3D腹腔镜单向式胃游离在食管癌微创化治疗中的应用

Application of single-direction gastric mobilization under 3D-laparoscopy in minimally invasive esophagectomy for the treatment of esophageal cancer

目的评价3D腹腔镜单向式胃游离法应用于食管癌微创化根治术的安全性、可行性及短期疗效。方法回顾性分析武汉大学人民医院胸外科2018年2月至2019年12月收治的行胸腹腔镜下Mc Keown三切口食管癌根治术(二野淋巴结清扫)的118例食管癌患者的临床资料,其中男94例、女24例,年龄53.7(41~77)岁。其中55例患者采用传统腔镜下行胃常规游离(传统胃游离组),63例患者采用3D腔镜下单向式胃游离(单向式胃游离组)。比较两组患者的临床资料。结果全组手术切缘均为阴性,R0切除率均为100%,无死亡和切口相关并发症发生,术后并发症总发生率22.9%。术后两组患者脾脏损伤、胃损伤、中转开腹、腹部再手术、颈部吻合口瘘的发生率差异均无统计学意义(P>0.05)。单向式胃游离组患者的胃游离相关并发症总发生率为1.6%(1/63),低于传统胃游离组的12.7%(7/55),差异有统计学意义(P<0.05);胃游离时间也明显短于传统胃游离组(P<0.05)。结论3D腹腔镜单向式胃游离技术行食管癌根治术是安全可行的,近期效果满意。

Objective To evaluate the safety,feasibility and short-term outcomes of single-direction gastric mobilization under 3 D-laparoscopy in minimally invasive esophagectomy for the treatment of esophageal cancer.Methods From February 2018 to December 2019,118 consecutive patients who underwent minimally invasive Mc Keown esophagectomy for esophageal squamous cell carcinoma in our hospital were included.There were 94 males and 24 females with an average age of 53.7(41–77)years.They were divided into two groups based on the methods of gastric mobilization:a traditional dissociation(TD)group(n=55)and a single-direction mobilization(MD)group(n=63).The clinical data of the two groups were compared.Results Enbloc resection and a negative resection margin were obtained in all patients.There was no postoperative mortality or incision complication.The rate of postoperative complications was 22.9%.There was no significant difference in the spleen injury,gastric injury,conversion to open surgery,abdominal reoperation as well as cervical anastomotic leakage between the two groups(P>0.05).It took significantly less time in the MD group compared with the TD group(P<0.05).There was an obvious statistical difference in the incidence of gastric mobilization related complications between the MD group(1.6%,1/63)and TD group(12.7%,7/55,P<0.05).Conclusion Application of single-direction gastric mobilization under 3 D-laparoscopy in minimally invasive esophagectomy for the treatment of esophageal cancer is safe and easy to perform with a satisfactory shortterm outcome.