腔镜微创与开放食管癌根治术围手术期并发症和淋巴结清扫的比较研究

Comparative study of perioperative complications and lymphadenectomy between minimally invasive esophagectomy and open procedure

目的比较早期腔镜微创与开放食管切除术治疗食管癌患者的围手术期并发症和淋巴结清扫情况差异。方法回顾性分析2011年1—12月间上海市胸科医院手术治疗的72例食管癌患者的临床资料。其中34例完成腔镜微创食管癌切除术（腔镜组），38例接受开放食管癌切除术（开放组）。腔镜组中16例行单纯胸腔镜加开腹手术，11例行单纯腹腔镜加开胸手术11例，7例行胸腹全腔镜联合手术。结果腔镜组早期病例（T1-2期）的比例高于开放组[79．4％（27／34）比55．3％（21／38），P〈0．05）。两组患者总并发症发生率分别为41．2％（14／34）和42．1％（16／38），差异无统计学意义（P〉0．05）；但腔镜组功能性并发症（主要为心肺并发症）发生率显著低于开放组[2．9％（1／34）比28．9％（11／38）．P〈0．01]，技术性并发症（主要包括吻合口瘘和喉返神经损伤）发生率则显著高于开放组[38．2％（13／34）比10．5％（4／38）。P〈0．05）。两组淋巴结清扫组数分别为（9．1±2．7）组／例和（11．2±2．1）组／例，差异无统计学意义（P〉0．05）；但腔镜组淋巴结清扫枚数[（13．5±5．9）枚／例]却明显少于开放组[（17．8±5．2）枚／例，P〈0．05]。按手术时间，腔镜组前期17例与后期17例患者技术性并发症发生率的差异无统计学意义（P〉0．05）．但后期患者胸腔淋巴结淋扫组数、枚数及阳性检出率均显著提高（均P〈0．05）。结论腔镜辅助微创食管癌手术可降低功能性并发症发生率．但早期技术不熟练时易增加吻合口瘘和喉返神经损伤等技术性并发症。腔镜下清扫淋巴结可以达到或接近开放手术水平。

Objective To analyze the differences in perioperative morbidity and lymph node dissection between minimally invasive esophageal carcinoma resection and open procedure. Methods From January to December 2011, 72 patients with esophageal cancer underwent surgery. Thirty-four patients underwent video-assisted esophagectomy, and 38 underwent open procedure. In the minimally invasive group, there were 7 thoracolaparoscopic cases, 16 thoracoscopic cases, and 11 laparoscopic cases. Results The early cases （T1-T2） were more common in the minimally invasive group than that in the open group[79.4%（27/34） vs. 55.3%（21/38）, P〈0.05]. The complication rate was 41.2%（11/ 34） in the open group and 42.1%（16/38） in the minimally invasive group, and the difference was not statistically significant （P〉0.05）. However, the functional complication in minimally invasive group was significantly lower than that in open group 12.9% （ 1/34） vs. 28.9% （11/38）, P〈0.01 ], while technical complications （anastomotic leak and recurrent laryngeal nerve injury） were significantly more common （38.2% vs. 10.5%, P〈0.05）. Lymph node group number in minimally invasive group was comparable with the open group （9.1 vs. 11.2, P〉0.05）, but the number of node in minimally invasive group was significantly lower （13.5±5.9 vs. 17.8±5.2, P〈0.05）. When stratified by time period, early 17 cases were associated with similar technical complication rate with the late 17 cases （P〉0.05）, while thoracic lymph node group number, number of node, and positive node were improved in the late phase （all P〉 0.05）. Conclusions Minimally invasive esophagectomy reduces functional morbidity, while technical complication including anastomotic leak and recurrent laryngeal nerve injury may be increased. Endoscopic lymph node dissection may be comparable to open surgery.