微创McKeown食管癌切除术行喉返神经旁淋巴结清扫的临床效果探讨

摘要

Objective To explore the feasibility and safety of Mckeown-type minimally invasive esophagectomy in para-recurrent laryngeal nerve lymphadenectomy. Methods A total of 163 cases underwent minimally invasive McKeown resection for esophageal carcinoma in the Affiliated Tumor Hospital of Xinjiang Medical University were retrospectively analyzed. Patients were divided into routine treatment group (n=63), right recurrent nerve lymph node dissection group (right group, n=53) and bilateral recurrent laryngeal nerve lymph node dissection group (bilateral group, n=47) according to the operation modes. The postoperative pathology, operation time, intraoperative bleeding volume, postoperative hospitalization time, number of lymph nodes and pneumonia, anastomotic fistula, laryngeal nerve injury and other complications were compared between three groups of patients. Pathological conditions were consisted of the location of tumor, the degree of differentiation, T stage and pathological stage. Postoperative complications were followed up for 6 months. Results There were no significant differences in tumor location, pathological differentiation degree, T stage and pathologic stage between three groups. The amount of bleeding was more in the routine group than that of the right group and the bilateral group (P<0.05). There was no significant difference in the amount of bleeding between the right group and the bilateral group. The total lymph nodes and thoracic lymph nodes were increased in order in routine group, the right group and the bilateral group, and there was significant difference between three groups(P<0.05). There were no significant differences in other operation data and complications between three groups. Conclusion McKeown-type minimally invasive esophagectomy shows good feasibility and safety for para-recurrent laryngeal nerve lymphadenectomy .%目的：探讨微创McKeown食管癌切除术行喉返神经旁淋巴结清扫的可行性、安全性。方法回顾性分析新疆医科大学附属肿瘤医院行微创McKeown食管癌切除术的食管鳞癌患者163例，依术式的不同分为常规组63例、右侧喉返神经旁淋巴结清扫组（右侧组）53例、双侧喉返神经旁淋巴结清扫组（双侧组）47例。比较各组患者术后病理情况、手术时间、术中出血量、术后住院时长、淋巴结清扫数及肺炎、吻合口瘘、喉返神经损伤等并发症情况。病理情况包括肿瘤部位、病理分化程度、T分期以及病理分期。术后并发症随访至术后6个月。结果常规组、右侧组、双侧组的肿瘤部位、病理分化程度、T分期以及病理分期差异均无统计学意义。常规组出血量大于右侧组和双侧组（P＜0.05），右侧组与双侧组出血量差异无统计学意义；常规组、右侧组及双侧组的总淋巴结清扫数及胸腔淋巴结清扫数依次升高，组间多重比较差异均有统计学意义（P＜0.05）；而其他组间手术情况及术后并发症差异均无统计学意义。结论微创McKeown食管癌切除术行双侧喉返神经旁淋巴结清扫具有较好的安全性及可行性。