胸腹腔镜联合微创食管癌根治术对喉返神经旁淋巴结清扫的效果及并发症分析

Analysis on Efficacy and Complications of Thoracoscope and Laparoscope with Minimally Invasive Esophagectomy for Lymph Node Dissection of the Recurrent Laryngeal Nerve

目的探讨胸腹腔镜联合微创食管癌根治术对喉返神经旁淋巴结清扫的效果及并发症。方法选取2015年4月至2018年12月赤峰市医院肿瘤外科住院确诊为食管癌且肿瘤无明显外侵,肿瘤为T2、T3分期无远处转移100例,采用随机数字法分为实验组与对照组,每组各50例。对照组采用常规开放下经右胸三切口及两切口食管癌根治术,实验组采用胸腹腔镜联合微创食管癌根治术,记录比较2组患者手术临床指标(包括术中失血量、手术时间、胸液引流量、术后住院时间)与淋巴结清扫数目(包括左、右喉返神经、气管隆突、食管旁、胃左动脉、肝总动脉等领域的淋巴清扫数目)及术后近期并发症(包括吻合口漏、肺感染、房颤、声音嘶哑、吻合口狭窄、乳糜胸)。结果实验组患者术中出血量、手术时间、胸液引流量、术后住院时间均少于对照组,组间差异具有统计学意义(P<0.05);实验组患者术中左、右喉返神经旁、气管隆突、食管旁、胃左动脉旁及肝总动脉旁的淋巴结清扫数目多于对照组,组间差异就有统计学意义(P<0.05)。实验组患者术后近期并发症总发生率(22.00%)显著低于对照组(56.00%),组间差异有统计学意义(P<0.05)。结论腹腔镜联合微创食管癌根治术在右喉返神经旁淋巴结清扫数目多于常规开放手术,术后近期并发症发生率较低,安全性高。

Objective To investigate the postoperative efficacy and complications of thoracoscope and laparoscope with minimally invasive esophagectomy in patients for lymph node dissection of the recurrent laryngeal nerve.Methods 100 patients with valid esophageal cancer which was T2 and T3 without obvious invasion and distant metastasis were enrolled and randomly divided into the experimental group and the control group,50 cases in each group.The control group underwent traditionally open thoracic three incision and two incision esophagectomy,while the experimental group was treated with thoracoscope and laparoscope with minimally invasive esophagectomy.The clinical indexes(including intraoperative blood loss and operation time,pleural fluid drainage,postoperative hospital stay)and number of lymph node dissection(including left and right recurrent laryngeal nerve,tracheal carina,esophageal,left gastric artery,common hepatic artery,etc.)and recent postoperative complications(including anastomotic leakage,lung infection,atrial fibrillation,hoarseness,anastomotic stricture,chylothorax)were compared in those patients.Results The intraoperative blood loss,operative time,pleural fluid drainage,and postoperative hospital stay were lower in the experimental group than that of the control group(P<0.05).In the experimental group,the number of lymph node dissections in the left and right recurrent laryngeal nerve,tracheal carina,paraesophageal,left gastric artery and common hepatic artery was higher than that of the control group(P<0.05).The total postoperative complication rate was lower in the experimental group than that of the control group(22.00%vs.56.00%,P<0.05).Conclusion The number of lymph node dissection of thoracoscope and laparoscope with minimally invasive esophagectomy in the recurrent laryngeal nerve is more common than conventional open surgery with low postoperative complications and high safety.