全腔镜食管癌左喉返神经旁淋巴结清扫技术改进的临床研究

发布时间：2018-05-06 06:08

本文选题：胸腔镜 + 食管癌　；参考：《安徽医科大学》2016年硕士论文

【摘要】：目的：对比分析改进后的淋巴结清扫技术对全腔镜食管癌根治术中区域淋巴结清扫的价值。其价值主要体现在：胸部手术时间(胸部食管游离+淋巴清扫时间)、胸部出血量、术后住ICU时间、清扫纵隔淋巴结数目、并发症发生率(主要包括左喉返神经损伤发生率、胸腔出血、气管及胸导管损伤发生率以及肺部感染等)。方法：1.将符合入组条件的87例按胸腔部分单肺通气方式不同分为实验组(即单腔气管插管+人工气胸+食管悬吊方法,42例)和对照组(双腔气管插管,45例)。2.对比分析2组胸部手术时间：包括：左喉返神经旁淋巴结清扫数量(分别记录完整淋巴结数目及破碎淋巴结数目)、左喉返神经旁淋巴结清扫时间(回顾手术录象计时)、胸部手术出血量、左喉返神经损伤发生率(术后声音嘶哑)其他并发症的发生率(气管损伤、胸导管损伤、肺部感染等)。结果：实验组手术时间明显少于对照组[(128.3±21.5)min vs (151.7±27.1)min, t=2.467,P=0.016],淋巴结清扫枚数更多(19.8±8.8vs17.2±7.5, t=2.184, p=0.032),在术中出血量、术后住ICU天数、住院天数等方面2组无明显差别。实验组喉返神经损伤[0 vs 5(11.11%), t=4.951,p=0.026]、肺部感染[1(2.38%) vs 7(15.56%), t=4.516,p=0.034]并发症少于对照组,而其他并发症发生率无明显区别。结论：1、实验组(即单腔气管插管+人工气胸+食管悬吊方法)胸部较对照组(双腔气管插管)节省手术时间,喉返神经损伤、肺部感染等并发症发生率低,淋巴结清扫数目多；2、在保证淋巴结清扫数量前提下,单腔气管插管+人工气胸+食管悬吊带来的手术技法与操作习惯的改变,可以降低并发症发生率,并能提高手术质量,增加淋巴结清扫的彻底性,使患者获益。
[Abstract]:Objective: to compare and analyze the value of improved lymph node dissection technique for regional lymph node dissection in total endoscopic radical resection of esophageal carcinoma. Its value is mainly reflected in the time of thoracic operation (thoracic esophagus free lymph node dissection time, chest bleeding, postoperative ICU time, the number of mediastinal lymph nodes dissected, the incidence of complications (including the incidence of left recurrent laryngeal nerve injury). Thoracic hemorrhage, trachea and chest duct injury, and pulmonary infection. Method 1: 1. 87 patients who were in accordance with the conditions of admission were divided into experimental group (42 cases) and control group (45 cases with double lumen endotracheal intubation) according to the different ventilation mode of thoracic part of pneumothorax (42 cases with single cavity tracheal intubation) and control group (45 cases with double lumen endotracheal intubation). Comparison and analysis of the time of thoracic surgery in two groups: the number of lymph nodes dissected by the left recurrent laryngeal nerve (including the number of complete lymph nodes and the number of broken lymph nodes and the time of dissection of the left recurrent laryngeal nerve lymph nodes were recorded respectively). Timing, chest surgery, blood loss, Incidence of left recurrent laryngeal nerve injury (postoperative hoarseness) other complications (tracheal injury, thoracic duct injury, pulmonary infection, etc.) Results: the operative time in the experimental group was significantly shorter than that in the control group [128.3 卤21.5)min vs 151.7 卤27.1 min, 2.467 21.5)min, 0.016], the number of lymph node dissection was 19.8 卤8.8vs17.2 卤7.5, the volume of intraoperative bleeding, the days of postoperative ICU, and the length of hospitalization were not significantly different between the two groups. In the experimental group, the complications of recurrent laryngeal nerve injury [0 vs 5: 11.11, t 4. 951 P 0. 026], pulmonary infection [1 2. 38) vs 7 15. 56%, t 5. 516% p 0. 034] were less than those in the control group, but there was no significant difference in other complications. Conclusion the operation time of the experimental group (single cavity tracheal intubation artificial pneumothorax esophageal suspension method) was less than that of the control group (double lumen tracheal intubation). The incidence of complications such as recurrent laryngeal nerve injury and pulmonary infection was lower in the experimental group than in the control group. The number of lymph node dissection is more than 2. Under the premise of ensuring the number of lymph node dissection, the change of operation technique and operation habit caused by single cavity tracheal intubation artificial pneumothorax esophageal suspension can reduce the incidence of complications and improve the quality of operation. Increase the thoroughness of lymph node dissection to the benefit of patients.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R735.1

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