手辅助电视胸腔镜行食管癌切除术

目的　探讨手辅助电视胸腔镜行食管癌切除术的可行性及优缺点。方法　对 45例术前判断分期T3N1MO以下食管癌患者行手辅助电视胸腔镜食管癌切除术 (研究组),同期施行常规开胸手术 45例(对照组),比较两组患者术中淋巴结清扫情况及围手术期情况。结果　研究组手术效果满意。研究组和对照组手术清扫的食管旁淋巴结分别为(3 .6±1. 0)和 (3 .3±1 .5)个,贲门旁淋巴结分别为(1 .3±1 .1)和(1. 6±1 .1)个,胃左动脉周围淋巴结分别为 (4 .3±1 .4)和 (4. 7±2. 1)个,两组差异无统计学意义(P>0 .05);隆突下淋巴结分别为(6 .6±3. 7)和(3 .8±2 .5)个,研究组好于对照组(χ2 =2 95,P<0 05)。研究组与对照组手术时间分别为 (29±5)和 (60±6)min,胸部失血量分别为(93±19)和(145±35)ml,术后第 1天引流量分别为(201±45)和(295±57)ml,差异均有统计学意义(χ2 =18. 69, 6. 13, 6 .08,P均<0 .001)。结论　手辅助电视胸腔镜食管癌切除术能够达到常规开胸手术相同的切除效果,且具有手术时间短、创伤小、恢复快等优点。

Hand-assisted video-thoracoscopy for resection of esophageal cancer

OBJECTIVE: To explore the feasibility and advantages of hand-assisted video-thoracoscopy for resection of esophageal cancer. METHODS: Forty-five patients with esophageal cancer received hand-assisted video-thoracoscopic esophagectomy (group I). 45 patients underwent esophagectomy through routine open thoracotomy during the same period as control (group II). The data of lymph node resection, operating time and blood loss were compared. RESULTS: There were no operative mortality in 2 groups. In group I, the number of dissected paraesophageal lymph nodes, cardiac lymph nodes and left gastric nodes were (3.6 +/- 1.0), (1.3 +/- 1.1) and (4.3 +/- 1.4), respectively. While for group II the dissected lymph nodes were (3.3 +/- 1.5), (1.6 +/- 1.1) and (4.7 +/- 2.1), respectively. There was no significant difference between two groups (P > 0.05). However, the number of dissected mediastinal nodes was (6.6 +/- 3.7) for group I and (3.8 +/- 2.5) for group II (chi(2) = 2.95, P < 0.05). The mean operating time was (29 +/- 5) minutes for group I and (60 +/- 6) minutes for group II. The mean blood loss was (93 +/- 19) ml for group I and (145 +/- 35) ml for group II. The mean chest tube drainage was (201 +/- 45) ml for group I and (295 +/- 57) ml for group II in the first postoperative day. The difference in above parameters between 2 groups was significant (chi(2) = 18.69, 6.13, 6.08, P < 0.001). CONCLUSIONS: It is suggested that hand-assisted video-thoracoscopic esophagectomy is a safer, minimal invasive procedure in the resection of esophagus carcinoma.