微创McKeown食管鳞癌根治术学习曲线特点及喉返神经旁淋巴结清扫对疗效的影响  

Learning curve characteristics of Mckeown-type minimally invasive esophagectomy and effects of the para- recurrent laryngeal nerve lymphadenectomy on efficacy

作　　者：薛亚斌[1] 吕红博[1] 瓦热斯江·依不拉音[1] 孙晓宏[1] 何丹[1] 罗洞波[1] 汪洋[1] 刘翼[1] 孙伟[1] Xue Yabin;Lyu Hongbo;Waresifiang Yibulayin;Sun Xiaohong;He Dan;Luo Dongbo;Wang Yang;Liu Yi;Sun Wei(Department of Thoracic Surgery,Affiliated Tumor Hospital,Xinjiang Medical University,Urumqi 830001,China)

机构地区：[1]新疆医科大学附属肿瘤医院胸外科,乌鲁木齐830001

出　　处：《中华消化外科杂志》2018年第8期825-829,共5页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金（81460419）;新疆维吾尔自治区自然科学基金（2016D01C369）

摘　　要：目的：探讨微创McKeown食管鳞癌根治术学习曲线特点及喉返神经旁淋巴结清扫对疗效的影响。方法：采用回顾性队列研究方法。收集2011年1月至2015年12月新疆医科大学附属肿瘤医院收治的163例行微创McKeown食管鳞癌根治术患者的临床病理资料。163例患者中，根据不同学习曲线阶段（早期、中期和后期）喉返神经旁淋巴结清扫情况，早期49例患者未行喉返神经旁淋巴结清扫，设为 A组；中期65例患者行右侧喉返神经旁淋巴结清扫，设为B组；后期49例患者行双侧喉返神经旁淋巴结清扫，设为C组。观察指标：（1）3组患者术中和术后恢复情况比较。（2）3组患者随访和生存情况比较。（3）手术时间、术中出血量与微创McKeown食管鳞癌根治术学习曲线例数相关性分析。采用门诊和电话方式进行随访，了解患者术后生存情况。随访时间截至2017年4月。正态分布的计量资料以x^-±s表示，多组间比较采用方差分析，两两比较采用独立样本t检验。偏态分布的计量资料以M（范围）表示。计数资料比较采用χ2检验。采用Kaplan-Meier法计算患者生存时间，Log-rank检验进行生存分析。相关性分析采用Spearman秩相关检验。结果：（1）3组患者术中和术后恢复情况比较：3组患者均顺利完成微创McKeown食管鳞癌根治术，无中转开放手术患者。A、B、C组食管鳞癌患者手术时间分别为（395±94）min、（329± 67）min、（301±51）min，淋巴结清扫总数分别为（14.7±6.9）枚、（20.4±9.1）枚、（25.8±11.0）枚，胸部淋巴结清扫数目分别为（9.6±5.4）枚、（11.4±7.3）枚、（14.8±10.1）枚，术中出血量分别为（175±100）mL、（117±49）mL、（115±50）mL，3组患者上述指标比较，差异均有统计学意义（F=21.962，1.992，5.775，12.744，P〈0.05）。其中A组患者上述指标与B组比较，差异均有统计学意义（t=3.135，Objective：To explore the learning curve characteristics of Mckeown-type minimally invasive esophagectomy and effects of the para-recurrent laryngeal nerve lymphadenectomy on efficacy. Methods：The retrospective cohort study was conducted. The clinicopathological data of 163 patients with esophageal squamous cell carcinoma （ESCC） who underwent Mckeown-type minimally invasive esophagectomy in the Affiliated Tumor Hospital of Xinjiang Medical University between January 2011 and December 2015 were collected. According to the para-recurrent laryngeal nerve lymphadenectomy in the different learning curve stages （early, medium and later stages）, 49 patients who didn′t undergo right para-recurrent laryngeal nerve lymphadenectomy were allocated into the group A, 65 who underwent para-recurrent laryngeal nerve lymphadenectomy were allocated into the group B, and 49 underwent bilateral para-recurrent laryngeal nerve lymphadenectomy were allocated into the group C. Observation indicators： （1） comparisons of intra and postoperative recovery among groups; （2） comparisons of followup and survival among groups; （3） correlation analysis between operation time or volume of intraoperative blood loss and cases of learning curve of Mckeown-type minimally invasive esophagectomy. Followup using outpatient examination and telephone interview was performed to detect postoperative survival up to April 2017. Measurement data with normal distribution were represented as x^-±s. Comparison among groups was analyzed using the ANOVA, and pairwise comparison was done using the independentsample t test. Measurement data with skewed distribution were described as M （range）, and comparison of count data was done using the chisquare test. The survival time was calculated by the KaplanMeier method, and Log-rank test was used for survival analysis.Correlation analysis was done by Spearman rank correlation. Results：（1） Comparisons of intra and postoperative recovery among groups： patients in the 3 groups underwen

关 键 词：食管肿瘤 根治术 微创手术 胸腔镜检查 腹腔镜检查 淋巴结清扫 喉返神经:学习曲线 

分 类 号：R735.1[医药卫生—肿瘤]