CAJ | 학술논문

目的：探讨胸腔镜下系统纵隔淋巴结清扫的安全性和可行性。方法回顾性分析2009年5月至2011年12月间四川大学华西医院采用胸腹腔镜联合食管切除术治疗的125例食管癌患者的临床资料。根据患者是否行系统纵隔淋巴结清扫分为系统清扫组（72例）和非系统清扫组（53例），比较两组的围手术期指标。结果与非系统清扫组相比，系统清扫组胸部手术失血量减少[（140．6±62．1） ml比（167．7±69．2） ml，P＜0．05]，胸部淋巴结清扫数目增多[（12．2±4．2）枚比（9．0±4．1）枚，P＜0．01]。系统纵隔淋巴结清扫可使每例患者额外清扫出（2．4±1．5）枚喉返神经旁淋巴结，其阳性率为23．6％（17/72），其中7例（9．7％）患者术后TNM分期升级。两组患者在胸部手术时间、ICU监护时间、术后住院时间、术后并发症发生率及围手术期死亡率方面的差异均无统计学意义（P＞0．05）。结论胸腔镜下系统纵隔淋巴结清扫术安全可行，不仅可以增加纵隔淋巴结清扫的数目、提高术后TNM分期的准确性，而且并不会增加围手术期并发症发生率和病死率。
목적：탐토흉강경하계통종격림파결청소적안전성화가행성。방법회고성분석2009년5월지2011년12월간사천대학화서의원채용흉복강경연합식관절제술치료적125례식관암환자적림상자료。근거환자시부행계통종격림파결청소분위계통청소조（72례）화비계통청소조（53례），비교량조적위수술기지표。결과여비계통청소조상비，계통청소조흉부수술실혈량감소[（140．6±62．1） ml비（167．7±69．2） ml，P＜0．05]，흉부림파결청소수목증다[（12．2±4．2）매비（9．0±4．1）매，P＜0．01]。계통종격림파결청소가사매례환자액외청소출（2．4±1．5）매후반신경방림파결，기양성솔위23．6％（17/72），기중7례（9．7％）환자술후TNM분기승급。량조환자재흉부수술시간、ICU감호시간、술후주원시간、술후병발증발생솔급위수술기사망솔방면적차이균무통계학의의（P＞0．05）。결론흉강경하계통종격림파결청소술안전가행，불부가이증가종격림파결청소적수목、제고술후TNM분기적준학성，이차병불회증가위수술기병발증발생솔화병사솔。
Objective To explore the safety and feasibility of extensive mediastinal lymphadenectomy during thoracoscopic esophagectomy in the treatment of esophageal carcinoma. Methods Clinical data of 125 patients with esophageal carcinoma undergoing thoracoscopic and laparoscopic esophagectomy (TLE) in West China Hospital of Sichuan University between May 2009 and December 2011 were retrospectively analyzed . Patients were divided into 2 groups: non-extensive mediastinal lymphadenectomy group (non-extensive group, n=53) and extensive mediastinal lymphadenectomy group (extensive group, n=72). Perioperative outcomes of these two groups were compared. Results No significant differences were found in the time of thoracic operation , length of intensive care unit stay and postoperative hospital stay , postoperative complication and the overall mortality between the two groups. Compared with non-extensive group , extensive group showed less blood loss during thoracic operation[(140.6±62.1) ml vs. (167.7±69.2) ml, P=0.023], more thoracic lymph nodes harvested (12.2 ±4.2 vs. 9.0 ±4.1, P<0.01). Seventeen patients (23.6%) in extensive group were found to have positive recurrent laryngeal nerve lymph nodes , which resulted in upstaging of TNM in 7 patients (9.7%). The incidence of recurrent laryngeal nerve palsy was higher in extensive group as compared to non-extensive group, but the difference was not statistically significant (6.9% vs. 1.9%, P=0.240). Conclusion Extensive mediastinal lymphadenectomy during thoracoscopic esophagectomy is a feasible and safe procedure for esophageal carcinoma patients , which can increase the number of harvested lymph node and the accuracy of tumor staging.