食管系膜切除在胸、腹腔镜食管癌手术质量控制中的应用-《中国微创外科杂志》

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Title:: Application of Esophageal Cancer Mesoesphagel Excision in the Quality Control of Thoracoscopic Combined Laparoscopic Esophagectomy

作者:: 傅俊惠**; 郑浩胜; 杜泽森; 李卓毅; 杨枫; 谢鹏鑫; 汕头市中心医院中山大学附属汕头医院肿瘤外科，汕头515031

Author(s):: Fu Junhui; Zheng Haosheng; Du Zesen; et al.; Department of Surgical Oncology, Shantou Central Hospital, Shantou 515031, China

关键词:: 食管癌; 食管系膜; 腹腔镜; 胸腔镜; 食管系膜切除术; 质量控制

Keywords:: Esophageal cancer; Mesoesophagus; Laparoscope; Thoracoscope; Mesoesphagel excision; Quality control

文献标志码:: A

摘要:: 目的探讨食管系膜切除在胸、腹腔镜食管癌手术操作流程优化及手术质量控制中的应用价值。方法回顾性比较2013年3月~2014年10月262例食管癌手术的临床资料，根据病人和家属的意愿选择术式，分为胸、腹腔镜食管癌食管系膜切除组（EME组，n=132）和开放食管癌切除组（开放组,n=130），比较2组术中出血量、术后胸腔引流量、术后住院时间、清扫淋巴结数、淋巴结转移率、食管系膜转移率、术后并发症发生率。结果EME组术中出血量（105.6±34.5）ml，明显少于开放组（168.4±40.7）ml（t=-13.480，P=0.000)；术后引流量 (975±267）ml，明显少于开放组 (1289±287）ml（t=-9.171，P=0.000)；术后住院时间(9.6±2.8)d，明显短于开放组 (14.7±3.5)d（t=-13.034，P=0.000)；清扫淋巴结数（243±12.1）枚,明显多于开放组（18.9±12.1）枚（t=3.612，P=0.000）；淋巴结转移率65.1%(86/132),明显高于开放组46.2%(60/130)（χ2=9.581，P=0.002)；淋巴结外转移率43.2%(57/132),明显高于开放组13.8%(18/130)（χ2=27.587，P=0.000)；食管系膜转移率71.9%(95/132)，明显高于开放组45.3%(59/130)（χ2=19.105，P=0.000)。2组术后并发症发生率（25.6% vs. 27.7%）差异无显著性(P>0.05 ）。EME组局部复发率9.8%(13/132)，明显低于开放组26.9% (35/130)（χ2=12.760，P=0.000)。EME组与开放组生存率比较无统计学差异（χ2=3.129，P=0.077）。结论EME创伤小、术后恢复快、淋巴结清扫更彻底，可降低肿瘤的局部复发；以食管周围间隙及食管系膜的界标为平面进行整块切除，优化了手术流程，有利于食管癌手术质量控制。

Abstract:: ObjectiveTo explore the application of esophageal cancer mesoesphagel excision (EME) on the quality control of thoracoscopic combined laparoscopic esophagectomy and the optimization of operation. MethodsA total of 262 patients from March 2013 to October 2014 were analyzed retrospectively, among which 132 patients were performed thoracoscopic combined laparoscopic esophagectomy with EME (EME group) while 130 patients were given thoracotomy(thoracotomy group). Results As compared with the thoracotomy group, the EME group had less blood loss ［(105.6±34.5) ml vs. (168.4±40.7) ml, t=-13.480, P=0000］, less drainage ［(975±267) ml vs. (1289±287) ml, t=-9.171, P=0.000］, and less hospital stay ［(9.6±2.8) d vs. (14.7±3.5) d, t=-13.034, P=0.000)］. Meanwhile, the EME group had more resected lymph nodes ［(24.3±12.1) vs. (189±12.1), t=3612, P=0.000］, higher metastasis rate of lymph nodes ［65.1%(86/132) vs. 46.2%(60/130), χ2=9581, P=0.002］, higher metastasis rate of non-lymph nodes ［43.2%(57/132) vs. 13.8%(18/130), χ2=27.587, P=0.000］, and higher metastasis rate of mesoesphagus ［71.9% (95/132) vs. 45.3% (59/130), χ2=19.105, P=0.000］. There was no difference between the two groups in complication rate (25.6% vs. 27.7%, P>0.05). The EME group had lower local recurrence rate than the thoracotomy group ［9.8% (13/132) vs. 26.9% (35/130), χ2=12.760, P=0.000］. There was no difference between the two groups in overall survival (χ2=3.129, P=0.077). Conclusions EME has less surgical invasion, rapid postoperative recovery, thorough lymph nodes resection, and low local recurrence rate. En bloc resection with peri-esophageal space and mesoesphagus help optimize the process of esophagectomy and quality control.

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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

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