对比两种单肺通气技术对胸腔镜食管癌纵隔淋巴结清扫的影响

摘要

Objective To estimate the effect of single-lumen and double lumen tracheal intubation on mediastinal lymph node dissection in esophagectomy by video-assisted thoracoscopy (VATS).Methods Clinical data of One hundred and thirty-seven esophageal cancer patients from July 2011 to January 2015 underwent esophagectomy with lymph node dissection by VATS were retrospectively reviewed.Seventy-two patients received artificial pneumothorax and single lumen tracheal intubation were set as experimental group,and 65 patients received double lumen tracheal intubation were in control group.The effect and complications of the two groups were observed.Results The operation time of experimental group was less than that of control group [(137.7-±20.7) min vs.(163.8±27.3) min,P＜0.001)].The number of lymph node dissection in experimental group was more than that of control group (22.2±3.3 vs.19.8-±4.6,P=0.024).The incidence of recurrent laryngeal nerve injury and pulmonary infection in experimental group was lower than those in control group (1.4％ vs.9.2％,P =0.037;2.8％ vs.12.3％,P =0.032).There was no statistical difference in postoperative hemorrhage,postoperative ICU days,hospitalization days,anastomotic fistula,chylothorax,pleural hemorrhage,wound infection,poor gastric emptying between the two groups.Conclusion Single lumen endotracheal intubation and artificial pneumothorax can increase the number of lymph node dissection,improve the quality of operation and reduce the incidence of complications.%目的 比较两种单肺通气技术对胸腔镜食管癌纵隔淋巴结清扫的影响.方法 收集2011年7月至2015年1月137例食管癌患者的临床资料,按胸腔部分单肺通气方式分为试验组(单腔气管插管+人工气胸,n=72例)和对照组(双腔气管插管,n=65例),对比分析两组术中指标,观察患者术后并发症的发生情况,评价两组淋巴结清扫效率和安全性.结果 试验组手术时间为(137.7±20.7)min,短于对照组的(163.8±27.3) min(P＜0.001);试验组淋巴结清扫数量为(22.2±3.3)枚,多于对照组的(19.8±4.6)枚(P=0.024).试验组喉返神经损伤和肺部感染的发生率均低于对照组(1.4％vs.9.2％,P=0.037;2.8％vs.12.3％,P=0.032);两组术中出血量、术后住ICU天数、住院天数、吻合口瘘、乳糜胸、胸腔内出血、切口感染、胃排空不良等并发症发生率的差异均无统计学意义(P＞0.05).结论 单腔气管插管+人工气胸可以增加淋巴结清扫数量,提高手术质量,降低并发症发生率.