Page 77 - 南京医科大学学报自然科学版

第44卷第3期 南京医科大学学报（自然科学版）
2024年3月 Journal of Nanjing Medical University（Natural Sciences） ·367 ·

·临床研究·

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

卢荣鑫，刘锦源，薛 磊，范 骏，骆金华 *
南京医科大学第一附属医院胸外科，江苏 南京 210029

［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—2018年6月在南京医科大学第一附属医院行胸腔镜联合食管癌根治术（Mckeown术式）患者168例，其中解剖系
膜法行左喉返神经链淋巴结清扫100例，传统手术方法68例，对比2种淋巴结清扫方法患者手术资料、围手术期并发症等，Cox
回归分析左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）min vs.（197.2±16.7）min］、平均住院时间［（12.5±2.4）d vs.（12.1±2.1）d］、术中出血量
［（138.8±52.4）mL vs.（132.7±43.3）mL］等差异无统计学意义，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
［（2.93±1.19）个vs.（2.57±0.98）个，P=0.036］，而喉返神经损伤比例明显降低（2% vs. 13%，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、肿瘤分化程度是影响食管癌生存期的独立危险因素（P=0.012、0.037、0.045）。结
论：解剖系膜法清扫左喉返神经链淋巴结可明显降低食管癌手术后并发症，有效提高食管癌术后无病生存期，解剖系膜法在左
喉返神经链淋巴结清扫中具有较大应用价值。
［关键词］ 食管癌；左侧喉返神经链淋巴结；解剖系膜法
［中图分类号］ R655.4 ［文献标志码］ A ［文章编号］ 1007⁃4368（2024）03⁃367⁃05
doi：10.7655/NYDXBNSN230581

The application of the anatomical meso ⁃ esophageal dissection in the left recurrent
laryngeal nerve chain lymph node dissection during thoracoscopic esophagectomy

*
LU Rongxin，LIU Jinyuan，XUE Lei，FAN Jun，LUO Jinhua
Department of General Surgery，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China

［Abstract］ Objective： To compare the efficacy，complications，and healing between the anatomical meso⁃esophageal dissection and
traditional methods in thoracoscopic esophageal cancer surgery for left recurrent laryngeal nerve lymph node dissection. Methods：A
total of 168 patients who underwent thoracoscopic combined minimally invasive esophagectomy（McKeown procedure）in our hospital
for esophageal cancer from January 2017 to June 2018 were collected. Among them，the anatomical membrane method was performed
in 100 cases for left recurrent laryngeal nerve lymph node dissection，while traditional surgical method was used in 68 cases. The
surgical data and perioperative complications of the two lymph node dissection methods were compared. Cox regression analysis was
used to determine whether the left recurrent laryngeal nerve lymph node dissection method was an independent risk factor affecting
disease⁃free survival（DFS）in esophageal cancer patients. Results：There were no significant difference in surgical time［（191.5±19.6）
min vs.（197.2±16.7）min］，average length of hospital stay［（12.5±2.4）d vs.（12.1±2.1）d］，intraoperative blood loss［（138.8±52.4）mL
vs.（132.7±43.3）mL］，etc. between the two groups. The number of resected left recurrent laryngeal nerve lymph nodes dissected in the
modified group was significantly high［（2.93±1.19）vs.（2.57±0.98），P=0.036］，while the proportion of recurrent laryngeal nerveinjury
was significantly low（2% vs. 13%，P=0.010），compared with traditional group. Multivariate Cox regression analysis suggested that the
method of the dissection of recurrent laryngeal nerve lymph node，TMN stage，and tumor differentiation were independent risk factors
for esophageal cancer recurrence（P=0.012，0.037，0.045）. Conclusion：The use of the anatomical membrane method to dissect the left
recurrent laryngeal nerve lymph nodes can significantly reduce postoperative complications of esophageal cancer，effectively improve
disease⁃free survival（DFS）after surgery，and has great application value in the dissection of the left recurrent laryngeal nerve lymph

［基金项目］ 吴阶平医学基金课题（320.6750.19008）
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通信作者（Corresponding author），E⁃mail： ljhua@126.com