改良充气式纵隔镜在早期胸段食管癌中的临床应用

Clinical application of modified inflatable video-assisted mediastinoscopic transhiatal esophagectomy in patients with early esophageal cancer

目的探讨改良充气式纵隔腔镜食管癌切除术治疗早期食管癌的安全性、有效性和近期疗效。方法收集中国科技大学附属第一医院胸外科2017年7月至2018年6月行微创食管癌切除术的54例cT1N0M0食管癌患者的临床资料,根据手术方式不同分为改良充气式纵隔镜组(23例)和微创Meckowen组(31例)。比较分析两组患者的临床病理资料、围手术期资料、淋巴结清扫情况。结果改良充气式纵隔镜组的微小并发症总发生比例、微小并发症中肺部感染发生比例、总并发症发生比例、肺部并发症总发生比例(微小+重大)均小于微创Mckowen组(P<0.05);改良充气式纵隔镜组的术中出血量、手术时间、术后3天总引流量(胸+纵隔)均少于微创Meckowen术组(P<0.05)。两组患者在清扫左喉返神经旁淋巴结、上段食管旁淋巴结、隆凸下淋巴结、中段食管旁淋巴结、下段食管旁淋巴结、膈上淋巴结方面差异均无统计学意义(P>0.05)。结论改良充气式纵隔腔镜治疗早期食管癌安全有效,近期疗效满意。

Objective To investigate the feasibility, safety and short-term efficacy of modified inflatable video-mediastinoscopy in patients with early esophageal cancer. Methods The study retrospectively evaluated 54 patients with cT1N0M0 esophageal carcinoma who received minimally invasive esophagectomy in the First Affiliated Hospital of University of Science and Technology of China between July 2017 and June 2018. Of those patients, 23 patients underwent modified inflatable video-assisted mediastinoscopic transhiatal esophagectomy(MIVMTS) and 31 underwent minimally invasive McKeown esophagectomy(MIME). The clinicopathologic factors, operational factors, postoperative complications and lymph node dissection of patients were compared. Results There was no significant difference in clinicopathological data between the MIVMTS group and MIME group. The incidence of total minor postoperative complications, pulmonary infection of minior postoperative complications, total postoperative complications and total pulmonary complications in MIME group were higher than MIVMTS group. The incidence of recurrent laryngeal nerve injury, arrhythmia and air leaks in minior and pulmonary infection, chylothorax, anastomotic fistula in major postoprative complications were no different in the two groups with P>0.05. The intraoperative blood loss, duration of surgery and postoperative thoracic drainage fluid volume of MIVMTS group were less than MIME group, the difference was statistically significant. The postoperative hospitalization of the two groups have no statistics significance(P>0.05). There were no significant difference in the lymph node dessection of the left laryngeal recurrent nerve lymph nodes, paraesophageal lymph nodes, subcarinal lymph nodes and superior phrenic lymph node of the two groups. However, when compared with MIVMTS group, the MIME group have advantage in the right laryngeal recurrent para-nerve lymph node dissection. Conclusion MIVMTS can be safely and effectively performed for early esophageal cancer with favorable short-term efficacy.