2.5野淋巴结清扫在高龄与非高龄食管癌患者手术治疗中的对比研究

A comparative study on surgery treatment of 2.5-field lymphadenectomy in elderly patients and not-elderly patients with esophageal carcinoma

目的 探讨胸腔镜联合腹腔镜食管癌根治术行2.5野淋巴结清扫在高龄食管癌患者中的可行性和安全性。方法 回顾性分析2014年12月至2016年12月收治的179例采用胸腔镜联合腹腔镜下食管癌根治术,利用左侧俯卧位下、单腔气管插管、人工气胸、术中食管悬吊以及经颈胸喉返神经淋巴结清扫的方法进行2.5野淋巴结清扫的食管癌患者的临床资料。以65岁为年龄分界,年龄≥65岁为高龄组( n =52),<65岁为非高龄组( n =127),比较两组患者术中、术后相关指标。结果 两组患者均顺利完成手术,无中转开胸或开腹病例。高龄组的总并发症发生率、术后住院天数及住院费用均显著高于非高龄组,差异有统计学意义( P <0.05);但两组间手术出血量、胸腔引流量、清扫淋巴结总数、阳性淋巴结数、淋巴结转移率、围手术期病死率及重新入院率等指标比较,差异均无统计学意义( P > 0.05 )。结论 胸腔镜联合腹腔镜下食管癌根治术,在左侧俯卧位、单腔气管插管、人工气胸、食管悬吊及经颈胸喉返神经淋巴结清扫的的辅助下,经胸腔镜下可完成双侧甲状腺下动脉以下101组淋巴结的清扫,对高龄食管癌患者采用2.5野淋巴结清扫是安全可行的,在远期生存结果上还需要进一步随访。

Objective To explore the feasibility and safety of the radical surgery for esophageal carcinoma with thoracoscopy and laparoscopy and 2.5-field lymphadenectomy in treatment of esophageal cancer of elderly patients. Methods We collected the clinical data and retrospectively analyzed the data of 179 patients of esophageal cancer who underwent radical resection of esophageal carcinoma with thoracoscopy and laparoscopy from December 2014 to December 2016. The patients were treated in 2.5-field lymphadenectomy in left decubitus position by single lumen endotracheal intubation, artificial pneumothorax,and intraoperative esophageal suspension,and through cervicothoracic recurrent laryngeal nerve lymph node dissection. 52 patients aged 65 and over are in the elderly group and the non-elderly group are 127 patients aged less than 65. Intraoperative and postoperative data were compared between the two groups. Results Operations in two groups were all completed successfully, with no conversion to thoracotomy or laparotomy. The total complication ratio, postopetative hospitalization duration and hospitalization costs were significantly higher in the elderly group than in the non-elderly group( P< 0.05 ). But differences were not statistically significant ( P>0.05) in the amount of blood loss, thoracic drainage volume, the total number of lymph node dissection, the number of positive lymph nodes, lymph node metastasis rate, periopetative mortality, and rehospitalization rate. Conclusions The radical resection of esophageal carcinoma with thoracoscopy and laparoscopy was safe and feasible to use 2.5-field lymphadenectomy in the treatment of esophageal cancer of elderly patients assisted by the methods of left decubitus position, single lumen endotracheal intubation, artificial pneumothorax, intraoperative esophageal suspension and through cervicothoracic recurrent laryngeal nerve lymph nodes dissection. The 101 group of lymph nodes dissection below bilateral inferior thyroid artery can be completed under thoracoscopy. The further follow-up was needed for long-term survival outcomes.