食管鳞癌经胸腔镜下2.5野淋巴结清扫术中喉返神经损伤的危险因素分析

Risk factors of recurrent laryngeal nerve injury during thoracoscopic 2.5-field lymphadenectomy for esophageal squamous cell carcinoma

目的 探讨食管癌术中喉返神经损伤的影响因素。方法 收集福建医科大学附属协和医院胸外科2015年12月—2018年4月连续收治的行侧俯卧位胸腹腔镜联合食管鳞癌根治术的224例食管鳞癌患者的资料。所有患者接受经胸腔镜2.5野淋巴结清扫,在胸腔镜下清扫双侧喉返神经旁淋巴结至甲状腺下动脉水平,分析患者临床与病理学特征与喉返神经损伤的关系。术后纤维支气管镜或电子喉镜检查证实单侧或双侧声带麻痹定义为喉返神经损伤。结果 224例患者中20例(8.93%)术后发生喉返神经损伤,其中右侧声带麻痹2例,左侧声带麻痹17例,双侧声带麻痹1例。经鼻气管插管于术后12 d顺利拔除,声音嘶哑于术后半年明显缓解。单因素分析结果显示:肿瘤部位、T分期和左、右喉返神经旁淋巴结转移是出现喉返神经损伤的危险因素。进一步的多因素分析结果显示:肿瘤位于胸上段、 T分期≥3及左侧喉返神经旁淋巴结转移为喉返神经损伤的危险因素。结论 肿瘤位于胸上段、T分期≥3和喉返神经旁淋巴结转移是食管鳞癌2.5野淋巴结清扫术中出现喉返神经损伤的危险因素。

Objective To investigate the influencing factors of recurrent laryngeal nerve injury during the radical resection of esophageal cancer. Methods We collected the clinical data of 224 patients with esophageal squamous cell carcinoma treated by lateral prone thoracoscopy combined with esophageal squamous cell carcinoma radical resection from December 2015 to April 2018 in the Department of Thoracic Surgery, Fujian Medical University Union Hospital . All patients underwent thoracoscopic 2.5-field lymph node dissection;and bilateral paralaryngeal lymph nodes were dissected to the level of inferior thyroid artery under thoracoscope. The relationship between clinical and pathological features and recurrent laryngeal nerve injury was analyzed. Postoperative fiberoptic bronchoscopy or electronic laryngoscopy confirmed that unilateral or bilateral vocal cord paralysis was defined as recurrent laryngeal nerve injury. Results Among 224 patients, twenty patients (8.93%) had recurrent laryngeal nerve injury after operation, including 2 cases of right vocal cord paralysis, 17 cases of left vocal cord paralysis and 1 case of bilateral vocal cord paralysis. The nasotracheal intubation was successfully removed 12 days after operation, and hoarseness was relieved significantly in half a year after operation. Univariate analysis showed that the location of the tumor, T stage and lymph node metastasis beside the left and right recurrent laryngeal nerve were risk factors for recurrent laryngeal nerve injury. Multivariate analysis showed that tumors located in the upper thoracic segment, T stage (≥ 3) and lymph node metastasis of left recurrent laryngeal nerve were risk factors for recurrent laryngeal nerve injury. Conclusions Tumors located in the upper thoracic segment, T stage (≥ 3) and lymph node metastasis near the recurrent laryngeal nerve are risk factors for recurrent laryngeal nerve injury during 2.5 field lymph node dissection for esophageal squamous cell carcinoma.