食管胃结合部腺癌患者行微创手术中淋巴结的清扫效果

Effect of minimally invasive surgery on lymphadenectomy in patients with adenocarcinoma of esophagogastric junction

目的探讨腹腔镜下行食管胃结合部腺癌(AEG)根治术中淋巴结的清扫效果。方法选取2014年6月-2015年9月该院收治的105例行开腹或腹腔镜根治术的AEG患者为研究对象,根据手术方式分为微创组(n=70)和开腹组(n=35),比较两组的基线资料、淋巴结清扫结果及围手术期资料。结果微创组的脾门淋巴结清扫总数明显多于开腹组(P<0.05)。两组的术中淋巴结清扫总数、阳性数目、阳性患者例数、脾门淋巴结阳性数目和阳性患者例数等比较,差异无统计学意义(P>0.05)。微创组的手术时间、术中失血量、切口长度、近端切缘阳性率、胸腹部联合切除率和脾切除率等均明显低于开腹组,近端食管切除长度明显大于开腹组(P<0.05)。所有患者术后均未出现死亡,微创组的首次排气时间、首次下床时间、首次进流质时间等均明显低于开腹组(P<0.05)。两组的并发症发生率比较,差异无统计学意义(P>0.05)。结论与开腹手术相比,腹腔镜AEG根治术在清扫脾门淋巴结方面较有一定优势,且切除的食管更长,胸腹部联合切除率与脾切除率更低,安全可行,值得临床推广应用。

Objective To investigate the effect of laparoscopic lymphadenectomy in patients withadenocarcinoma of esophagastric junction(AEG).Methods105patients with AEG underwent open or laparoscopicsurgery from June2014to September2015were enrolled in the study and divided into minimally invasive group(n=70)and laparotomy group(n=35).The baseline data,lymphadenectomy result and perioperative data werecompared between the two groups.Results Total number of splenic hilar lymph nodes dissection in minimallyinvasive group was significantly more than that in laparotomy group(P<0.05).But there were no significantdifferences in the total number of lymph node dissection,number of positive lymph node dissection,positive rateof all node,number of positive splenic hilar lymph node dissection and positive ratef of splenic hilar lymph nodebetween two groups(P>0.05).Operation time,intraoperative blood loss,length of incision,positive proximalmargins rate,thoracoabdominal resection rate and spleen resection rate in minimally invasive group were significantlylower than that in laparotomy group,esophagus resection length was significantly bigger than that in laparotomygroup(P<0.05).No death occurred postoperatively in all patients.The time of anus exsufflation,first intakeliquid diet and postoperative ambulatory episode in minimally invasive group were significantly lower than that inlaparotomy group(P<0.05).There were no significant differences in the incidence of complications between twogroups(P>0.05).Conclusions Compared with open surgery,laparoscopic surgery is superior in splenic hilar lymph nodes dissection of AEG,with longer esophageal cutting distances,lower thoracoabdominal resection and spleenresection rate.It is safe and feasible,worthy of clinical promotion.