食管系膜的微创解剖及全食管系膜切除在胸腹腔镜食管癌根治术中的应用

The micro anatomy of mesoesophagus and research of total mesoesophagus excision in thoracoscopic combined laparoscopic esophagectomy

目的:探讨胸腹腔镜下食管癌切除术中食管系膜微创解剖特点及食管全系膜切除的方法。方法:回顾性分析2007年9月至2012年5月收治的101例食管癌切除患者的临床病理资料。101例患者分为食管全系膜切除组(A组,40例)、非食管全系膜切除组(B组,61例)。比较两组患者手术时间、术中出血量、术后引流量、清扫淋巴结组数、清扫淋巴结数和术后并发症发生情况。结果:与B组相比,A组手术时间长(t=2.483,P=0.015),但术中出血少(t′=-4.103,P=0.000),术后引流量差异无显著性。A组清扫淋巴结组数及淋巴结数均明显高于B组(P=0.000)。术后30d内出现近期并发症共20例(19.8%),两组并发症发生率分别为15%(6/40)和22.95%(14/61),差异无显著性(χ2=0.962,P=0.327)。结论:胸腹腔镜食管癌切除术按食管系膜的微创解剖行食管全系膜切除,手术创伤小,淋巴结清扫较彻底,有望使临床疗效不断提高。

Objective To explore the micro anatomy of mesoesophagus and the skill of total mesoesophagus excision in combined use of laparoscopic and thoracoscopic esophagectomy for the treatment of esophageal carcinoma. Methods Clinic and pathological data were collected retrospectively in 101 patients with esophageal cancer who underwent surgery in our department between September 2007 and May 2012. Forty cases of them underwent total mesoesophagus excision with thoracoscopy combined laparoscopy while 61 cases underwent non-total mesoesophagus excision with thoracoscopy combined laparoscopy. Analysis of t test or t＇ test was used to evaluate the variability of clinical data. X2 test was used to evaluate the difference of complication rates. Results Compared with non-total mesoesophagus excision group, total mesoesophagus excision group was with more surgical time （t = 2.483,P = 0.015） and less surgical blood loss （t＇ = -4.103, P = 0.000）. There was no difference of chest drainage between the two groups. Compared with non-total mesoesophagus excision group, total mesoesophagus excision was with rather more resected lymph node groups and total lymph nodes （P = 0.000）. The total complication rate was 19.80% and there was no difference between the two groups （~2 = 0.962,P = 0.327）. Conclusions Total mesoesophagus excision in thoracoscopic combined laparoscopic esophagectomy is based on the micro anatomy of mesoesophagus which is painless and may be thorough for the lymphadenectomy of esophageal cancer. It is hoped to improve the treatment effect of esophageal cancer.