胸腹腔镜下胸中上段食管癌三野淋巴结清扫术的安全性及短期疗效分析  

Safety and short-term curative effect analysis of thoracolaparoscopy three-field lymphadenectomy in treatment of upper and middle thoracic esophageal carcinoma

作　　者：郭孟刚[1] 胡杰伟[1] 朱允和[1] 钟钏[1] 马幸生[1] GUO Menggang;HU Jiewei;ZHU Yunhe;ZHONG Chuan;MA Xingsheng(Department of Thoracic Surgery,Suining Municipal Central Hospital,Suining,Sichuan 629000,China)

机构地区：[1]四川省遂宁市中心医院胸外科,629000

出　　处：《检验医学与临床》2019年第3期367-370,共4页Laboratory Medicine and Clinic

摘　　要：目的探讨并分析胸腹腔镜下胸中上段食管癌三野淋巴结清扫术的安全性及短期疗效。方法回顾性分析2013年12月至2015年12月收治的98例胸中上段食管癌患者的临床资料及近期随访结果,所有患者均行胸腹腔镜手术,其中50例行三野淋巴结清扫术(三野组),48例行二野淋巴结清扫术(二野组),比较两组患者围术期相关指标、淋巴结清扫数、淋巴结转移率、术后并发症、颈部淋巴结复发率和生存率。结果胸腹腔镜三野组淋巴结清扫手术时间较二野组长,差异有统计学意义(P<0.05),但术中出血、留置胸引流管时间及住院时间差异无统计学意义(P>0.05)。三野组与二野组平均清扫淋巴结数分别为(22.94±3.26)枚、(15.41±1.84)枚,淋巴结转移率分别为66.00%(33/50)、43.75%(21/48),差异均有统计学意义(P<0.05)。三野组与二野组喉返神经损伤率分别为26.00%、10.42%,差异有统计学意义(P<0.05)。两组患者吻合口瘘、乳糜胸、肺部感染、肺栓塞、心律失常、胃排空障碍等并发症发生率差异无统计学意义(P>0.05)。三野组术后1年、2年颈部淋巴结复发率较二野组低,差异有统计学意义(P<0.05)。三野组术后1年、2年生存率明显高于二野组,差异有统计学意义(P<0.05)。结论胸中上段食管癌行胸腹腔镜三野淋巴结清扫术安全可行,淋巴结清扫更彻底,可降低局部复发率,提高患者术后生存率,具有一定的临床应用价值。Objective To investigate and analyze the safety and short-term curative effect of thoracolaparoscopy three-field lymphadenectomy in the treatment of upper and middle thoracic esophageal carcinoma.Methods The clinical data and recent follow-up results of 98 patients with upper and middle thoracic esophageal carcinoma treated in hospital from December 2013 to December 2015 were retrospectively analyzed.All patients underwent thoracolaparoscopy surgery,including 50 cases of three-field lymphadenectomy and 48 cases of two-field lymphadenectomy.The perioperative related indicators,lymph node dissection number,lymph node metastasis rate,postoperative complications,cervical lymph node recurrence rate and survival rate were compared between the two groups.Results The operation time of thoracolaparoscopy three-field lymphadenectomy was longer than that of thoracolaparoscopy two-field lymphadenectomy,the difference was statistically significant(P<0.05),but there were no statistically significant differences in intraoperative hemorrhage,indwelling thoracic catheterization time and hospitalization time(P >0.05).The average number of lymph node dissection in the three-field and two-field groups were 22.94±3.26 and 15.41±1.84 respectively,the lymph node metastasis rates were 66.00%(33/50)and 43.75%(21/48)respectively,the differences were statistically significant(P<0.05).The injury rates of recurrent laryngeal nerve in the three-field and the two-field groups were 26.00%and 10.42%respectively,the difference was statistically significant(P<0.05).There were no statistically significant differences in the incidence rates of complications such as anastomotic leakage,chylothorax,pulmonary infection,pulmonary embolism,arrhythmia and gastric emptying disorder between the two groups(P >0.05).The postoperative 1-year and 2-year recurrence rate of cervical lymph nodes in the three-field group were lower than those in the two-field group(P<0.05).The postoperative 1-year and 2-year survival rates in the three-field group were significan

关 键 词：食管癌 胸腹腔镜 三野淋巴结清扫术 

分 类 号：R735.1[医药卫生—肿瘤]