解剖系膜法在胸腔镜食管癌左喉返神经链淋巴结清扫中的应用
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南京医科大学第一附属医院胸外科

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吴阶平医学基金课题(320.6750.19008)


The application of "anatomical membrane method" in the resection of left recurrent laryngeal nerve chain lymph node in minimal invasive esophagectomy
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1.Thoracic Surgery,Jiangsu province people'2.'3.s hospital

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    摘要:

    目的:对比解剖系膜法和传统方法在胸腔镜食管癌左喉返神经链淋巴结清扫中的效果,并发症及愈合。方法 收集2017年1月至2018年6月在我院行胸腹腔镜联合食管癌根治术(Mckeown术式)手术患者168例,其中运用解剖系膜法行左喉返神经链淋巴结清扫100例,运用传统手术方法68例,对比两种淋巴结清扫方法手术资料、围手术期并发症等,COX回归分析喉返神经链淋巴结清扫方式是否为影响食管癌患者无病生存期(Disease-free survival,DFS)的独立危险因素。结果 两组患者手术时间(191.5±19.6 : 197.2±16.7分钟)、平均住院时间(12.5±2.4 : 12.1±2.1天)、术中出血量(138.8±52.4 : 132.7±43.3 ml)等无明显差异,改良组左喉返神经链淋巴结清扫数量较传统方式明显增多(2.57±0.98 : 2.93±1.19, P=0.036),而喉返神经损伤比例明显降低(13% : 2% P=0.010)。多因素COX回归分析提示:左侧喉返神经链淋巴结清扫方式,TNM分期,肿瘤分化程度(P=0.012,0.037,0.045)是影响食管癌生存期的独立危险因素。结论 运用解剖系膜法清扫左喉返神经链旁淋巴结可明显降低食管癌手术后并发症,可有效提高食管癌术后无病生存率,解剖系膜法在左喉返神经链旁淋巴结清扫中具有较大应用价值。

    Abstract:

    Objectives: To compare the effectiveness,complication and prognosis between "anatomical membrane method" and traditional method in the resection of left recurrent laryngeal nerve chain lymph node in minimal invasive esophagectomy. Methods: Between January 2017 and June 2018, 168 patients with esophageal cancer undergoing minimally invasive?McKeown?esophagectomy were enrolled in this study. Patients were divided into two groups according to the method of the resection of left recurrent laryngeal nerve chain lymph node. Among them, 100 patient received "anatomical membrane method" while 68 patients received traditional method in the resection of left recurrent laryngeal nerve chain lymph node. Time of the resection of operation, perioperative complications and survival were compared between the two groups. Cox regression analysis were used for the analysis of risk factor association with the survival of esophageal cancer. Results: A significant difference was found in the number of resected left recurrent laryngeal nerve chain lymph node and the injure of recurrent laryngeal nerve (13% vs 2%, P=0.010) between the two groups, but no significant difference was found in the time of operation(191.5±19.6 vs 197.2±16.7minutes), average length of stay(12.5±2.4 vs 12.1±2.1 days), mean blood loss in operation (138.8±52.4 vs 132.7±43.3 ml). In multi-variate cox regression analysis, the method of the dissection of recurrent?laryngeal?nerve lymph node, TMN staging and degree?of?tumor?differentiation (P=0.012,0.037,0.045) were independent risk factors for cancer recurrence. Conclusions: This new method of the dissection of recurrent?laryngeal?nerve lymph node was proved to be safe and yielded good clinical outcomes. Therefore, it deserves to be considered as a new treatment for patients with esophageal cancer.

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  • 收稿日期:2023-06-08
  • 最后修改日期:2023-11-23
  • 录用日期:2024-02-27
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