侧俯卧位全腔镜食管癌手术淋巴结清扫的临床分析

Clinical Analysis of Lymphadenectomy in Thoracoscopic and Laparoscopic Esophagectomy for Esophageal Carcinoma in Prone Position

目的总结侧俯卧位全腔镜食管癌切除术清扫胸腹二野淋巴结的临床经验。方法回顾性分析2009年9月-2011年2月82例全腔镜食管癌切除术与78例常规颈、胸、腹三切口食管癌切除术的临床资料。比较2组手术的胸腹部各区域淋巴结清扫数目、淋巴结转移度、生存率及术后并发症发生率。结果2组均顺利完成手术，2组清扫左右喉返神经旁淋巴结数目分别为（4．1±3．4）枚及（1．1±1．7）枚，上纵隔淋巴结数目分别为（6．8±5．O）枚及（4．9±4．0）枚，腔镜组均多于开放组（P〈0．05）。腔镜组3年生存率（65．4％）与开放组（62．3％）相似（10g—rank检验，X2=0．022，P=0．886）。结论侧俯卧位全腔镜食管癌切除淋巴结清扫疗效肯定，尤其是清扫上纵隔及左右喉返神经旁淋巴结方面，更为有效及彻底。

Objective To analyze and summarize the clinical experience of two-field lymphadenectomy in thoracoscopic and laparoscopic esophageetomy for esophageal carcinoma in prone position. Methods A retrospeefiw analysis was carried out on the clinical data of 82 patients with esophageal carcinoma who had undergone minimally invasive esophagectomy and 78 patients who had undergone traditional esophagectomy from September 2009 to February 2011. The chest abdomen lymph node dissection number, regional lymph node metastasis degree, survival rate and postoperative complication were compared between the two groups. Results All the surgeries in the two groups were completed successfully. The number of lymph node dissection around the recurrent laryngeal nerve （4.1±3.4） and superior mediastinum （6.8±5.0） in minimally invasive esophagectomy group was more than that of the traditional esophagectomy group （ 1.1±1.7 and 4.9 ±4.0 respectively, P 〈 0.05 ）. The 3-year survival rate of the minimally invasive esophagectomy group （65.4%） was similar to that of the traditional esophagectomy group （62.3% , log-rank test, X2 = 0. 022, P =0. 886）. Conclusion The curative effect of lymphadenectomy in thoracoscopic and laparoscopic esophagectomy for esophageal carcinoma in prone position is positive, especially for the dissection of the lymph nodes around the superior mediastinum and recurrent laryngeal nerve.