单操作孔胸腔镜联合腹腔镜在McKeown食管癌根治术中的应用评估

目的 评估单操作孔胸腔镜联合腹腔镜在McKeown食管癌根治术中的安全性及可行性.方法 分析广西壮族自治区人民医院心胸外科2015年1月至2016年1月40例接受McKeown食管癌根治术的中下段食管癌患者资料,其中11例行单操作孔胸腔镜联合腹腔镜McKeown食管癌根治术(single-utility incision total endoscopy McKeown esophagectomy,sTEME),29例行三孔胸腔镜腹部开放McKeown食管癌根治术(three-port thoracoscope combined with laparotomy McKeown esophagectomy,tTLME),比较两组的术中情况、手术结果及术后并发症的发生率.结果 两组在胸部手术时间、胸部术中出血量及胸部淋巴结清扫数量方面差异无统计学意义(P＞0.05);sTEME组的腹部手术时间较tTLME组长(P＜0.05),腹部术中出血量、术后24 h疼痛指数评分及术后住院时间优于tTLME组(P＜0.05).两组腹部淋巴结清扫数、术后重症监护时间、术后并发症发生率及术后6个月淋巴结复发转移情况差异无统计学意义(P＞0.05).结论 单操作孔胸腔镜联合腹腔镜McKeown术治疗中下段食管癌可行,虽然会延长手术时间,但手术创伤小、住院时间短、近期效果满意.

Evaluation of single-utility incision thoracoscopy combined with laparoscopy in radical McKeown esophagectomy for esophageal cancer

Objective To evaluate the safety and the feasibility of single-utility incision thoracoscopy combined with laparoscopy in radical McKeown esophagectomy (sTLME) for esophageal cancer.Methods Clinical data of 40 patients with esophageal carcinoma undergoing minimally invasive esophagectomy in our department from January 2015 to January 2016 were collected and retrospectively analyzed.Among the 40 patients,11 patients underwent sTLME,and the other 29 subjects were treated with three-port thoracoscopy combined with laparotomy McKeown esophagectomy (tTLME).The patient's surgery situations,operative outcomes,and postoperative complications were compared between the 2 groups.Results There were no significant differences in thoracic operative time,blood loss and number of lymph node dissection between the sTLME and tTLME groups (P ＞ 0.05).But the sTEM group though had a longer abdominal operative time (P ＜0.05),it had less blood loss,lower postoperative pain index and shorter length of hospital stay (P ＜0.05).However,no significant differences were observed in number of abdominal lymph node dissection,post-operative duration for intensive care,occurrence of post-operative complications,and recurrence and metastasis in lymph node within 6 months between the 2 groups (P ＞ 0.05).Concltusion sTLME is feasible for middle and lower esophageal cancer.Although it will extend the operation time,but has less surgical trauma,shorter hospital stay and satisfactory short-term outcomes.