摘要：
Objective To evaluate the feasibility of right neck anastomosis in thoracoscopic and laparoscopic esophagectomy. Methods This study used a retrospective cohort study method. Clinical data of 169 patients with stageⅠ-Ⅲ esophageal squamous cell carcinoma undergoing neck anastomosis in thoracoscopic and laparoscopic esophagectomy at the Department 5 of Thoracic Surgery, the Fourth Hospital of Hebei Medical University from November 2013 to October 2016 were retrospectively analyzed. Eighty-two cases underwent right neck anastomosis (right neck anastomosis group) and 87 cases underwent left neck anastomosis (left neck anastomosis group). Both groups underwent routine thoracoscopic and laparoscopic radical resection of esophageal cancer. The entry of right and left neck anastomosis group was at the anterior edge of the right and left sternocleidomastoid muscle respectively. Anastomosis of the esophagogastric junction was performed and the drainage tube was placed in the neck incision. The operation time, intraoperative blood loss, lymph node dissection and morbidity of postoperative complications were compared between the two groups. Results There were 101 males and 68 females among 169 patients with esophageal cancer. There were no significant differences in age , gender, tumor location, clinical stage between two groups (all P>0.05). The total operation time of left and right neck anastomosis groups was (278.3±39.4) minutes and (287.8±39.4) minutes, respectively (t=1.563, P=0.120). The intraoperative blood loss was (134.9 ±71.5) ml and (147.9 ±85.5) ml, respectively (t=1.074, P=0.284). The number of lymph node dissections was (17.45 ±5.68) and (16.47 ±4.98), respectively (t=1.190, P=0.236). Seventeen cases (20.7％) in the right neck anastomosis group developed postoperative complications, while 31 cases (35.6％) in the left neck anastomosis group developed postoperative complications (χ2=4.609,P=0.032). Compared with left neck anastomosis group, right neck anastomosis group had lower rate of gastric emptying disorder (0％ vs. 6.9％, P=0.029), anastomotic fistula (7.3％ vs. 18.4％, χ2=4.572, P=0.033), pneumonia (18.3％ vs. 32.2％, χ2=4.294, P=0.038) and ICU management (4.9％ vs. 16.1％, χ2=4.726, P=0.030). Conclusion Thoracoscopic and laparoscopic esophagectomy with right neck anastomosis is safe and effective, can completely remove the tumor, at the same time, has less complications than left neck anastomosis, and improve the quality of life.%目的 评价胸腹腔镜联合食管癌切除右颈部吻合术的可行性.方法 本研究采用回顾性队列研究方法.分析2013年11月至2016年10月期间,在河北医科大学第四医院胸五科行全腔镜食管癌根治颈部吻合术的169例Ⅰ～Ⅲ期食管鳞状细胞癌患者临床资料.全组均行常规胸腹腔镜联合食管癌根治术,其中82例行右颈部吻合(右颈部吻合组),87例行左颈部吻合(左颈部吻合组).右颈部吻合组与左颈部吻合组分别从右、左颈胸锁乳突肌前缘切口进入游离食管,经食管床上提管状胃并行食管胃端侧吻合,颈部切口均留置引流管.对比两组手术时间、术中出血量、淋巴结清扫情况及术后并发症发生率等方面情况.结果 169例食管癌患者中,男101例,女68例.右颈部吻合组与左颈部吻合组在年龄、 性别、 肿瘤位置及肿瘤分期等方面的差异均无统计学意义(均P>0.05).左、右颈部吻合组的总手术时间分别为(278.3±39.4)min和(287.8±39.4)min(t=1.563,P=0.120);术中出血量分别为(134.9±71.5)ml和(147.9±85.5)ml(t=1.074,P=0.284);淋巴结清扫数分别为(17.5±5.7)枚和(16.5±5.0)枚(t=1.190,P=0.236),差异均无统计学意义.左颈部吻合组31例(35.6％)术后发生并发症,右颈部吻合组17例(20.7％)术后发生并发症,差异有统计学意义(χ2=4.609,P=0.032).右颈部吻合组术后发生胃排空障碍[0比6.9％(6/87),P=0.029]、吻合口漏[7.3％(6/82)比18.4％(16/87),χ2=4.572,P=0.033]和肺炎[18.3％(15/82)比32.2％(28/87),χ2=4.294,P=0.038]的比率均较左颈部吻合组更少,差异均有统计学意义.左、右颈部吻合组分别有14例(16.1％)和4例(4.9％)患者术后转ICU(χ2=4.726,P=0.030).结论 胸腹腔镜联合食管癌切除右颈部吻合手术治疗食管癌安全、有效,在完全切除肿瘤的同时,能相对降低术后并发症,提高生活质量.
