侧俯卧位与侧卧位胸腔镜食管癌根治术的临床对照研究

Clinical comparative analysis of thoracscopic esophagectomy in left lateral and forward position or lateral position

目的:探讨侧俯卧位及侧卧位胸腔镜食管癌根治术的安全性、可行性及近期临床疗效。方法:选择我院2013年3月至2015年10月施行侧俯卧位胸腔镜食管癌根治术40例(试验组)与同期施行侧卧位食管癌根治术42例(对照组),比较两组患者临床疗效。结果:侧俯卧位胸腔镜组手术时间(5.10±0.74)h显著短于侧卧位胸腔镜组(5.76±0.96)h(P=0.001);侧俯卧位胸腔镜组术中出血量(125.75±44.94)ml、术后胸腔引流时间(5.05±1.69)天、术后住院时间(12.73±5.01)天、术后并发症发生率12.5%(5/40),比侧卧位组术中出血量(131.67±56.22)ml、术后胸腔引流时间(4.90±1.53)天、术后住院时间(11.95±4.17)天、术后并发症发生率11.9%(5/42),差异无统计学意义(P>0.05)。结论:侧俯卧位胸腔镜食管切除术在技术上是安全、微创、可行的,在一定程度上可以缩短手术时间。

Objective：To investigate the safety, feasibility and recent clinical efficacy of thoracscopic esophagectomy in left lateral and forweard position or lateral position. Methods：From March 2013 to October 2015,82 patients underwent thoracoscopic esophagectomy in left lateral and forweard inclination position （40） or lateral position （42）. Patients had a left lateral position and 45° forweard inclination after anesthesia. Thoracic esophagus dissociation and lymph nodes dissection were finished with totally thoracoscopic surgery. Results：The operative time in left lateral and forweard position thoracoscopy group （5.10 ±0.74） h was significantly shorter than in the lateral position thoracoscopy group （5.76 ± 0.96） h （ P = 0. 001 ）. Blood loss in left lateral and forward position was （ 125.75 ±44.94） ml, postoperative chest drainage time （5.05 ± 1.69） days, postoperative hospital stay （ 12.73 ±5.01 ） days, incidence of postoperative complications （5/40,12.5%） ,and in the lateral position group blood loss （ 131.67 ±56.22） ml, postoperative chest drainage time（4.90 ±1.53 ） days, postoperative hospital stay （ 11.95 ±4.17 ） days, incidence of postoperative complications （5/42,11.9% ） ,and other aspects of the differences were not statistically significant （P 〉 0.05 ）. Conclusion：Thoracoscopic esophagectomy in left lateral and forward inclination position is safe, minimally invasive, feasible, and to some extent, it can shorten the operation time.