刘波, 刘鹏飞, 康明强, 李旭, 邱明链, 赖繁彩. 胸腹腔镜与开放手术食管癌切除术二野淋巴结清扫治疗中期食管癌的对比研究[J]. 中国肿瘤临床, 2014, 41(24): 1577-1581. DOI: 10.3969/j.issn.1000-8179.20141311
引用本文: 刘波, 刘鹏飞, 康明强, 李旭, 邱明链, 赖繁彩. 胸腹腔镜与开放手术食管癌切除术二野淋巴结清扫治疗中期食管癌的对比研究[J]. 中国肿瘤临床, 2014, 41(24): 1577-1581. DOI: 10.3969/j.issn.1000-8179.20141311
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LIU Bo, LIU Pengfei, KANG Mingqiang, LI Xu, QIU Minglian, LAI Fancai. Comparison of clinical study for thoracolaparoscopic esophagectomy and open two-field lymph node dissection esophagectomy for stage middle esophageal carcinoma[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2014, 41(24): 1577-1581. DOI: 10.3969/j.issn.1000-8179.20141311
Citation: LIU Bo, LIU Pengfei, KANG Mingqiang, LI Xu, QIU Minglian, LAI Fancai. Comparison of clinical study for thoracolaparoscopic esophagectomy and open two-field lymph node dissection esophagectomy for stage middle esophageal carcinoma[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2014, 41(24): 1577-1581. DOI: 10.3969/j.issn.1000-8179.20141311
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胸腹腔镜与开放手术食管癌切除术二野淋巴结清扫治疗中期食管癌的对比研究

Comparison of clinical study for thoracolaparoscopic esophagectomy and open two-field lymph node dissection esophagectomy for stage middle esophageal carcinoma

    摘要
  • 摘要:
      目的  探讨胸、腹腔镜中期（Ⅱ、Ⅲ期）食管癌切除术二野淋巴结清扫的安全性、根治性及临床价值。
      方法  回顾性对比分析2009年1月至2013年7月胸、腹腔镜手术和开放手术行二野淋巴结清扫的Ⅱ、Ⅲ期食管癌410例资料（开放组193例、全腔镜组217例）。2组性别、年龄、术前合并症、肿瘤侵犯深度、肿瘤位置等无显著性差异（P > 0.05）。比较两组手术情况、术后并发症等，分析两种手术方式的临床效果。
      结果  与开放组比较，腔镜组术中出血量少（206±138）mL vs.（240±111）mL，t=2.726，P=0.007，清扫淋巴结多（26.6±8.6）枚vs.（21.7±9.2）枚，t=-5.626，P < 0.001，胸腔手术时间短（157±36）min vs.（166±31）min，t=-2.696，P= 0.007，总体并发症发生率低25.8%（56/217）vs. 35.2%（68/193），χ2=4.303，P=0.038。全腔镜组肺部感染、心律失常的发生率明显低于开放组（P < 0.05），而吻合口狭窄、声音嘶哑发生率高于开放组（P < 0.05）。
      结论  胸、腹腔镜联合食管癌切除二野淋巴结清扫术安全、可行，淋巴结清扫更彻底，值得在Ⅱ、Ⅲ期食管癌中推广应用。

     

    Abstract:
      Objective  To explore the security and the radical and clinical value of thoracoscopic-laparoscopic esophagectomy with two-field lymph node dissection for middle esophageal cancer through comparison with open esophagectomy.
      Methods  A total of 410 stage Ⅱ to stage Ⅲ esophageal cancer patients who underwent two-field lymph node dissection with two different methods (thora-colaparoscopic esophagectomy and open esophagectomy) from January 2009 to July 2013 in Uninon Hospital, Fujian Medical Universi-ty, were analyzed retrospectively. General pathological parameters, operative procedures, and short-term outcomes were collected and compared between the two groups (TLG and OG).
      Results  No significant differences were found regarding general pathological pa-rameters, such as gender, age, etc. Significant differences between thoracolaparoscopic and open two-field lymph node dissection esoph-agectomy were observed in terms of esophagectomy intraoperative blood loss (206 ± 138) mL vs. (240±111) mL and the mean num-ber of dissected lymph node per person (26.6±8.6)/per vs. (21.7±9.2)/per. Overall postoperative morbidity rate in OG was 35.2%, and its difference from that of TEG (25.8%) is statistically significant (P < 0.05). Regarding single complications, such as pulmonary infec-tion and arrhythmia, OG showed evidently superior results (P < 0.05). Meanwhile, anastomotic stricture and hoarseness rate are higher in TEG (P < 0.05), and the difference was statistically significant as well.
      Conclusion  Thoracolaparoscopic two-field esophagectomy is technically feasible and safe and can achieve radical tumor resection.

     

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