中华肿瘤杂志
中華腫瘤雜誌
중화종류잡지
CHINESE JOURNAL OF ONCOLOGY
2015年
7期
530-533
,共4页
毛友生%赫捷%章智荣%董静思%高树庚%孙克林%程贵余%牟巨伟%薛奇%刘向阳%方德康%王大力%赵峻%李鉴%王永岗%高禹舜%黄进丰
毛友生%赫捷%章智榮%董靜思%高樹庚%孫剋林%程貴餘%牟巨偉%薛奇%劉嚮暘%方德康%王大力%趙峻%李鑒%王永崗%高禹舜%黃進豐
모우생%혁첩%장지영%동정사%고수경%손극림%정귀여%모거위%설기%류향양%방덕강%왕대력%조준%리감%왕영강%고우순%황진봉
食管肿瘤%淋巴结切除术%外科手术,微创性%外科手术
食管腫瘤%淋巴結切除術%外科手術,微創性%外科手術
식관종류%림파결절제술%외과수술,미창성%외과수술
Esophageal neoplasms%Lymph node excision%Surgical procedures,minimally invasive%Surgical procedures,operative
目的：探讨胸段食管癌经胸腔镜手术切除在淋巴结清扫程度和手术并发症发生率等方面与常规开胸手术的差异。方法收集2009年5月至2013年7月间经胸腔镜手术治疗的129例患者（胸腔镜组）的临床资料，选择同期经右侧常规开胸手术、具有相同术前临床分期的129例胸段食管癌患者（常规开胸组）进行配对比较。回顾性分析两组患者的近期疗效，研究两种方式在胸腔镜手术探索发展的初期淋巴结清扫和并发症方面是否存在差异。结果胸腔镜组和常规开胸组患者的年龄、性别、病变位置和术前临床分期差异均无统计学意义（均P＞0．05）。胸腔镜组和常规开胸组患者的总淋巴结阳性率分别为35．7％和37．2％，差异无统计学意义（ P＝0．897）。胸腔镜组和常规开胸组患者的平均清扫淋巴结总枚数分别为12．1和16．2枚，差异有统计学意义（ P＝0．001）。胸腔镜组和常规开胸组患者的平均清扫淋巴结总组数分别为3．2和3．6组，差异有统计学意义（P＝0．038）。胸腔镜组和常规开胸组患者的左侧喉返神经旁平均淋巴结清扫枚数分别为2．0和3．7枚，差异有统计学意义（ P＝0．012）；右侧喉返神经旁平均淋巴结清扫枚数分别为2．9和3．4枚，差异无统计学意义（ P＝0．231）。胸腔镜组和常规开胸组患者的总并发症发生率分别为41．1％和42．6％，差异无统计学意义（ P＝0．801）；心肺并发症发生率分别为25．6％和27．1％，差异无统计学意义（ P＝0．777）；手术相关并发症发生率均为18．6％；死亡率均为0．8％。胸腔镜组和常规开胸组患者的平均输血率分别为23．2％和41．8％，差异有统计学意义（P＝0．001）。胸腔镜组和常规开胸组患者的平均住院天数分别为15．9和19．2 d，差异有统计学意义（P＝0．049）。胸腔镜组和常规开胸组患者的平均手术时间分别为161．3和127．8 min，差异有统计学意义（ P＜0．01）。结论在探索应用胸腔镜手术治疗胸段食管癌初期，清扫淋巴结总组数、总枚数和左侧喉返神经链淋巴结清扫程度均差于常规开胸手术组。在胸腔镜食管癌手术初期，宜选择无明显外侵和淋巴结转移的早期食管癌患者进行探索治疗。
目的：探討胸段食管癌經胸腔鏡手術切除在淋巴結清掃程度和手術併髮癥髮生率等方麵與常規開胸手術的差異。方法收集2009年5月至2013年7月間經胸腔鏡手術治療的129例患者（胸腔鏡組）的臨床資料，選擇同期經右側常規開胸手術、具有相同術前臨床分期的129例胸段食管癌患者（常規開胸組）進行配對比較。迴顧性分析兩組患者的近期療效，研究兩種方式在胸腔鏡手術探索髮展的初期淋巴結清掃和併髮癥方麵是否存在差異。結果胸腔鏡組和常規開胸組患者的年齡、性彆、病變位置和術前臨床分期差異均無統計學意義（均P＞0．05）。胸腔鏡組和常規開胸組患者的總淋巴結暘性率分彆為35．7％和37．2％，差異無統計學意義（ P＝0．897）。胸腔鏡組和常規開胸組患者的平均清掃淋巴結總枚數分彆為12．1和16．2枚，差異有統計學意義（ P＝0．001）。胸腔鏡組和常規開胸組患者的平均清掃淋巴結總組數分彆為3．2和3．6組，差異有統計學意義（P＝0．038）。胸腔鏡組和常規開胸組患者的左側喉返神經徬平均淋巴結清掃枚數分彆為2．0和3．7枚，差異有統計學意義（ P＝0．012）；右側喉返神經徬平均淋巴結清掃枚數分彆為2．9和3．4枚，差異無統計學意義（ P＝0．231）。胸腔鏡組和常規開胸組患者的總併髮癥髮生率分彆為41．1％和42．6％，差異無統計學意義（ P＝0．801）；心肺併髮癥髮生率分彆為25．6％和27．1％，差異無統計學意義（ P＝0．777）；手術相關併髮癥髮生率均為18．6％；死亡率均為0．8％。胸腔鏡組和常規開胸組患者的平均輸血率分彆為23．2％和41．8％，差異有統計學意義（P＝0．001）。胸腔鏡組和常規開胸組患者的平均住院天數分彆為15．9和19．2 d，差異有統計學意義（P＝0．049）。胸腔鏡組和常規開胸組患者的平均手術時間分彆為161．3和127．8 min，差異有統計學意義（ P＜0．01）。結論在探索應用胸腔鏡手術治療胸段食管癌初期，清掃淋巴結總組數、總枚數和左側喉返神經鏈淋巴結清掃程度均差于常規開胸手術組。在胸腔鏡食管癌手術初期，宜選擇無明顯外侵和淋巴結轉移的早期食管癌患者進行探索治療。
목적：탐토흉단식관암경흉강경수술절제재림파결청소정도화수술병발증발생솔등방면여상규개흉수술적차이。방법수집2009년5월지2013년7월간경흉강경수술치료적129례환자（흉강경조）적림상자료，선택동기경우측상규개흉수술、구유상동술전림상분기적129례흉단식관암환자（상규개흉조）진행배대비교。회고성분석량조환자적근기료효，연구량충방식재흉강경수술탐색발전적초기림파결청소화병발증방면시부존재차이。결과흉강경조화상규개흉조환자적년령、성별、병변위치화술전림상분기차이균무통계학의의（균P＞0．05）。흉강경조화상규개흉조환자적총림파결양성솔분별위35．7％화37．2％，차이무통계학의의（ P＝0．897）。흉강경조화상규개흉조환자적평균청소림파결총매수분별위12．1화16．2매，차이유통계학의의（ P＝0．001）。흉강경조화상규개흉조환자적평균청소림파결총조수분별위3．2화3．6조，차이유통계학의의（P＝0．038）。흉강경조화상규개흉조환자적좌측후반신경방평균림파결청소매수분별위2．0화3．7매，차이유통계학의의（ P＝0．012）；우측후반신경방평균림파결청소매수분별위2．9화3．4매，차이무통계학의의（ P＝0．231）。흉강경조화상규개흉조환자적총병발증발생솔분별위41．1％화42．6％，차이무통계학의의（ P＝0．801）；심폐병발증발생솔분별위25．6％화27．1％，차이무통계학의의（ P＝0．777）；수술상관병발증발생솔균위18．6％；사망솔균위0．8％。흉강경조화상규개흉조환자적평균수혈솔분별위23．2％화41．8％，차이유통계학의의（P＝0．001）。흉강경조화상규개흉조환자적평균주원천수분별위15．9화19．2 d，차이유통계학의의（P＝0．049）。흉강경조화상규개흉조환자적평균수술시간분별위161．3화127．8 min，차이유통계학의의（ P＜0．01）。결론재탐색응용흉강경수술치료흉단식관암초기，청소림파결총조수、총매수화좌측후반신경련림파결청소정도균차우상규개흉수술조。재흉강경식관암수술초기，의선택무명현외침화림파결전이적조기식관암환자진행탐색치료。
Objective Video?assisted thoracoscopic ( VATS ) esophagectomy has been performed for more than 10 years in China. However, compared with the conventional esophagectomy via right thoracotomy, whether VATS esophagectomy has more advantages or not in the lymph node ( LN) dissection and prevention of perioperative complications is still controversial and deserves to be further investigated. The aim of this study was to explore whether there are significant differences in this issue between the two surgical modalities or not. Methods The results of lymph node dissection and perioperative complications as well as other parameters in the patients treated by VATS esophagectomy and those by conventional esophagectomy via right thoracotomy at our department from May 1,2009 to July 30,2013 were compared using SPSS 16.0 in order to investigate whether there was any significant difference between these two treatment modalities in the learning curve stage of VATS esophagectomy. Results One hundred and twenty?nine cases underwent VATS esophagectomy between May 1, 2009 and July 30, 2013, and another pared 129 cases with the same preoperative cTNM stage treated by conventional esopahgectomy via right thoracotomy were selected in order to compare the results of lymph node dissection and perioperative complications as well as other parameters between those two groups of patients. There were no significant differences in the sex, age, lesion locations and cTNM stage between these two groups. The total LN metastatic rate in the VATS esophagectomy group was 35.7% and that of the conventional esophagectomy group was 37.2% (P>0.05). The total average number of dissected lymph nodes was 12.1 vs. 16.2 ( P<0.001) . The average dissected LN stations was 3.2 vs. 3.6 ( P=0.038) . The total average number of dissected LN along the left recurrent laryngeal nerve was 2.0 vs. 3.7 ( P=0.012) . The total average number of dissected LN along the right recurrent laryngeal nerve was 2.9 vs. 3.4 (P=0.231). However, there was no significant difference in the total average number of dissected LN in the other thoracic LN stations, and in the perioperative complications between the two groups. The total postoperative complication rate was 41. 1% in the VATS group versus 42. 6% in the conventional group ( P=0.801) . The cardiopulmonary complication rate was 25.6% vs. 27.1% ( P=0.777) . The death rate was the same in the two groups (0.8%). The VATS group had less blood infusion (23.2% vs. 41.8%, P=0.001) and shorter hospital stay (15.9 days vs. 19.2 days, P=0.049) but longer operating time (161.3 min vs. 127.8 min, P<0.01). Conclusions In the learning curve stage of VATS esophagectomy, compared with the conventional esophagectomy, less LN number and stations can be dissected in the VATS group due to unskillful VATS manipulation, especially it is more difficult in the LN dissection along the left recurrent laryngeal nerve. Therefore, it is more suitable to select patients with early esophageal cancer without obvious enlarged lymph nodes for VATS esophagectomy in the learning curve stage.
