摘要
目的：探讨食管系膜悬吊法应用于胸腔镜食管癌切除术中对上纵隔淋巴结清扫质量的改善作用。方法回顾性分析2012年10月至2015年6月间在福建医科大学附属协和医院行胸腹腔镜食管切除二野淋巴结清扫的164例食管癌患者的临床资料，其中80例采用传统方法行上纵隔淋巴结清扫（传统清扫组），84例采用上段“食管系膜悬吊”技术将胸上段食管连同上纵隔区域淋巴结“整块”清除行上纵隔淋巴结清扫（系膜悬吊组）。比较两组患者的手术时间、术中出血量、淋巴结清扫数量及术后并发症发生率。结果两组患者性别、年龄、肿瘤部位及病理分期等基线资料的差异均无统计学意义（均P ＞0．05）。两组患者手术时间的差异无统计学意义，但系膜悬吊组术中胸腔出血量明显少于传统清扫组[（85±5） ml比（140±7） ml，P＝0．000]，左、右喉返神经旁淋巴结数目亦明显多于传统清扫组，其中位数（四分位间距）分别为3（2～4）枚比2（1～3）枚（P＝0．013）和3（2～6）枚比2（1～3）枚（P＝0．007）。两组患者各组淋巴结转移率的差异均无统计学意义，其中区域转移率最高的是贲门旁淋巴结[分别为22．6％（19／84）和22．5％（18／80）]，其次为右喉返神旁淋巴结[分别为17．9％（15／84）和15．0％（12／80）]和左喉返神经旁淋巴结[分别为16．7％（14／84）和12．5％（10／80）]。两组患者术后肺炎、喉返神经麻痹、吻合口瘘等主要并发症发生率的差异均无统计学意义（均P ＞0．05）。结论上纵隔双侧喉返神经旁淋巴结是胸段食管癌淋巴结转移的好发部位；食管系膜悬吊技术应用于胸腔镜食管癌切除术可以提高双侧喉返神经旁淋巴结的清扫质量。
Objective To explore the application of mesoesophagus suspension technique to improve the upper mediastinal lymph node dissection during thoracoscopic esophagectomy in the treatment of esophageal cancer. Methods Clinical data of 164 thoracic esophageal cancer patients who underwent combined thoracoscopic and laparoscopic esophagectomy with two-field lymph node dissection in the Union Hospital of Fujian Medical University between October 2012 and June 2015 were retrospectively analyzed. Among 164 patients, 80 cases underwent upper mediastinal lymph node dissection by traditional method （traditional group）, and the remaining 84 cases underwent upper mediastinal lymph node dissection by mesoesophagus suspension technique （suspension group）. The operation time, estimated blood loss, number of excised lymph nodes and postoperative complications were compared between the two groups. Results There were no significant differences in gender, age, location of tumor and pathology stage between the two groups. The operation time in the two groups was similar. The suspension group had significantly less thoracic blood loss than traditional group [（85 ± 5） ml vs.（140 ± 7） ml, P=0.000]. The number of dissected lymph nodes of bilateral recurrent laryngeal nerve was more in suspension group [median （interquartile range）： left： 3 （2 to 4） vs. 2 （1 to 3）, P = 0.013; right： 3 （2 to 6） vs. 2 （1 to 3）, P = 0.007]. There was no significant difference in metastatic rate of lymph node in different sites between the two groups. The highest metastatic rate of suspension and traditional group was found at paracardia lymph nodes [22.6%（19/84） and 22.5%（18/80）], the next was at right laryngeal nerve lymph nodes [17.9%（15/84） and 15.0%（12/80）] and left laryngeal nerve lymph nodes [16.7%（14/84） and 12.5%（10/80）]. There were no significant differences with regard to the incidence of major postoperative complications between two groups , including respiratory complication, anastomotic leakage, vocal cord palsy. Conclusions Upper mediastinal bilateral recurrent laryngeal nerve lymph node is the predilection site of lymphatic metastasis of thoracic esophageal cancer. Application of mesoesophagus suspension technique in thoracoscopic esophagectomy can improve the clearance quality of bilateral recurrent laryngeal nerve lymph nodes.
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2016年第9期999-1003,共5页
Chinese Journal of Gastrointestinal Surgery
关键词
食管肿瘤
食管切除术
胸腔镜
食管系膜
Esophageal neoplasms
Esophagectomy
Thoracoscopy
Mesoesophagus
