经纵隔镜与胸腔镜治疗早期食管癌的围手术期结果

Clinical effects of mediastinoscopy and thoracoscopy in the treatment of early esophageal cancer

目的探讨经纵隔镜与经胸腔镜两种术式治疗早期食管癌的临床效果。方法回顾性分析常州市第一人民医院胸外科自2015年1月至2020年6月60例经纵隔镜食管癌切除(MATHE)及60例经胸腔镜食管癌切除(TATTE)患者的病史资料。按手术方式分为MATHE组与TATTE组,统计并分析两组间手术时间、术中出血量、纵隔淋巴结清扫数目、肺部感染及喉返神经损伤及吻合口瘘发生情况。结果 MATHE组手术时间优于TATTE组,差异有统计学意义(P<0.05);而与MATHE组相比,TATTE组纵隔淋巴结清扫、术中出血量有明显优势,差异有统计学意义(均P<0.05)。两组肺部感染、喉返神经损伤及吻合口瘘发生情况差异无统计学意义(均P>0.05)。结论经纵隔镜与经胸腔镜治疗早期食管癌都可行,但在减少术中出血和淋巴结清扫上,经胸腔镜手术较经纵隔镜手术具有更大的优势。

Objective To compare the clinical efficacy of two minimally invasive esophagectomy methods of mediastinoscope-assisted transhiatal esophagectomy and thoracoscope-assisted transthoracic esophagectomy in esophageal cancer.Methods Clinical data of 60 cases of esophageal carcinoma resected by mediastinoscope and 60 cases of esophageal carcinoma resected by thoracoscopic from January 2015 to June 2020 in the Department of Thoracic Surgery of Changzhou First People’s Hospital were retrospectively analyzed.The patients were divided into a mediastinoscope-assisted transhiatal esophagectomy(MATHE)group and a thoracoscope-assisted transthoracic esophagectomy(TATTE)group according to the treatment method.The operation time,intraoperative bleeding volume,number of mediastinal lymph node dissection,pulmonary infection,recurrent laryngeal nerve injury and anastomotic fistula were statistically analyzed between the two groups.Results The operation time in the MATHE group was superior to that in the TATTE group,and the difference was statistically significant(P<0.05).The mediastinal lymph node dissection and intraoperative blood loss in the TATTE group had significant advantages compared with the MATHE group,the differences were statistically significant(all P<0.05).There was no statistical difference between the MATHE group and the TATTE group in pulmonary infection,recurrent laryngeal nerve injury and anastomotic fistula(all P>0.05).Conclusion Both mediastinoscope-assisted transhiatal esophagectomy and thoracoscope-assisted transthoracic esophagectomy are feasible in the treatment of early esophageal cancer,but in reducing intraoperative bleeding and lymph node dissection,thoracoscope-assisted transthoracic esophagectomy has greater advantages than mediastinoscope-assisted transhiatal esophagectomy.