胸腔内食管牵引挑离法在微创食管癌切除术中左侧喉返神经旁淋巴结清扫的应用

Application of “Intracavitary Esophagus Traction” Method in Lymph Node Dissection of Left Recurrent Laryngeal Nerve in Minimally Invasive Esophagectomy

目的探讨胸腔内食管牵引挑离法在微创食管癌切除术中左侧喉返神经旁淋巴结清扫的应用价值。方法回顾性分析2014年10月~2016年10月微创食管癌切除术180例资料,2015年10月以后90例采用胸腔内食管牵引挑离法进行左侧喉返神经旁淋巴结清扫(改良组),2015年9月前90例采用传统方法(传统组)。比较2组左喉返神经旁淋巴结清扫时间、淋巴结清扫数量及术后并发症发生率。结果与传统组比较,改良组左喉返神经旁淋巴结清扫时间短[(12.2±6.2)min vs.(18.2±7.4)min,t=-5.896,P=0.000],左喉返神经旁淋巴结清扫数目多[(3.7±1.2)枚vs.(2.3±0.9)枚,t=8.854,P=0.000]。2组术后肺部感染、声音嘶哑、吻合口漏、乳糜胸、心律失常等主要并发症发生率及喉返神经淋巴结转移率差异均无统计学意义(P>0.05)。结论胸腔内食管牵引挑离法在微创食管癌切除术中安全、可行,有利于神经暴露,提高左侧喉返神经旁淋巴结的清扫数量,缩短手术时间。

Objective To explore the application of ＂intracavitary esophagus traction＂method in left recurrent laryngeal nerve lymph node dissection in minimally invasive esophagectomy. Methods We retrospectively collected data of 180 patients who underwent minimally invasive esophagectomy from October 2014 to October 2016. The test group（ n = 90） underwent left laryngeal lymphadenectomy with ＂intracavitary esophagus traction＂method from October 2015 to October 2016. The traditional group（ n = 90）were treated with traditional methods to remove left laryngeal lymph node from October 2014 to September 2015. The time of lymph node dissection,number of lymph node dissection and postoperative complications were compared between the two groups. Results As compared to the traditional group,the test group got shorter operation time [（ 12. 2 ± 6. 2） min vs.（ 18. 2 ± 7. 4） min,t =-5. 896,P = 0. 000] and more lymph nodes dissection of the left recurrent laryngeal nerves [（ 3. 7 ± 1. 2） nodes vs.（ 2. 3 ± 0. 9）nodes,t = 8. 854,P = 0. 000]. There was no significant difference in the incidence of major complications such as pulmonary infection,hoarseness,anastomotic leakage,chylothorax,arrhythmia and lymph node metastasis of recurrent laryngeal nerve in the two groups（ P〈0. 05）. Conclusions ＂Intracavitary esophagus traction ＂ method is safe and effective in minimally invasive esophagectomy. It is beneficial for nerve exposure. It can increase the number of lymph node dissection and shorten the operation time.