微创食管癌切除术中转开胸的单中心回顾性分析  

Conversion to thoracotomy during minimally invasive esophagectomy:Retrospective analysis in a single center

作　　者：吕会来[1] 许石 王明博[1] 李振华[1] 刘钊 李嘉宸 黄超[1] 张帆[1] 盖春月 田子强[1] LV Huilai;XU Shi;WANG Mingbo;LI Zhenhua;LIU Zhao;LI Jiachen;HUANG Chao;ZHANG Fan;GAI Chunyue;TIAN Ziqiang(Department of Thoracic Surgery,The Fourth Hospital of Hebei Medical University,Shijiazhuang,050011,P.R.China)

机构地区：[1]河北医科大学第四医院胸外科,石家庄050011

出　　处：《中国胸心血管外科临床杂志》2023年第6期879-883,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：河北省自然科学基金(H2022206443)。

摘　　要：目的探讨微创食管癌切除术(minimally invasive esophagectomy,MIE)中转开胸手术的原因,以期对MIE中转开胸的时机获得更深层次的理解和认识。方法回顾性分析2011年9月9日—2022年2月12日河北医科大学第四医院胸外科单手术组行MIE患者的临床资料,并对中转开胸的主要影响因素及围术期死亡率进行分析。结果单手术组连续791例(男520例、女271例,食管多发癌29例,胸上段食管癌156例、胸中段524例、胸下段82例)MIE患者中有46例因不同原因中转开胸。中转开胸主要原因为肿瘤分期过晚26例、麻醉相关5例、广泛胸腔粘连6例、误伤重要结构8例。中转开胸患者与未中转开胸患者肿瘤位置分布差异有统计学意义(P<0.05),中转开胸患者多发癌和胸上段癌比例高于未中转开胸患者,胸下段癌比例低于未中转开胸患者。中转开胸患者术后围术期存活率(100.00%)与未开胸患者(98.52%)差异无统计学意义(P=1.000)。结论在MIE中,肿瘤T分期过晚、麻醉相关、广泛胸腔粘连、误伤重要结构是MIE中转开胸的主要原因。肿瘤位于不同位置的中转开胸率不同,食管多发癌和胸上段癌中转开胸率较高;胸下段癌中转开胸率较低。术中中转开胸并不影响MIE的围术期死亡率。Objective To explore the causes of conversion to thoracotomy in patients with minimally invasive esophagectomy(MIE)in a surgical team,and to obtain a deeper understanding of the timing of conversion in MIE.Methods The clinical data of patients who underwent MIE between September 9,2011 and February 12,2022 by a single surgical team in the Department of Thoracic Surgery of the Fourth Hospital of Hebei Medical University were retrospectively analyzed.The main influencing factors and perioperative mortality of patients who converted to thoracotomy in this group were analyzed.Results In the cohort of 791 consecutive patients with MIE,there were 520 males and 271 females,including 29 patients of multiple esophageal cancer,156 patients of upper thoracic cancer,524 patients of middle thoracic cancer,and 82 patients of lower thoracic cancer.And 46 patients were converted to thoracotomy for different causes.The main causes for thoracotomy were advanced stage tumor(26 patients),anesthesiarelated factors(5 patients),extensive thoracic adhesions(6 patients),and accidental injury of important structures(8 patients).There was a statistical difference in the distribution of tumor locations between patients who converted to thoracotomy and the MIE patients(P<0.05).The proportion of multiple and upper thoracic cancer in patients who converted to thoracotomy was higher than that in the MIE patients,while the proportion of lower thoracic cancer was lower than that in the MIE patients.The perioperative mortality of the thoracotomy patients was not significantly different from that of the MIE patients(P=1.000).Conclusion In MIE,advanced-stage tumor,anesthesia-related factors,extensive thoracic adhesions,and accidental injury of important structures are the main causes of conversion to thoracotomy.The rate varies at different tumor locations.Intraoperative conversion to thoracotomy does not affect the perioperative mortality of MIE.

关 键 词：微创食管癌切除术 中转开胸 原因分析 围术期死亡率 

分 类 号：R735.1[医药卫生—肿瘤]