“鼓楼径路”在腔镜食管癌根治术左侧喉返神经旁淋巴结清扫中的安全性和应用价值  

Safety and application value of the"Gulou Approach"in lymph node dissection of the left recurrent laryngeal nerve for patients undergoing endoscopic esophagectomy

作　　者：石荣兴 魏威 陈阳 徐天成 何晓峰[1] 张鹏飞 韦韦 唐巍峰 尹伯瞻 胡振东 Shi Rongxing;Wei Wei;Chen Yang;Xu Tiancheng;He Xiaofeng;Zhang Pengfei;Wei Wei;Tang Weifeng;Yin Bozhan;Hu Zhendong(Department of Thoracic Surgery-Esophageal Surgery,Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院胸外科-食管外科,南京210008

出　　处：《中华解剖与临床杂志》2024年第5期337-341,共5页Chinese Journal of Anatomy and Clinics

基　　金：南京市卫生科技发展专项资金(YKK23083)。

摘　　要：目的探讨“鼓楼径路”在纵隔腔镜联合腹腔镜食管癌根治术左喉返神经旁淋巴结清扫中的安全性和应用价值。方法病例系列报告。纳入2022年10月—2023年4月南京大学医学院附属鼓楼医院胸外科-食管外科食管癌患者54例,其中男43例、女11例,年龄47~80(67.9±7.6)岁。食管癌TNM分期ⅠB 8例、ⅡA 9例、ⅡB 4例、ⅢA 3例、ⅢB 26例、ⅣA 4例。患者均行“鼓楼径路”纵隔腔镜联合腹腔镜食管癌根治术,术中于直视下清扫左喉返神经旁淋巴结。观察指标:(1)观察患者左喉返神经旁淋巴结的清扫时间、清扫数目、淋巴结清扫率、淋巴结转移率、淋巴结转移度,以及术后喉返神经损伤、吻合口瘘、肺部感染、乳糜胸、切口感染等并发症发生情况。(2)术后1、3个月随访,观察术后出现喉返神经损伤患者的恢复情况,观察患者进食情况,以及有无新发吻合口瘘或吻合口狭窄、二次入院、死亡等情况。结果54例患者手术均顺利,术中左喉返神经淋巴结清扫时间20~50(30.2±7.9)min、清扫数目0~11(2.9±2.4)枚,淋巴结清扫率85.2%(46/54),淋巴结转移率13.0%(7/54),淋巴结转移度8.9%(14/158)。54例患者术后发生喉返神经损伤6例(11.1%),肺部感染5例(9.3%),吻合瘘1例(1.9%)。患者术后无二次手术,无切口感染、乳糜胸、颈部淋巴瘘等并发症发生。54例患者术后1、3个月随访复查,6例喉返神经损伤患者经治疗后,4例恢复嗓音、2例无明显缓解。术后1个月,1例患者经电子胃镜检查明确为吻合口狭窄,行胃镜下扩张治疗后恢复正常饮食;无新发饮水呛咳或声音变化等喉返神经损伤病例,无新发吻合口瘘,无肿瘤复发、转移,无二次入院和死亡病例。结论采用“鼓楼径路”行纵隔腔镜联合腹腔镜食管癌根治术,术中清扫左喉返神经旁淋巴结,技术上安全可行,清扫效果较好,具有一定的临床应用价值。Objective This study aimed to investigate the safety and application value of the"Gulou Approach"in lymph node dissection of the left recurrent laryngeal nerve during esophageal cancer surgery conducted by video-assisted mediastinoscopy combined with laparoscopy.Methods This was a case series report.Clinical data of 54 patients with esophageal cancer in the Department of Esophageal Surgery,Drum Tower Hospital,Nanjing University School of Medicine were collected from October 2022 to April 2023.The study included 43 males and 11 females,with an average age of 47-80(67.9±7.6)years,with 8,9,4,3,26,and 4 having stageⅠB,ⅡA,ⅡB,ⅢA,ⅢB andⅣA.All patients underwent esophageal cancer radical surgery with the"Gulou Approach"by mediastinoscopy combined with laparoscopy under direct visualization.The observation indicators were as follows,(1)The time,number,clearance rate,metastasis rate of the lymph nodes adjacent,and the degree of lymph node metastasis to the left recurrent laryngeal nerve during the procedure,as well as the occurrence of postoperative complications such as recurrent laryngeal nerve injury,anastomotic fistula,pulmonary infection,chylothorax,and incision infection.(2)Patients'eating situation,the recovery of cases with anastomotic fistula and stenosis,the recovery of cases with recurrent laryngeal nerve injury after surgery,and the survival situation of patients requiring rehospitalization were observed during the first and third month follow-up period.Results All 54 patients successfully completed the operation.The time of lymph nodes dissection of left recurrent laryngeal nerve procedure was 20-50(30.2±7.9)the average number of left recurrent laryngeal nerve lymph nodes was 0-11(2.9±2.4),the lymph node clearance rate was 85.2%(46/54),the lymph node metastasis rate was 13.0%(7/54),and the degree of lymph node metastasis was 8.9%(14/158).There were 6 cases(11.1%)of left recurrent laryngeal nerve injury,5 cases(9.3%)of pulmonary infection and 1 case(1.9%)of anastomotic fistula.There were no cases

关 键 词：食管肿瘤 食管癌根治术 左侧喉返神经损伤 淋巴结清扫 鼓楼径路 

分 类 号：R735.1[医药卫生—肿瘤]