CAJ | 학술논문

目的比较早期腔镜微创与开放食管切除术治疗食管癌患者的围手术期并发症和淋巴结清扫情况差异.方法回顾性分析2011年1-12月间上海市胸科医院手术治疗的72例食管癌患者的临床资料,其中34例完成腔镜微创食管癌切除术(腔镜组),38例接受开放食管癌切除术(开放组).腔镜组中16例行单纯胸腔镜加开腹手术,11例行单纯腹腔镜加开胸手术11例,7例行胸腹全腔镜联合手术.结果腔镜组早期病例(T1～2期)的比例高于开放组[79.4％(27/34)比55.3％(21/38),P＜0.05).两组患者总并发症发生率分别为41.2％(14/34)和42.1％(16/38),差异无统计学意义(P＞0.05)；但腔镜组功能性并发症(主要为心肺并发症)发生率显著低于开放组[2.9％(1/34)比28.9％(11/38),P＜0.01],技术性并发症(主要包括吻合口瘘和喉返神经损伤)发生率则显著高于开放组[38.2％(13/34)比10.5％(4/38),P＜0.05).两组淋巴结清扫组数分别为(9.1±2.7)组/例和(11.2±2.1)组/例,差异无统计学意义(P＞0.05)；但腔镜组淋巴结清扫枚数[(13.5±5.9)枚/例]却明显少于开放组[(17.8±5.2)枚/例,P＜0.05].按手术时间,腔镜组前期17例与后期17例患者技术性并发症发生率的差异无统计学意义(P＞0.05),但后期患者胸腔淋巴结淋扫组数、枚数及阳性检出率均显著提高(均P＜0.05).结论腔镜辅助微创食管癌手术可降低功能性并发症发生率,但早期技术不熟练时易增加吻合口瘘和喉返神经损伤等技术性并发症.腔镜下清扫淋巴结可以达到或接近开放手术水平.
목적 비교조기강경미창여개방식관절제술치료식관암환자적위수술기병발증화림파결청소정황차이.방법 회고성분석2011년1-12월간상해시흉과의원수술치료적72례식관암환자적림상자료,기중34례완성강경미창식관암절제술(강경조),38례접수개방식관암절제술(개방조).강경조중16례행단순흉강경가개복수술,11례행단순복강경가개흉수술11례,7례행흉복전강경연합수술.결과 강경조조기병례(T1～2기)적비례고우개방조[79.4％(27/34)비55.3％(21/38),P＜0.05).량조환자총병발증발생솔분별위41.2％(14/34)화42.1％(16/38),차이무통계학의의(P＞0.05)；단강경조공능성병발증(주요위심폐병발증)발생솔현저저우개방조[2.9％(1/34)비28.9％(11/38),P＜0.01],기술성병발증(주요포괄문합구루화후반신경손상)발생솔칙현저고우개방조[38.2％(13/34)비10.5％(4/38),P＜0.05).량조림파결청소조수분별위(9.1±2.7)조/례화(11.2±2.1)조/례,차이무통계학의의(P＞0.05)；단강경조림파결청소매수[(13.5±5.9)매/례]각명현소우개방조[(17.8±5.2)매/례,P＜0.05].안수술시간,강경조전기17례여후기17례환자기술성병발증발생솔적차이무통계학의의(P＞0.05),단후기환자흉강림파결림소조수、매수급양성검출솔균현저제고(균P＜0.05).결론 강경보조미창식관암수술가강저공능성병발증발생솔,단조기기술불숙련시역증가문합구루화후반신경손상등기술성병발증.강경하청소림파결가이체도혹접근개방수술수평.
Objective To analyze the differences in perioperative morbidity and lymph node dissection between minimally invasive esophageal carcinoma resection and open procedure.Methods From January to December 2011,72 patients with esophageal cancer underwent surgery.Thirty-four patients underwent video-assisted esophagectomy,and 38 underwent open procedure.In the minimally invasive group,there were 7 thoracolaparoscopic cases,16 thoracoscopic cases,and 11 laparoscopic cases.Results The early cases (T1-T2) were more common in the minimally invasive group than that in the open group[79.4％(27/34) vs.55.3％(21/38),P＜0.05].The complication rate was 41.2％( 11/34) in the open group and 42.1％(16/38) in the minimally invasive group,and the difference was not statistically significant (P＞0.05).However,the functional complication in minimally invasive group was significantly lower than that in open group[2.9％(1/34) vs.28.9％( 11/38),P＜0.01],while technical complications (anastomotic leak and recurrent laryngeal nerve injury) were significantly more common (38.2％ vs.10.5％,P＜0.05).Lymph node group number in minimally invasive group was comparable with the open group (9.1 vs.11.2,P＞0.05),but the number of node in minimally invasive group was significantly lower (13.5±5.9 vs.17.8±5.2,P＜0.05).When stratified by time period,early 17 cases were associated with similar technical complication rate with the late 17 cases (P＞0.05),while thoracic lymph node group number,number of node,and positive node were improved in the late phase (all P＞0.05).Conclusions Minimally invasive esophagectomy reduces functional morbidity,while technical complication including anastomotic leak and recurrent laryngeal nerve injury may be increased.Endoscopic lymph node dissection may be comparable to open surgery.