微创食管癌手术中“镂空法”加“牵拉法”清扫双侧喉返神经旁淋巴结46例分析

Analysis of 46 cases of bilateral recurrent laryngeal nerve lymph node dissection by"hollowed-out method"and"traction method"in minimally invasive esophageal cancer surgery

目的总结微创食管癌手术中“镂空法”加“牵拉法”清扫双侧喉返神经旁淋巴结的效果,以为临床提供参考。方法2017年1月至2020年12月笔者所在团队共接收46例微创食管癌手术患者,术中采用“镂空法”加“牵拉法”清扫双侧喉返神经旁淋巴结。术中定位右喉返神经起始部,左弯钳钝性分离右喉返神经旁淋巴结,完全“镂空”后用超声刀或组织剪切断滋养血管,以纱布条压迫止血,以7#丝线于主操作孔处向前“牵拉”食管,定位左喉返神经,清扫左喉返神经旁淋巴结。结果手术均获成功,总手术时间240~720 min,清扫双侧喉返神经旁淋巴结用时20~45 min;双侧喉返神经旁淋巴结清扫数目4~18枚;术中出血量20~400 mL。术后声音嘶哑1例,术后第7天声音明显改善;术后2例发生阻塞性肺炎、部分肺不张,在给予三代头孢菌素的基础上行纤维支气管镜肺泡灌洗后治愈。结论微创食管癌手术中“镂空法”加“牵拉法”清扫双侧喉返神经旁淋巴结在技术上安全可行,值得推广应用。

Objective To summarize the effect of bilateral recurrent laryngeal nerve lymph node dissection by"hollowed-out method"and"traction method"in minimally invasive esophageal cancer surgery,so as to provide reference for clinic.Methods From January 2017 to December 2020,the author's team received 46 patients underwent minimally invasive esophageal cancer surgery,the"hollowed-out method"and"traction method"were used to clean bilateral recurrent laryngeal nerve lymph node during the operation.During the operation,the starting part of the right recurrent laryngeal nerve was located,the right recurrent laryngeal nerve lymph node was bluntly separated by left curved forceps;after completely"hollowed-out",the nutrient vessels was cut off by ultrasonic knife or surgical scissors,the gauze strip was pressed to stop bleeding,and the esophagus was"pulled"forward with 7#silk thread at the main operating hole;the left recurrent laryngeal nerve was located and the left recurrent laryngeal nerve lymph node was dissected.Results All the operations were successful,the total operation time was 240-720 min,and it took 20-45 min to clean bilateral recurrent laryngeal nerve lymph node;the number of bilateral recurrent laryngeal nerve lymph node dissection was 4-18;and the amount of intraoperative bleeding was 20-400 mL.One case had hoarseness after operation,and the sound improved significantly on the 7th day after operation.Two cases developed obstructive pneumonia and partial atelectasis after operation,and then were cured by fiberoptic bronchoscopic alveolar lavage on the basis of three generations of cephalosporins.Conclusion The bilateral recurrent laryngeal nerve lymph node dissection by"hollowed-out method"and"traction method"in minimally invasive esophageal cancer surgery is safe and feasible,which is worthy of popularization and application.