早中期食管鳞状细胞癌患者全腔镜下根治术不同颈部吻合方案的疗效及安全性

Efficacy and safety of different kinds of cervical anastomosis schemes in early and middle stage esophageal squamous cell carcinoma patients undergoing total endoscopic radical surgery

目的:探讨全腔镜下根治术左侧和右侧颈部吻合方案对早中期食管鳞状细胞癌患者疗效及安全性的影响。方法:回顾性分析我院2013年1月-2017年3月收治的行全腔镜下根治术的早中期食管鳞状细胞癌患者共102例临床资料,其中62例采用左侧颈部吻合方案设为对照组,40例采用右侧颈部吻合方案设为观察组;比较两组总手术操作时间、术中出血量、淋巴结清扫数目、术后并发症发生情况及ICU转送率。结果:两组总手术操作时间、术中出血量及淋巴结清扫数目比较差异无显著性(P>0.05);观察组肺部感染、胃排空障碍及吻合口瘘发生率均显著低于对照组(P<0.05);两组乳糜胸和声带麻痹发生率比较差异无显著性(P>0.05);同时观察组ICU转送率显著低于对照组(P<0.05)。结论:全腔镜下根治术右侧颈部吻合用于食管鳞状细胞癌患者安全有效,且能够有效降低并发症发生风险,避免转送ICU,同时操作难度、术中出血及淋巴结清扫效果与左侧颈部吻合方案相近。

Objective:To investigate the influence of left side and right side cervical anastomosis schemes under total endoscopy on clinical efficacy and safety of patients with esophageal squamous cell carcinoma in early and middle stage.Methods:Clinical data of 102 patients with esophageal squamous cell carcinoma in early and middle stage were retrospectively chosen in the period from January 2013 to March 2017 in our hospital and divided into 2 groups including control group(62 patients)with left side cervical anastomosis and observation group(40 patients)with right side cervical anastomosis,and the total operation time,intraoperative bleeding volume,lymph node dissection number,complications incidence and ICU transfer rate of 2 groups were compared.Results:There was no significant difference in the total operation time,intraoperative bleeding volume and lymph node dissection number between 2 groups(P>0.05).The incidence of pulmonary infection,gastric emptying disorder and anastomotic leakage of observation group were significantly less than control group(P<0.05).There was no significant difference in the incidence of chylothorax and vocal cord paralysis between 2 groups(P>0.05).The ICU transfer rate of observation group was significantly lower than control group(P<0.05).Conclusion:Right side cervical anastomosis schemes under total endoscopy on patients with esophageal squamous cell carcinoma in early and middle stage should be safe and effective and can efficiently reduce the risk of complications and avoid transfer to ICU,while right side cervical anastomosis schemes application can possess the same operation difficulty,intraoperative hemorrhage and lymph node dissection effects compared with left side cervical anastomosis.