中华肿瘤杂志
中華腫瘤雜誌
중화종류잡지
CHINESE JOURNAL OF ONCOLOGY
2014年
11期
863-866
,共4页
王祥%李强%庄翔%杨晓军%谢天鹏%肖平%马可%胡彬
王祥%李彊%莊翔%楊曉軍%謝天鵬%肖平%馬可%鬍彬
왕상%리강%장상%양효군%사천붕%초평%마가%호빈
食管肿瘤%外科手术%胸腔镜%淋巴结切除术%手术后并发症
食管腫瘤%外科手術%胸腔鏡%淋巴結切除術%手術後併髮癥
식관종류%외과수술%흉강경%림파결절제술%수술후병발증
Esophageal neoplasms%Surgical procedures,operative%Thoracoscopy%Lymph node excision%Postoperative complications
目的 比较侧俯卧位胸腔镜食管癌根治术与开胸食管癌根治术的围手术期结果及淋巴结清扫情况.方法 选取2011年11月至2012年12月行侧俯卧位胸腔镜食管癌根治术(胸腔镜组)患者62例,2009年行上腹、右胸和左颈三切口开胸手术(开胸手术组)患者62例,观察两组患者住院时间、手术时间、手术出血量、术后并发症和淋巴结清扫情况.结果 胸腔镜组和开胸手术组患者住院时间分别为(12.4±7.4)d和(13.6±6.7)d,差异无统计学意义(P=0.713).胸腔镜组患者中位手术总时间和中位胸部手术时间分别为270 min和130 min,中位手术总出血量和中位胸部手术出血量分别为300 ml和180 ml;开胸手术组患者中位手术总时间和中位胸部手术时间分别为290 min和150 min,中位手术总出血量和中位胸部手术出血量分别为300 ml和180ml.两组的中位手术总时间、胸部手术时间差异有统计学意义(P＜0.01),而中位手术总出血量和中位胸部手术出血量差异无统计学意义(P＞0.05).胸腔镜组和开胸手术组的中位淋巴结清扫数目分别为20.5枚和16.9枚,差异有统计学意义(P＜0.01).胸腔镜组和开胸手术组的中位纵隔淋巴结清扫数分别为12.4枚和8.8枚,中位左喉返神经旁淋巴结清扫数分别为1.8枚和1.0枚,中位右喉返神经旁淋巴结清扫数分别为2.9枚和1.2枚,差异均有统计学意义(均P＜0.01).胸腔镜组喉返神经旁淋巴结阳性8例(12.9％),开胸手术组喉返神经旁淋巴结阳性5例(8.1％),差异无统计学意义(P＞0.05).胸腔镜组和开胸手术组均无围手术期死亡患者,术后无大出血再次手术止血患者,无胸胃瘘.结论 侧俯卧位胸腔镜食管癌根治术可以达到良好的手术野暴露,为食管切除、淋巴结的彻底清扫和消化道重建提供可能.随着技术的成熟,与开胸食管癌根治术比较,侧俯卧位胸腔镜食管癌根治术在降低术后并发症和纵隔淋巴结清扫上可能更具有优势.
目的 比較側俯臥位胸腔鏡食管癌根治術與開胸食管癌根治術的圍手術期結果及淋巴結清掃情況.方法 選取2011年11月至2012年12月行側俯臥位胸腔鏡食管癌根治術(胸腔鏡組)患者62例,2009年行上腹、右胸和左頸三切口開胸手術(開胸手術組)患者62例,觀察兩組患者住院時間、手術時間、手術齣血量、術後併髮癥和淋巴結清掃情況.結果 胸腔鏡組和開胸手術組患者住院時間分彆為(12.4±7.4)d和(13.6±6.7)d,差異無統計學意義(P=0.713).胸腔鏡組患者中位手術總時間和中位胸部手術時間分彆為270 min和130 min,中位手術總齣血量和中位胸部手術齣血量分彆為300 ml和180 ml;開胸手術組患者中位手術總時間和中位胸部手術時間分彆為290 min和150 min,中位手術總齣血量和中位胸部手術齣血量分彆為300 ml和180ml.兩組的中位手術總時間、胸部手術時間差異有統計學意義(P＜0.01),而中位手術總齣血量和中位胸部手術齣血量差異無統計學意義(P＞0.05).胸腔鏡組和開胸手術組的中位淋巴結清掃數目分彆為20.5枚和16.9枚,差異有統計學意義(P＜0.01).胸腔鏡組和開胸手術組的中位縱隔淋巴結清掃數分彆為12.4枚和8.8枚,中位左喉返神經徬淋巴結清掃數分彆為1.8枚和1.0枚,中位右喉返神經徬淋巴結清掃數分彆為2.9枚和1.2枚,差異均有統計學意義(均P＜0.01).胸腔鏡組喉返神經徬淋巴結暘性8例(12.9％),開胸手術組喉返神經徬淋巴結暘性5例(8.1％),差異無統計學意義(P＞0.05).胸腔鏡組和開胸手術組均無圍手術期死亡患者,術後無大齣血再次手術止血患者,無胸胃瘺.結論 側俯臥位胸腔鏡食管癌根治術可以達到良好的手術野暴露,為食管切除、淋巴結的徹底清掃和消化道重建提供可能.隨著技術的成熟,與開胸食管癌根治術比較,側俯臥位胸腔鏡食管癌根治術在降低術後併髮癥和縱隔淋巴結清掃上可能更具有優勢.
목적 비교측부와위흉강경식관암근치술여개흉식관암근치술적위수술기결과급림파결청소정황.방법 선취2011년11월지2012년12월행측부와위흉강경식관암근치술(흉강경조)환자62례,2009년행상복、우흉화좌경삼절구개흉수술(개흉수술조)환자62례,관찰량조환자주원시간、수술시간、수술출혈량、술후병발증화림파결청소정황.결과 흉강경조화개흉수술조환자주원시간분별위(12.4±7.4)d화(13.6±6.7)d,차이무통계학의의(P=0.713).흉강경조환자중위수술총시간화중위흉부수술시간분별위270 min화130 min,중위수술총출혈량화중위흉부수술출혈량분별위300 ml화180 ml;개흉수술조환자중위수술총시간화중위흉부수술시간분별위290 min화150 min,중위수술총출혈량화중위흉부수술출혈량분별위300 ml화180ml.량조적중위수술총시간、흉부수술시간차이유통계학의의(P＜0.01),이중위수술총출혈량화중위흉부수술출혈량차이무통계학의의(P＞0.05).흉강경조화개흉수술조적중위림파결청소수목분별위20.5매화16.9매,차이유통계학의의(P＜0.01).흉강경조화개흉수술조적중위종격림파결청소수분별위12.4매화8.8매,중위좌후반신경방림파결청소수분별위1.8매화1.0매,중위우후반신경방림파결청소수분별위2.9매화1.2매,차이균유통계학의의(균P＜0.01).흉강경조후반신경방림파결양성8례(12.9％),개흉수술조후반신경방림파결양성5례(8.1％),차이무통계학의의(P＞0.05).흉강경조화개흉수술조균무위수술기사망환자,술후무대출혈재차수술지혈환자,무흉위루.결론 측부와위흉강경식관암근치술가이체도량호적수술야폭로,위식관절제、림파결적철저청소화소화도중건제공가능.수착기술적성숙,여개흉식관암근치술비교,측부와위흉강경식관암근치술재강저술후병발증화종격림파결청소상가능경구유우세.
Objective Thoracoscopic esophagectomy has gained worldwide popularity.This study compared the perioperative outcomes and lymphadenectomy after thoracoscopic esophagectomy in semi prone position and open esophagectomy.Methods Sixty-two consecutive patients after thoracoscopic esophagectomy were compared with 62 patients who underwent open esophagectomy.Outcomes included surgical time,blood loss,length of hospital stay,30-day mortality,complications and gained lymph nodes.Results The mean length of hospital stay of the thoracoscopic group was 12.4 ±7.4 days,and 13.6 ± 6.7 days in the open esophagectomy group (P ＞ 0.05).The median total operation time and median thoracic operation time were 270 and 130 min,the median total blood loss and median thoracic blood loss were 300 and 180 ml in the thoracoscopic group,while the results in open esophagectomy group were 290,150 min and 300,180 ml.The median total operation time and median thoracic operation time were of statistically significant difference (P ＜ 0.01).But there were no significant differences between the two groups in total blood loss and thoracic blood loss (P ＞ 0.05).The numbers of obtained lymph nodes in the thoracoscopic group and open esophagectomy group were 20.5 and 16.9 (P ＜ 0.01).Among them,the median numbers of mediastinal lymph nodes in the thoracoscopic group and open esophagectomy group were 12.4 and 8.8,the left recurrent laryngeal nerve lymph nodes were 1.8 and 1.0,and the right recurrent laryngeal nerve lymph nodes were 2.9 and 1.2 (P ＜0.01 for all).There were 8 positive recurrent laryngeal nerve lymph nodes (12.9％) in the thoracoscopic group,while 5 in the open esophagectomy group (8.1％,P ＞0.05).There were no perioperative period death,heavy bleeding,or thoracic gastric fistula in both groups.Conclusions Thoracoscopic esophagectomy in semi prone position may achieve good surgical field exposure,therefore,to make esophagectomy,lymph node dissection and digestive tract reconstruction possible.These findings suggest that with further technical refinement,thoracoscopic esophagectomy may have the upper hand on reducing postoperative complications and performing mediastinal lymph node dissection.
