Zhang Zhenming, Song Yu, Gao Yongshan, Wang Yun
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2014 Sep;17(9):902-6.
To explore the safety and feasibility of extensive mediastinal lymphadenectomy during thoracoscopic esophagectomy in the treatment of esophageal carcinoma.
Clinical data of 125 patients with esophageal carcinoma undergoing thoracoscopic and laparoscopic esophagectomy(TLE) in West China Hospital of Sichuan University between May 2009 and December 2011 were retrospectively analyzed. Patients were divided into 2 groups: non-extensive mediastinal lymphadenectomy group(non-extensive group, n=53) and extensive mediastinal lymphadenectomy group(extensive group, n=72). Perioperative outcomes of these two groups were compared.
No significant differences were found in the time of thoracic operation, length of intensive care unit stay and postoperative hospital stay, postoperative complication and the overall mortality between the two groups. Compared with non-extensive group, extensive group showed less blood loss during thoracic operation [(140.6±62.1) ml vs. (167.7±69.2) ml, P=0.023], more thoracic lymph nodes harvested (12.2±4.2 vs. 9.0±4.1, P<0.01). Seventeen patients (23.6%) in extensive group were found to have positive recurrent laryngeal nerve lymph nodes, which resulted in upstaging of TNM in 7 patients(9.7%). The incidence of recurrent laryngeal nerve palsy was higher in extensive group as compared to non-extensive group, but the difference was not statistically significant (6.9% vs. 1.9%, P=0.240).
Extensive mediastinal lymphadenectomy during thoracoscopic esophagectomy is a feasible and safe procedure for esophageal carcinoma patients, which can increase the number of harvested lymph node and the accuracy of tumor staging.
探讨胸腔镜食管癌切除术中扩大纵隔淋巴结清扫术治疗食管癌的安全性及可行性。
回顾性分析2009年5月至2011年12月在四川大学华西医院接受胸腔镜辅助腹腔镜食管癌切除术（TLE）的125例食管癌患者的临床资料。患者分为2组：非扩大纵隔淋巴结清扫组（非扩大组，n = 53）和扩大纵隔淋巴结清扫组（扩大组，n = 72）。比较两组的围手术期结果。
两组在开胸手术时间、重症监护病房停留时间、术后住院时间、术后并发症及总体死亡率方面差异无统计学意义。与非扩大组相比，扩大组开胸手术中出血量更少[（140.6±62.1）ml对（167.7±69.2）ml，P = 0.023]，清扫的胸段淋巴结更多（12.2±4.2对9.0±4.1，P < 0.01）。扩大组17例患者（23.6%）发现喉返神经淋巴结转移阳性，其中7例（9.7%）导致TNM分期上调。扩大组喉返神经麻痹发生率高于非扩大组，但差异无统计学意义（6.9%对1.9%，P = 0.240）。
胸腔镜食管癌切除术中扩大纵隔淋巴结清扫术对食管癌患者是一种可行且安全的手术方式，可增加淋巴结清扫数量及肿瘤分期的准确性。
