充气式纵隔镜联合腹腔镜食管癌切除术的临床分析  

Clinical analysis of inflatable video-assisted mediastinoscopic transhiatal esophagectomy combined with laparoscopy

作　　者：黄志宁 柳常青 郭明发 徐美青 孙效辉 王高祥 解明然 Huang Zhining;Liu Changqing;Guo Mingfa;Xu Meiqing;Sun Xiaohui;Wang Gaoxiang;Xie Mingran(Department of Thoracic Surgery,Anhui Provincial Hospital Affiliated with Anhui Medical University,Hefei 230000,China;Department of Thoracic Surgery,the First Affiliated Hospital of University of Science and Technology of China,Hefei 230000,China)

机构地区：[1]安徽医科大学附属省立医院胸外科,合肥230000 [2]中国科学技术大学附属第一医院胸外科,合肥230000

出　　处：《中华外科杂志》2023年第1期48-53,共6页Chinese Journal of Surgery

基　　金：国家自然科学基金(81973643);安徽省重点研究与开发计划(202004j07020017)。

摘　　要：目的探讨充气式纵隔镜联合腹腔镜食管癌切除术的安全性与有效性。方法回顾性分析安徽医科大学附属省立医院胸外科2017年9月至2021年12月收治的269例接受充气式纵隔镜联合腹腔镜食管癌切除术(IVMTE组)或胸腹腔镜联合微创Mckeown食管癌切除术(MIME组)的患者资料。IVMTE组47例,男性31例,女性16例,年龄(68.6±7.5)岁(范围:54~87岁);MIME组222例,男性159例,女性63例,年龄(66.8±8.8)岁(范围:42~93岁)。采用倾向性评分匹配法对两组患者进行1∶1匹配,匹配后MIME组38例,IVMTE组38例。采用t检验、Wilcoxon秩和检验、χ^(2)检验、Fisher确切概率法等比较两组患者术中情况和术后并发症发生率。结果IVMTE组患者术中出血量较少[(96.0±39.2)ml比(123.8±49.3)ml,t=-2.627,P=0.011],手术时间较短[(239.1±47.3)min比(264.2±57.2)min,t=-2.086,P=0.040],术后3 d引流量较少[85(89)ml比675(573)ml,Z=-7.575,P<0.01],差异有统计学意义。两组患者的引流管带管时间、术后住院时间,以及淋巴结清扫组数和枚数差异无统计学意义(P均>0.05)。IVMTE组Clavien-Dindo并发症分级系统1~2级肺部感染[7.9%(3/38)比31.6%(12/38),χ^(2)=6.728,P=0.009]、总体并发症[21.1%(8/38)比47.4%(18/38),χ^(2)=5.846,P=0.016]和肺部总并发症[13.2%(5/38)比42.1%(16/38),χ^(2)=7.962,P=0.005]的发生率低于MIME组。结论充气式纵隔镜联合腹腔镜食管癌切除术安全可行,可达到与胸腔镜手术相同的肿瘤学切除范围。Objective To examine the safety and effectiveness of inflatable video-assisted mediastinoscopic transhiatal esophagectomy(IVMTE).Methods Totally 269 patients admitted to the Anhui Provincial Hospital of Anhui Medical University who underwent IVMTE(IVMTE group,n=47)or thoracoscopy combined with minimally invasive Mckeown esophageal cancer resection(MIME group,n=222)from September 2017 to December 2021 were analyzed retrospectively.There were 31 males and 16 females in IVMTE group,aged(68.6±7.5)years(range:54 to 87 years).There were 159 males and 63 females in MIME group,aged(66.8±8.8)years(range:42 to 93 years).A 1∶1 match was performed on both groups by propensity score matching,with 38 cases in each group.The intraoperative conditions and postoperative complication rates of the two groups were compared by t test,Wilcoxon rank,χ^(2) test,or Fisher exact probability method.Results Patients in IVMTE group had less intraoperative bleeding((96.0±39.2)ml vs.(123.8±49.3)ml,t=-2.627,P=0.011),shorter operation time((239.1±47.3)minutes vs.(264.2±57.2)minutes,t=-2.086,P=0.040),and less drainage 3 days after surgery(85(89)ml vs.675(573)ml,Z=-7.575,P<0.01)compared with that of MIME group.There were no statistically significant differences between the two groups in terms of drainage tube-belt time,postoperative hospital stay,and lymph node dissection stations and numbers(all P>0.05).The incidence of Clavien-Dindo grade 1 to 2 pulmonary infection(7.9%(3/38)vs.31.6%(12/38),χ²=6.728,P=0.009),total complications(21.1%(8/38)vs.47.4%(18/38),χ²=5.846,P=0.016)and total lung complications(13.2%(5/38)vs.42.1%(16/38),χ²=7.962,P=0.005)in the IVMTE group were significantly lower.Conclusion Inflatable video-assisted mediastinoscopic transhiatal esophagectomy combined with laparoscopic esophagectomy is safe and feasible,which can reach the same range of oncology as thoracoscopic surgery.

关 键 词：食管肿瘤 纵隔镜检查 食管切除术 手术后并发症 

分 类 号：R735.1[医药卫生—肿瘤]