3D与2D单孔充气式纵隔镜联合腹腔镜食管癌根治术的近期疗效对比研究

Clinical comparative study of 3D and 2D single-portal inflatable mediastinoscopic and laparoscopic esophagectomy for esophageal cancer

目的探讨3D单孔充气式纵隔镜联合腹腔镜食管癌根治术的安全性和有效性。方法回顾性分析2018年6月至2019年6月我科收治的28例实施单孔充气式纵隔镜联合腹腔镜食管癌根治术的食管鳞状细胞癌患者的临床资料,其中男25例、女3例,年龄51~76岁。根据手术方法不同,将患者分为两组,即3D纵隔镜组(3D组,10例)和2D纵隔镜组(2D组,18例)。比较两组近期疗效。结果3D组手术时间明显短于2D组(P=0.017)、清扫淋巴结数目多于2D组(P=0.005)、出血量少于2D组(P=0.015),差异均有统计学意义。两组在主刀医师眩晕感及视觉重影方面差异无统计学意义(P>0.05)。两组在颈部引流管置管时间、术后住院时间、肺部感染、心律失常、吻合口瘘、喉返神经损伤等方面差异无统计学意义(P>0.05)。结论3D充气式纵隔镜联合腹腔镜食管癌根治术优化了2D操作,实践中是安全、可行的,可以作为未来的一种术式去尝试。

Objective To investigate the safety and efficacy of 3D single-portal inflatable mediastinoscopic and laparoscopic esophagectomy for esophageal cancer.Methods Clinical data of 28 patients,including 25 males and 3 females,aged 51-76 years,with esophageal squamous cell carcinoma undergoing single-portal inflatable mediastinoscopic and laparoscopic esophagectomy from June 2018 to June 2019 were retrospectively analyzed.Patients were divided into two groups according to different surgical methods including a 3D mediastinoscopic group(3D group,10 patients)and a 2D mediastinoscopic group(2D group,18 patients).The perioperative outcome of the two groups were compared.Results Compared with the 2D group,the 3D group had shorter operation time(P=0.017),more lymph nodes resected(P=0.005)and less estimated blood loss(P=0.015).There was no significant difference between the two groups in the main surgeon's vertigo and visual ghosting(P>0.05).The other aspects including the indwelling time,postoperative hospital stay,pulmonary infection,arrhythmia,anastomotic fistula,recurrent laryngeal nerve injury were not statistically significant between the two groups(P>0.05).Conclusion The 3D inflatable mediastinoscopic and laparoscopic esophagectomy for esophageal cancer,which optimizes the surgical procedures of 2D,is safe and feasible,and is worthy of clinical promotion in the future.