不同麻醉技术对胸腹腔镜食管癌手术的疗效比较

A comparison of the different anesthesia techniques after thoracoscopic and laparoscopic esophagectomy for esophageal carcinoma

目的比较两种不同麻醉技术在胸腹腔镜联合手术治疗食管癌的疗效。方法分析我院胸外科在2015年9月~2017年9月期间行胸腹腔镜食管癌根治术的106例患者临床资料,按照术中采用的麻醉技术分为人工气胸下单腔插管双肺通气技术组(A组)51例和双腔插管单肺通气技术组(B组)55例,比较两组麻醉技术的临床效果,并随访患者术后3年生存状况。结果A组在胸腔镜手术时间、胸部术中出血量、术后住院时间、术后胸腔引流总量等均显著优于B组(P<0.05);同时通过对比B组,A组在左喉返神经旁手术视野更加清晰,且更加利于提高左喉返神经旁淋巴结清扫数目(P<0.001)。组间对比术后相关并发症,A组在肺部感染的发生率显著低于B组(P=0.032),其余术后并发症发生率均无统计学差异(P>0.05)。两组3年生存率比较无统计学意义(P>0.05)。结论在胸腹腔镜联合手术治疗食管癌中,人工气胸下单腔插管双肺通气在左喉返神经旁手术视野更加清晰,利于提高左喉返神经旁淋巴结清扫数目,能够有效降低术后肺部感染发生率,且3年累积生存率无统计学意义,不影响患者中远期临床预后。

Objective To delve into different results of the clinical efficacy and safety of the different anesthesia techniques on thoracoscopic and laparoscopic esophagectomy for esophageal carcinoma.Methods The clinical data of 106 patients undergoing laparoscopic radical resection of esophageal cancer in the Department of Thoracic Surgery of our hospital from September 2015 to September 2017 were analyzed.According to the anesthesia technique used during operation,the patients were divided into artificial pneumothorax single-cavity intubation double-lung ventilation technique group(group A),51 cases,and double-cavity intubation single-lung ventilation technique group(group B),55 cases.The clinical effect of anesthesia technique was compared between the two groups.Patients were followed up 3 years after operation.Results Group A was significantly better than Group B in thoracoscopic operation time,intraoperative chest blood loss,postoperative hospital stay,and total postoperative chest drainage(P<0.05).Compared with Group B,group A had clearer surgical field and was more beneficial to improve the number of lymph nodes dissected by left recurrent laryngeal nerve(P<0.05).By comparing postoperative complications between groups,the incidence of pulmonary infection in Group A was significantly lower than that in Group B(P=0.03),and there was no statistical difference in the incidence of other postoperative complications(P>0.05).There was no statistical significance in 3-year survival rate between the two groups(P>0.05).Conclusion Compared with the techniques of double lumen endotracheal intuation,the conclusion can be drawn that the artificial single pneumothorax beside the left recurrent laryngeal nerve ensures a better vision,thus enhancing the number of lymphaden beside the left recurrent laryngeal nerve and effectively reducing the postoperative pulmonary infection.Taking the statistical significance of 3-year cumulative survival into account,this technique cannot affect the long-term clinical prognosis of patients.