食管内翻拔脱手术在喉咽部肿瘤及颈段食管肿瘤治疗中的应用  

Application of esophageal varus extraction in the treatment of laryngopharyngeal and cervical esophageal tumors

作　　者：张云峰[1] 于磊[1] 柯冀[1] Zhang Yunfeng;Yu Lei;Ke Ji(Department of Thoracic Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院胸外科,北京100730

出　　处：《中华胸心血管外科杂志》2022年第2期88-91,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨食管内翻拔脱手术在颈部肿瘤(喉咽部及颈段食管)治疗中的应用情况及效果。方法回顾性分析2010年3月至2020年3月首都医科大学附属北京同仁医院胸外科手术治疗颈部肿瘤(喉咽部及颈段食管)患者238例。男135例,女103例;年龄42~78岁,中位年龄62岁。手术方式包括开放性腹部手术96例,腹腔镜手术142例。分别对腹部术中出血量、腹部手术时间及术后腹腔引流量等指标进行分析。采用SPSS 13.0统计学软件对数据进行分析,采用χ2检验进行临床特征比较,t检验进行临床指标比较。结果全部患者无术中死亡。腹腔镜组所有患者均顺利完成管状胃经原食管床牵拉至颈部,完成颈部吻合。1例(0.70%)因主动脉撕裂中转开胸,无术后出血二次手术。无切口感染及伤口液化。开放手术组1例(1.04%)行脾切除,2例(2.08%)切口感染,3例(3.12%)伤口脂肪液化。开放手术组和腹腔镜组术中腹腔出血量分别为(187±28)ml和(79±23)ml(t=1.836,P=0.032);两组术后腹腔引流量分别为(172±33)ml和(56±24)ml(t=1.964,P=0.028),两组间差异有统计学意义。开放手术组和腹腔镜组的手术时间分别为(125±33)min和(118±27)min(t=1.224,P=0.203),两组间差异无统计学意义。结论较传统开腹手术而言,腹腔镜下食管内翻拔脱手术在喉咽部肿瘤及颈段食管肿瘤治疗中具有切口美观、手术创伤小、术野显露清晰、术后并发症少等优势,符合微创治疗理念。无气腹悬吊装置的应用较好得解决了食管拔脱后纵隔压迫止血及无气腹状态下牵引管状胃至颈部的关键环节,使腹腔镜技术得以应用。但此类手术需严格把握指征,避免严重并发症的发生。Objective To investigate the application and effect of esophageal varus extraction in the treatment of cervical tumors(laryngopharynx and cervical esophagus).Methods A retrospective analysis was performed on 238 patients with cervical tumors(laryngopharynx and cervical esophagus)who underwent thoracic surgery in Beijing Tongren Hospital affiliated to Capital Medical University from March 2010 to March 2020.There were 135 males and 103 females,aged from 42 to 78 years,with a median age of 62 years.Surgical methods included open abdominal surgery in 96 cases and laparoscopic surgery in 142 cases.The intraoperative abdominal bleeding volume,abdominal operation time and postoperative abdominal drainage volume were analyzed.χ2 test was used to compare the clinical characteristics of the two groups,t test was used to compare the clinical indicators,and statistical software SPSS 13.0 was used to analyze.Results No intraoperative death occurred in all patients.In the laparoscopic group,all cases successfully completed tubular gastric traction through the original esophageal bed to the neck,and completed cervical anastomosis.One patient(0.70%)was converted to thoracotomy due to aortic tear,and no post-operative bleeding occurred.No incision infection and wound liquefaction.Splenectomy was performed in 1 patient(1.04%),incision infection in 2 patients(2.08%),and fat liquefaction in 3 patients(3.12%)in the open surgery group.The intraoperative abdominal bleeding volume in the open surgery group and the laparoscopic group was(187±28)ml and(79±23)ml,respectively(t=1.836,P=0.032);the postoperative abdominal drainage volume in the two groups was(172±33)ml and(56±24)ml,respectively(t=1.964,P=0.028),and there was a significant difference between the two groups.The operation time of open operation group and laparoscopy group was(125±33)min and(118±27)min respectively(t=1.224,P=0.203),and there was no significant difference between the two groups.Conclusion Laparoscopic esophageal varus extraction has advantages over traditi

关 键 词：食管内翻拔脱术 腹腔镜 喉咽部肿瘤 

分 类 号：R739.6[医药卫生—肿瘤] R735.1[医药卫生—临床医学]