不同淋巴结处理策略对胸腹腔镜食管癌根治术临床效果的影响  

The impact of different lymph node management strategies on the clinical outcomes of thoracoscopic esophagectomy for esophageal cancer

作　　者：姬翔 杨三虎 贠宇辉 段禹舟 景鹏宇 Ji Xiang;Yang Sanhu;Yun Yuhui;Duan Yuzhou;Jing Pengyu(Department of Toracic Surgery,Second Affiliated Hospital of Airforce Medical University,Xi’an Shaannxi 710038,China)

机构地区：[1]空军军医大学第二附属医院胸腔外科,陕西西安710038

出　　处：《中国医刊》2025年第1期38-42,共5页Chinese Journal of Medicine

基　　金：陕西省重点研发计划(2018SF-472)。

摘　　要：目的探讨胸腹腔镜食管癌根治术中不同淋巴结处理策略对临床治疗效果的影响。方法回顾性选取2019年2月至2020年12月在空军军医大学第二附属医院胸腔外科接受胸腹腔镜食管癌根治术治疗的90例食管癌患者,根据淋巴结处理策略的不同分为对照组和观察组,每组45例。对照组术中采用常规喉返神经淋巴结(RLNLN)清扫策略,观察组术中采用镂空法RLNLN清扫策略。比较两组的围手术期指标、淋巴结清扫情况、不同分期RLNLN转移率与效能指数、手术前后肺功能[用力肺活量(FVC)、第1秒用力呼气容积占用力肺活量百分比(FEV_(1)/FVC)、最大通气量(MVV)]、并发症发生情况、复发率及生存率。结果两组手术时间、术中出血量、胸腔引流时间、胸腔引流量、经口进食时间、住院时间比较差异均无统计学意义(P>0.05)。观察组RLNLN清扫数量多于对照组,清扫时间短于对照组,差异有统计学意义(P<0.05);在T_(1)~T_(3)分期的患者中,观察组右侧及左侧的效能指数均高于对照组(P<0.05)。两组术后FVC、FEV_(1)/FVC、MVV均呈先降低后升高趋势(P<0.05),但组间比较差异无统计学意义(P>0.05)。观察组术后并发症发生率(6.7%)低于对照组(22.2%),差异有统计学意义(P<0.05)。术后随访36个月,观察组复发率低于对照组、生存率高于对照组,差异有统计学意义(P<0.05)。结论胸腹腔镜食管癌根治术中采用镂空法RLNLN清扫策略可提高淋巴结清扫效果,改善患者预后,且安全性较高。Objective To investigate the impact of different lymph node management strategies on the clinical outcomes of thoracoscopic esophagectomy for esophageal cancer.Method The clinical data of 90 patients with esophageal cancer who underwent thoracoscopic esophagectomy for radical treatment at the Second Affiliated Hospital of Air Force Medical University from February 2019 to December 2020 were retrospectively selected.The patients were divided into a control group and an observation group according to different intraoperative lymph node treatment strategies,with 45 cases in each group.The control group underwent routine resection of the recurrent laryngeal nerve lymph nodes(RLNLN)during the operation,while the observation group underwent hollow RLNLN resection during the operation.The perioperative indicators,lymph node dissection,RLNLN metastasis rate and efficacy index in different stages,pre-and post-operative lung function forced vital capacity(FVC),forced expiratory volume in one second(FEV_(1))/FVC,maximum voluntary ventilation(MVV),complication occurrence,recurrence rate,and survival rate were compared between the two groups.Result There was no significant difference between the two groups(P>0.05).The cleaning time of RLNLN in observation group was shorter than that in control group,and the cleaning quantity of left side,right side and total RLNLN in observation group was higher than that in control group(P<0.05).In T_(1)-T_(3) stages,the efficacy index on the right and left side of the observation group was higher than that of the control group(P<0.05).The FVC,FEV_(1)/FVC,and MVV in both groups showed a trend of decreasingfirst and then increasing after surgery(P<0.05),but there was no significant difference between the groups(P>0.05).The incidence of postoperative complications in the observation group(6.7%)was lower than that in the control group(22.2%),and the difference was statistically significant(P<0.05).After a follow-up period of 36 months,the recurrence rate in the observation group was lowe

关 键 词：食管癌根治术 肺功能 效能指数 

分 类 号：R734.2[医药卫生—肿瘤]