全腹腔镜下Siewert Ⅱ型贲门癌下纵膈淋巴结清扫术应用体会

Application of Total Laparoscopic Lower Mediastinal Lymph Node Dissection in Siewert Type Ⅱ Cardia Cancer

目的分析全腹腔镜下SiewertⅡ型贲门癌下纵膈淋巴结清扫术的应用.方法回顾性收集我院2015年5月-2018年9月治疗的23例SiewertⅡ型贲门癌患者的临床资料,其中全腹腔镜组13例,传统开腹组10例,对两组患者的近期临床治疗效果进行对比分析.结果两组患者手术均顺利完成,无围手术期死亡.两组患者的住院时间、平均手术时间、术中出血比较,差异均有统计学意义(P<0.05);两组患者的清扫淋巴结数目、术后并发症发生率,差异均无统计学意义(P>0.05).结论全腹腔镜在治疗SiewertⅡ型贲门癌患者的根治效果、术后并发症与开放手术相当;全腹腔镜具有术中出血少、住院时间短的优势.因此,为SiewertⅡ型贲门癌患者提供全腹腔镜下纵膈淋巴结清扫术治疗是安全及可行的,远期疗效有待大样本及长随访时间研究.

Objective To analyze the application of total laparoscopic lower mediastinal lymph node dissection in the treatment of Siewert type II cardia cancer. Methods The clinical data of 23 patients with Siewert type II cardiac cancer from May 2015 to September 2018 in our hospital were retrospectively reviewed, including 13 patients in the total laparoscopic group and 10 patients in the traditional laparotomy group. The shortterm efficacy was compared and analyzed. Results The operation of both groups was successfully completed without perioperative death. There were significant differences in hospitalization time, average operation time, and intraoperative blood loss between the two groups (P < 0.05). There was no significant difference in the number of lymph nodes and postoperative complications between the two groups (P > 0.05). Conclusion The curative effect and postoperative complications are equivalent between traditional laparotomy and total laparoscopic surgery in the treatment of Siewert type II cardiac cancer;total laparoscopic surgery has advantages such as less intraoperative bleeding, shorter hospital stay. Therefore, it is safe and feasible to provide total laparoscopic lower mediastinal lymph node dissection for Siewert type II cardiac cancer. The long-term efficacy needs to be studied in large samples and long follow-up time.