胸腹腔镜联合食管癌切除术行双侧喉返神经旁淋巴结清扫的临床可行性

Clinical Effect of Bilateral Laryngeal LymphnodeRetrograde Lymphadenectomy with Thoraco-laparoscopic and Esophagectomy

目的:探讨胸腹腔镜联合食管癌切除术行双侧喉返神经旁淋巴结清扫的临床可行性。方法:收集2012年1月-2016年3月在本院行胸腹腔镜联合食管癌切除术的食管癌患者126例,根据不同术式分为常规组(n=47),扩大双侧喉返神经旁淋巴结清扫组(扩大组)(n=79)。评价两种手术清除淋巴结效果及临床可行性评估。结果:与常规组相比,扩大组术中出血量显著降低及淋巴结清扫数显著升高(P<0.01);而两组手术时间和术后住院天数差异无显著性(P>0.05)。术后随访6个月,常规组出现肺炎、吻合口瘘、喉返神经损伤人数分别为4、4、6例,并发症发生率40.4%,而扩大组出现肺炎、吻合口瘘、喉返神经损伤人数分别为4、5、10例,并发症发生率17.7%,两者相比差异具有统计学意义(P<0.01)。结论:胸腹腔镜联合食管癌切除术行双侧喉返神经旁淋巴结清扫相对常规组,具有较好的安全性及可行性。

Objective:To investigate the feasibility andsafety of thoracic laparoscopy and esophageal resection in repairing bilateral lymphonasal lymph nodes.Methods:From January 2012 to March 2016,126 patients with esophageal cancer who underwent thoraco-laparoscopic and esophageal resection in our hospital were enrolled. According to the type of operation,47 patients were divided into two groups:conventional group 79 cases of lymph node dissection group(enlarged group). The operation time,intraoperative blood loss,postoperative length of hospital stay,lymph node dissection,pneumonia,anastomotic fistula and recurrent laryngeal nerve injury were compared between the two groups.Results:Compared with the conventional group,the bleeding volume were significantly decreased and the number of lymph node dissection in the enlarged group were significantly increase(P<0.01). There was no significant difference between the two groups in the operation time and the postoperative length of stay(P>0.05). The patients were followed up for 6 months. The number of pneumonia,anastomotic fistula and recurrent laryngeal nerve injury in the routine group were 4,5 and 10 cases respectively,the complication rate was 40.4%,while the complication rate in the enlarged group was 17.7% The difference was statistically significant esophageal resection of the bilateral para-recurrent laryngeal nerve lymph node dissection relative to the conventional group,has good safety and feasibility.