drainage was (207.6±20.06)mL in test group and (382.00±25.66)mL in control group in the first day after operation. The difference in above parameters between two groups was significant(all P< 0.01 ). Conclusion HVTS is a safer and less traumatic procedure in the treatment of esophagus carcinoma than routine open thracotomy.