3D与2D胸腹腔镜治疗食管癌的比较研究  

Comparative study of 3D thoracoscopic esophagectomy versus 2D thoracoscopic esophagectomy ;for esophageal carcinoma

作　　者：侯予龙[1] 郭伟[1] 杨志健[2] 赵建强[1] 

机构地区：[1]南京医科大学附属淮安第一医院胸心外科,223300 [2]江苏省人民医院心脏科

出　　处：《中华胃肠外科杂志》2015年第9期889-892,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：江苏省博士后科研资助计划（1201079C）;南京医科大学科技发展基金重点项目（2011NJMU237）

摘　　要：目的：探讨3D胸腹腔镜下食管根治切除术治疗食管癌的安全性和有效性。方法前瞻性纳入2013年10月至2014年3月在南京医科大学附属淮安第一医院胸心外科收治的临床分期在T3N1M0以下的154例食管癌患者，按随机数字表法分为3D腔镜组（78例）和2D腔镜组（76例）。手术应用3D或2D腔镜游离食管至胸廓入口，3D或2D腔镜游离胃，直线切割缝合器行管状胃成形后，食管胃颈部吻合。比较两组患者的手术安全性和近期疗效。结果154例患者均顺利完成手术，3D腔镜组手术时间较2D腔镜组明显缩短[（176．0±27．7） min比（203．0±31．5） min，P＜0．05]。两组患者术中出血量[（124．0±35．8） ml比（127．0±25．7） ml]、术中清扫淋巴结数目[（17．0±8．6）枚比（18．0±3．3）枚]、住院时间[（11．8±9．3） d比（12．6±8．8） d]及术后并发症发生率[12．8％（10／78）比14．5％（11／76）]的差异均无统计学意义（P＞0．05）。两组患者术后中位随访时间分别为5．6（3～8）月和5．2（5～7）月，随访期间无死亡或复发病例。结论与2D胸腹腔镜比较，应用3D胸腔镜在侧俯卧位下行食管根治切除在技术上安全可行。Objective To investigate the feasibility and safety of 3D laparoscopic and thoracoscopic esophagectomy. Methods From October 2013 to March 2014, 154 patients with esophageal cancer of clinical stage T3N1M0 undergoing 3D or 2D minimally invasive esophagectomy in lateral prone position in our department were enrolled prospectively, and randomly divided into 3D group（78 cases） and 2D group（76 cases）. The esophagus was dissociated by 3D or 2D laparoscope and thoracoscope to the entry of thorax. Stomach was dissociated by same telescopes and cut linearly. After tube stomach shaping was completed, esophagogastric anastomosis was performed in the left neck. The operative safety and short-term efficacy were compared between the two groups. Results The entire procedure was technically successful in 154 patients. The average total operative time in 3D group was shorter than that in 2D group [（176.0± 27.7） min vs. （203.0±31.5） min, P〈0.05]. No significant differences were observed in blood loss [（124.0± 35.8） ml vs. （127.0±25.7） ml], number of harvested lymph node （17.0±8.6 vs. 18.0±3.3）, postoperative hospital stay [（11.8±9.3） d vs. （12.6±8.8） d] （all P〉0.05）, and morbidity of postoperative complication [12.8%（10/78） vs. 14.5%（11/76）]. The median follow-up time was 5.6 （3-8） months and 5.2 （5-7） months in 3D and 2D groups respectively, and no death or relapse cases were found during the follow-up. Conclusion 3D laparoscopic and thoracoscopic esophagectomy under lateral prone position is technically feasible and safe for esophageal carcinoma, as compared to 2D procedure.

关 键 词：食管肿瘤 微创食管切除术 3D胸腹腔镜 

分 类 号：R735.1[医药卫生—肿瘤]