"镂空法"在胸腔镜食管癌根治术中清扫喉返神经旁淋巴结的应用价值

Application value of the"hollow-out"method in recurrent laryngeal nerve lymph node dissection in patients undergoing thoracoscopic radical esophagectomy

目的探讨在胸腔镜食管癌根治术中采用"镂空法"行喉返神经旁淋巴结清扫的临床应用价值。方法回顾性队列研究。纳入2017年1月—2020年6月厦门大学附属第一医院胸外科178例T1~T3期食管癌患者临床资料,其中男105例、女73例,年龄41~78岁。178例患者均采用微创McKeown食管癌切除术治疗,根据术中喉返神经淋巴结的清扫方式不同分为两组:采用传统方法100例纳入传统组,采用"镂空法"78例纳入镂空组。比较两组患者术中出血量、手术时间、喉返神经旁淋巴结清扫数、术后喉返神经损伤发生率及损伤程度、术后胸腔引流量、食管吻合口瘘及肺部相关并发症。结果两组患者年龄、性别、肿瘤病灶部位及临床分期等基线资料比较,差异均无统计学意义(P值均>0.05)。镂空组喉返神经旁淋巴结清扫数目左侧为(5.28±1.77)枚、右侧为(3.33±1.36)枚,传统组喉返神经旁淋巴结清扫数目左侧为(1.79±0.96)枚、右侧为(1.05±0.88)枚;同侧组间比较,镂空组均多于传统组,差异均有统计学意义(t=15.710、12.841,P值均<0.01)。镂空组78例中,喉返神经损伤共3例(3.85%),其中轻度损伤2例(2.56%)、中度损伤1例(1.28%);传统组100例中,喉返神经损伤12例(12.00%),其中轻度损伤8例(8.00%)、中度损伤4例(4.00%);镂空组喉返神经损伤的发生率及损伤程度低于传统组,但组间比较差异均无统计学意义(χ^(2)=3.775,Z=-1.936,P值均>0.05)。镂空组肺部感染7例(8.97%)、传统组为20例(20.00%),差异有统计学意义(χ^(2)=4.140,P<0.05)。两组术中出血量、手术时间、术后胸腔引流量及食管吻合口瘘发生率比较,差异均无统计学差异(P值均>0.05)。结论在胸腔镜食管癌切除术中采用"镂空法"清扫喉返神经旁淋巴结是安全、可行的,在增加喉返神经旁淋巴结清扫数目的同时不增加喉返神经损伤的发生率。

Objective This study aimed to explore the clinical value of the"hollow-out"method in resection of recurrent laryngeal nerve lymph nodes in patients undergoing thoracoscopic radical resection of esophageal carcinoma.Methods A retrospective cohort study was used.The Department of Thoracic Surgery of the First Affiliated Hospital of Xiamen University used clinical data of 178 patients with stage T1-T3 esophageal cancer who were admitted from January 2017 to June 2020.These patiens included 105 males and 73 females aged between 41 and 78 years.They were divided into two groups on the basis of recurrent laryngeal nerve lymph node dissection,of which 100 patiens were included in the traditional group by traditional method,and 78 patients recieved the"hollow-out"method in the hollow-out group.The two groups used minimally invasive McKeown esophageal cancer resection.Intraoperative blood loss,operation time,number of recurrent laryngeal nerve lymph node dissection,rate and degree of postoperative recurrent laryngeal nerve injury,postoperative thoracic drainage volume,and anastomotic fistula of the esophagus and pulmonary-related complications were compared between the two groups.Results No significant differences in baseline data(age,gender,patient,tumor location,and stage)were observed between the groups(all P values>0.05).The number of bilateral recurrent laryngeal nerve lymph nodes dissected in the hollow-out group(left:5.28±1.77,right:3.33±1.36)was significantly higher than each side of the traditional group(left:1.79±0.96,right:1.05±0.88;t=15.710,12.841;all P values<0.01).Among the 78 cases in the"hollow-out"group,three cases(3.85%)of recurrent laryngeal nerve injury were identified,including two cases(2.56%)of mild injury and one case(1.28%)of moderate injury.Of the 100 cases in the traditional group,12 cases(12.00%)of recurrent laryngeal nerve injury were identified,including eight cases(8.00%)of mild injury and four cases(4.00%)of moderate injury.There were no significant differences in the rate and degree of recurrent laryngeal nerve injury(χ^(2)=3.775,Z=-1.936,all P values>0.05)were found between the two groups.Seven cases(8.97%)of pulmonary infection were identified in the hollow-out group,and 20 cases(20.00%)in the traditional group showed statistical differences(χ^(2)=4.140,P<0.05).No statistically significant differences in intraoperative blood loss,operation time,postoperative thoracic drainage volume,and esophageal anastomotic leakage were found between the two groups(all P values>0.05).Conclusions The"hollow-out"method is safe and feasible in recurrent laryngeal nerve lymph node dissection in patients undergoing thoracoscopic resection of esophageal carcinoma.It can improve the number of recurrent laryngeal nerve lymph nodes dissected,and does not increase the incidence of laryngeal nerve injury.