胸腹腔镜下胸中上段食管癌三野淋巴结清扫术的安全性及短期疗效分析

Analysis of the Safety and Short-Term Efficacy of Thoracolaparoscopic Three-Field Lymph Node Dissection for Middle and Upper Thoracic Esophageal Carcinoma

目的探究食管癌患者接受胸腹腔镜联合三野淋巴结清扫术治疗的安全性及短期效果。方法该次选择2016年1月-2019年3月该院收治胸中上段食管癌患者100例为研究对象,参照计算机抽签结果分为观察组与对照组,对照组患者接受胸腹腔镜联合二野淋巴结清扫术,观察组患者接受腹腔镜联合三野淋巴结清扫术,分析各组患者手术指标差异,记录并计算各组患者淋巴结清扫数、淋巴结转移率及喉返神经损伤率。结果观察组患者手术用时(332.45±12.31)min明显长于对照组(t=34.57,P<0.05),但术中出血量(433.28±11.03)mL、留置胸引流管时间(9.28±1.02)d、患者住院总时间(20.31±3.57)d与对照组相比差异无统计学意义(t=2.89、0.07、0.41,P>0.05)。观察组患者淋巴结清扫为1568枚,淋巴结转移率6.00%与对照组相比差异有统计学意义(χ^2=8.29、9.38,P<0.05)。两组患者发生肺部感染、心律失常、乳糜胸、肺栓塞等并发症概率差异无统计学意义(χ^2=0.15,P>0.05)。结论胸中上段食管癌患者接受腹腔镜联合三野淋巴结清扫术治疗效果更佳,可更彻底清除淋巴结,预防复发,值得临床运用与推广。

Objective To explore the safety and short-term efficacy of thoracoscopic and laparoscopic three-field lymph node dissection in patients with esophageal cancer. Methods In this study, 100 patients with upper and middle thoracic esophageal cancer in our hospital from January 2016 to March 2019 were selected as the research object. According to the results of computer drawing, the patients were divided into observation group and control group. The patients in the control group received thoracoscopic and laparoscopic combined with two-field lymph node dissection, while the patients in the observation group received laparoscopic combined with three-field lymph node dissection. The number of lymph node dissection, the rate of lymph node metastasis and recurrent laryngeal nerve injury were analyzed. Results The operative time (332.45±12.31) min of the observation group was significantly longer than that of the control group (t=34.57, P<0.05), but there was no statistically significant difference in intraoperative blood loss (433.28±11.03)mL, duration of indwelling thoracic drainage tube (9.28±1.02) d, and total length of hospitalization (20.31±3.57) d between the observation group and the control group (t=2.89, 0.07, 0.41, P>0.05). The lymph node dissection was 1 568 in the observation group, and the lymph node metastasis rate was 6.00%, which were significantly different from those of the control group (χ2=8.29, 9.38, P<0.05). There was no significant difference in the incidence of pulmonary infection, arrhythmia, chylothorax, pulmonary embolism and other complications between the two groups (χ2=0.15, P>0.05). Conclusion The treatment effect of laparoscopy combined with three-field lymph node dissection for patients with thoracic middle and upper esophageal cancer is better. Lymph nodes can be removed more completely to prevent recurrence, which is worthy of clinical application and promotion.