膜解剖理论在胸腹腔镜食管癌根治术中的应用

Clinical application of thoracoscopy combined with laparoscopy for radical esophagectomy based on membrane anatomy theory

目的探讨膜解剖理论应用于胸腹腔镜联合食管癌根治术的可行性与合理性。方法回顾性分析2019年7月至2020年8月期间,于郑州大学第一附属医院行胸腹腔镜联合食管癌根治术的148例患者资料,其中膜解剖手术组69例、非膜解剖手术组79例,分析术后短期转归。结果148例患者均行胸腹腔镜联合食管癌根治术,无中转开腹。膜解剖手术组对比非膜解剖手术组,手术时间更短[(214.3±34.8)min比(294.8±56.7)min,P<0.05],术中出血量更少[(54.9±23.4)ml比(108.4±32.4)ml,P<0.05],淋巴结获取数目更多[(26.8±5.8)枚比(23.4±7.3)枚,P=0.002],术后并发症发生率更低[5.8%(4/69)比17.7%(14/79),P=0.027]。两组术后住院时间、开始进食流质饮食时间、术后胸腔引流管拔除时间比较,差异无统计学意义(P>0.05)。膜解剖手术组术后随访时间(16.0±3.1)个月、非膜解剖手术组术后随访时间(14.1±1.7)个月,术后随访期间两组复发转移情况比较,差异无统计学意义(P>0.05)。结论采用膜解剖理论指导胸腹腔镜联合食管癌根治术安全、可行,相比较于传统的胸腹腔镜联合食管癌根治术,手术时间更短、术中出血量更少、淋巴结获取数目更多、并发症更少,值得推荐。

Objective To explore the effect and clinical significance of en bloc esophagectomy through thoracoscopy-laparoscopy based on the membrane anatomy. Methods 148 patients who underwent en bloc esophagectomy through thoracoscopy combined with laparoscopy were retrospectively enrolled and divided into two groups, including 69 in the membrane anatomy(MA) group and 79 in the control group. The clinical data, surgical technique, complications and recurrence in short term were analyzed. Results Surgical treatment was successfully conducted in all patients. Compared to control group, the MA group showed less operation time [(214.3±34.8) min vs(294.8±56.7) min, P<0.001], less intraoperative blood loss [(54.9±23.4) ml vs(108.4±32.4) ml, P<0.05], more dissected lymph nodes [(26.8±5.8) vs(23.4±7.3), P<0.05] and low rate of complication [5.8%(4/69) vs 17.7%(14/79),P=0.027]. Postoperative hospital stay, first liquid feeding time and thoracic drainage tube removing time had no significance(P>0.05). During the follow-up [(16.0±3.1) months in MA group versus(14.1±1.7) months in control group], there was no significance in metastasis(P>0.05). Conclusions Based on the membrane anatomy theory, the en bloc radical esophagectomy through thoracoscopy combined with laparoscopy is safe, with shorter operation time, lower rate of metastasis, more lymph nodes dissection and decreased blood loss.