目的：探讨胸、腹腔镜中期（Ⅱ、Ⅲ期）食管癌切除术二野淋巴结清扫的安全性、根治性及临床价值。方法：回顾性对比分析2009年1月至2013年7月胸、腹腔镜手术和开放手术行二野淋巴结清扫的Ⅱ、Ⅲ期食管癌410例资料（开放组193例、全腔镜组217例）。2组性别、年龄、术前合并症、肿瘤侵犯深度、肿瘤位置等无显著性差异（P>0.05）。比较两组手术情况、术后并发症等，分析两种手术方式的临床效果。结果：与开放组比较，腔镜组术中出血量少[（206±138）mL vs.（240±111）mL，t=2.726，P=0.007]，清扫淋巴结多[（26.6±8.6）枚vs.（21.7±9.2）枚，t=-5.626，P<0.001]，胸腔手术时间短[（157±36）min vs.（166±31）min，t=-2.696，P=0.007]，总体并发症发生率低[25.8%（56/217）vs.35.2%（68/193），χ2=4.303，P=0.038]。全腔镜组肺部感染、心律失常的发生率明显低于开放组（P<0.05），而吻合口狭窄、声音嘶哑发生率高于开放组（P<0.05）。结论：胸、腹腔镜联合食管癌切除二野淋巴结清扫术安全、可行，淋巴结清扫更彻底，值得在Ⅱ、Ⅲ期食管癌中推广应用。%Objective: To explore the security and the radical and clinical value of thoracoscopic-laparoscopic esophagectomy with two-field lymph node dissection for middle esophageal cancer through comparison with open esophagectomy. Methods: A total of 410 stage II to stage III esophageal cancer patients who underwent two-field lymph node dissection with two different methods (thora-colaparoscopic esophagectomy and open esophagectomy) from January 2009 to July 2013 in Uninon Hospital, Fujian Medical Universi-ty, were analyzed retrospectively. General pathological parameters, operative procedures, and short-term outcomes were collected and compared between the two groups (TLG and OG). Results: No significant differences were found regarding general pathological pa-rameters, such as gender, age, etc. Significant differences between thoracolaparoscopic and open two-field lymph node dissection esoph-agectomy were observed in terms of esophagectomy intraoperative blood loss [(206 ± 138) mL vs. (240±111) mL] and the mean num-ber of dissected lymph node per person [(26.6±8.6)/per vs. (21.7±9.2)/per]. Overall postoperative morbidity rate in OG was 35.2%, and its difference from that of TEG (25.8%) is statistically significant (P<0.05). Regarding single complications, such as pulmonary infec-tion and arrhythmia, OG showed evidently superior results (P<0.05). Meanwhile, anastomotic stricture and hoarseness rate are higher in TEG (P<0.05), and the difference was statistically significant as well. Conclusion: Thoracolaparoscopic two-field esophagectomy is technically feasible and safe and can achieve radical tumor resection.
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