胸腹腔镜辅助小切口食管癌切除联合喉返神经旁淋巴结清扫术治疗食管鳞状细胞癌的疗效及生存分析

Efficacy and survival analysis of thoracoscopic-laparoscopic-assisted miniincision esophagectomy combined recurrent laryngeal nerve lymph node dissection in esophageal squamous cell carcinoma

目的探讨胸腹腔镜辅助小切口食管癌切除联合喉返神经旁淋巴结清扫治疗食管鳞状细胞癌的疗效及生存分析。方法选取食管鳞状细胞癌患者69例,按照随机数字表法分为对照组[行小切口食管癌切除术(n=34)]和观察组[行胸腹腔镜辅助小切口食管癌切除联合喉返神经旁淋巴结清扫(n=35)]。比较两组术中相关指标、术后并发症发生率及恢复情况和3年生存率;依据术后患者淋巴结病理结果,计算两组患者淋巴结阳性率。结果观察组患者手术时间和喉返神经旁淋巴结清扫时间均明显长于对照组,喉返神经旁淋巴结清扫数和淋巴结总清扫数均明显多于对照组,术中出血量明显少于对照组,差异均有统计学意义(P﹤0.01)。观察组患者术后卧床时间、术后开始进食时间及术后住院时间均明显短于对照组,术后引流量明显少于对照组,差异均有统计学意义(P﹤0.01)。观察组总淋巴结阳性率为37.14%(13/35),喉返神经旁淋巴结阳性率为34.29%(12/35),均高于对照组的29.41%(10/34)和26.47%(9/34),但差异均无统计学意义(P﹥0.05)。观察组喉返神经损伤发生率为2.86%(1/35),低于对照组的44.12%(15/34);3年生存率(62.9%)高于对照组(38.2%),差异均有统计学意义(P﹤0.05)。结论胸腹腔镜辅助小切口食管癌切除术可以较为彻底清扫喉返神经旁淋巴结,降低术后并发症发生率,提高3年生存率。

Objective To explore the efficacy and survival analysis of thoracoscopic-laparoscopic-assisted mini-incision esophagectomy combined recurrent laryngeal nerve lymph node dissection in esophageal squamous cell carcinoma.Method 69 patients with esophageal squamous cell carcinoma were selected and divided into control group(n=34)and observation group(n=35)by random number,in which the small incision esophageal cancer radical operation and thoracoscopic-laparoscopic-assisted small incision esophagectomy combined recurrent laryngeal nerve lymph node dissection were performed respectively.The operation-related indicators,incidence of postoperative complications,recovery and 3-year survival rate were compared between the two groups,and the positive rates of lymph nodes were calculated based on postoperative pathology results of lymph nodes.Result The operation time and the time of recurrent laryngeal nerve lymph node dissection in the observation group were significantly longer than those in the control group,the number of recurrent laryngeal nerve lymph nodes dissected and the total number of lymph nodes dissected significantly more than those in the control group,with significantly lower intraoperative blood loss(P<0.01).The postoperative bed rest time,postoperative feeding time,postoperative hospital stay and postoperative drainage volume in the observation group were significantly shorter or lower than those in the control group(P<0.01).The positive rates of total lymph nodes and the recurrent laryngeal nerve lymph nodes in the observation group were 37.14%(13/35)and 28.57%(10/35)respectively,higher than 29.41%(10/34)and 26.47%(9/34)in the control group,but both without statistic significance(P>0.05).Incidence of recurrent laryngeal nerve damage was 2.86%(1/35)in the observation group versus 44.12%(15/34)in the control group,and the 3-year survival rate was 62.9%versus 38.2%,both with statistic significance(P<0.05).Conclusion Laparoscopic-assisted mini-incision esophagectomy can remove the recurrent laryngeal nerve lymph nodes thoroughly,reduce postoperative complications and improve the 3-year survival rates.