不同体位胸腔镜食管切除术的临床比较

Comparison of thoracoscopic esophagectomy in decubitus position with prone position

目的比较采取侧卧位和俯卧位两种不同体位进行胸腔镜食管切除术的安全性和有效性。方法回顾性分析2008年1月至2009年12月间复旦大学附属中山医院胸外科收治的88例胸腔镜食管切除术患者的临床资料。其中侧卧位下胸腔镜食管切除术52例（侧卧位组），俯卧位下食管切除术36例（俯卧位组）。结果两组均无中转开胸病例。与侧卧位组相比，俯卧位下胸腔镜手术时间更短[（70±20）min比（82±17）min]，胸部出血量更少[（100±52）ml比（139±54）ml]，胸部淋巴结清扫数目更多[（12．2±6．2）枚比（8．6±4．3）枚]，差异均有统计学意义（均P〈0．01）。两组在胸管置管时间、ICU停留时间、术后住院时间以及术后并发症发生率方面的差异无统计学意义（均P〉0．05）。结论与侧卧位相比。俯卧位进行胸腔镜食管切除术具有术野显露优良、手术时间短、术中出血量少以及淋巴结清扫更为彻底的优点。

Objective To compare the safety and efficacy between two different surgical approachs for thoracoscopic esophagectomy including left lateral decubitus position and prone position. Methods From January 2008 to December 2009, 88 patients who underwent thoracoscopic esophagectomy were enrolled in this study. Among them, 52 patients were placed in decubitus position and 36 patients were placed in prone position. Results No conversion to thoracotomy occurred in either group. The operative time was shorter in the prone group than that in the decubitus group （70±20 min vs. 82±17 min, P〈0.01）. Blood loss during operation was less in the prone group （100±52 ml vs. 139±54 ml, P〈0.01）. More lymph nodes were harvested from chest in the prone group （12.2±6.2 vs. 8.6 ±4.3, P〈0.01）. There was no significant difference between the two groups in morbidity. Conclusion Thoracoscopic esophagectomy in prone position is associated with better exposure of surgical filed, shorter operative time, less blood loss, and more extensive lymph node dissection as compared to decubitus position.