胸腔镜食管癌切除术中行广泛纵隔淋巴结清扫的效果及对术后肺功能的影响

摘要

目的：探讨胸腔镜食管癌切除术中行广泛纵隔淋巴结清扫的效果及对术后肺功能的影响。方法：经术前胃镜活检组织病理证实的食管癌患者93例，其中48例行胸腔镜食管癌切除术，作为观察组；45例行常规开胸食管癌切除术，作为对照组。比较两组在清扫淋巴结数目及其他有关手术情况和术后并发症发生率的差异。同时，对观察组和对照组均于术后第7天进行肺功能检测，包括肺活量（ VC）、1s用力呼气容积（ FEV10．）、最大通气量（ MVV），观察两组术后肺功能的差异。结果：与对照组相比，观察组在清扫淋巴结数目比较上无明显差异（ P＞0．05）；而手术时间、住院时间均明显缩短；胸部出血量、术后第1天胸腔引流量均明显减少（ P 均＜0．01）；并发症总发生率明显升高（ P＜0．05），其中，喉返神经损伤和呼吸系统并发症发生率均明显升高（ P 均＜0．01），而吻合口瘘和心血管并发症发生率，两组间无显著性差异（ P＞0．05）；肺功能各值VC，FEV1．0， MVV均显著性降低（ P 均＜0．01）。结论：胸腔镜食管癌切除术可以提供一种安全有效、创伤小、术后容易恢复、减轻术后肺功能障碍的手术方案，但同时行广泛纵隔淋巴结清扫又增加了术后并发症发生率。因此，临床应在保证正常组织和功能的情况下最大限度切除肿瘤组织以及确定淋巴结清扫范围。%Objective:To explore the effect of lymph node dissection within widely mediastinum and the influence of lung function after resection of esophageal carcinoma in thoracoscope.Method:93 cases of e-sophageal carcinoma patients confirmed by gastroscope biopsy tissue pathology before operation were recrui-ted.48 cases were operated in thoracoscope as the observation group and 45 cases were traditionally operated by opening the chest as the control group.We compared the difference between the two groups in the number of cleaning lymph nodes and other related operation situation and the incidence rate of postoperative compli-cations.By the way, the lung function of both groups were also compared through detecting the lung function indicators includingvital capacity ( VC) , forced expiratory volume in one second ( FEV1.0) , maximum mi-nute ventilation ( MVV) on the seventh day after surgery.Result:Compared to the control group, the num-ber of cleaning lymph nodes showed no difference ( P>0.05);the time for operation and recovery were both shortened ( P<0.01);the amount of chest blooding and hydrops on the first day after surgery were both re-duced ( P<0.01);the total occurrence rate of postoperative complications was significantly increased ( P<0. 05) with occurrence rate of recurrent laryngeal nerve injury and respiratory complications in significant in-crease( P<0.01) , while the anastomotic fistula and cardiovascular complication not( P>0.05) in observation group;the level of all the lung function indicators including VC, FEV1.0, MVV were decreased with signifi-cant difference in observation group ( P<0.01) .Conclusion: Resection of esophageal carcinoma in thoraco-scope can provide a safe and effective method with small trauma, easy recovery and reduced lung function af-ter surgery, but the lymph node dissection within widely mediastinum simultaneously can increase the inci-dence rate of postoperative complications.Thus, it should be ensured that the organization and function are in normal under the condition of removing the tumor tissues to the utmost and determining the scope of the lymph node cleaning.