Xu Yanzhao, Shi Xinqiang, Cheng Jingge, Zhang Yuefeng, Wen Shiwang, Li Zhenhua, Lvy Huilai, Tian Ziqiang
Department 5 of Thoracic Surgery, The Fourth Hospital, Hebei Medical University, Shijiazhuang 050011, China Email:
Department of Anesthesiology, The Fourth Hospital, Hebei Medical University, Shijiazhuang 050011, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2018 Sep 25;21(9):1008-1012.
To evaluate the feasibility of right neck anastomosis in thoracoscopic and laparoscopic esophagectomy.
This study used a retrospective cohort study method. Clinical data of 169 patients with stage I-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.
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).
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.
评估胸腔镜及腹腔镜食管癌切除术中右颈部吻合术的可行性。
本研究采用回顾性队列研究方法。回顾性分析2013年11月至2016年10月在河北医科大学第四医院胸外科五病区接受胸腔镜及腹腔镜食管癌切除术并行颈部吻合术的169例Ⅰ-Ⅲ期食管鳞状细胞癌患者的临床资料。82例行右颈部吻合术（右颈部吻合术组），87例行左颈部吻合术（左颈部吻合术组）。两组均行常规胸腔镜及腹腔镜食管癌根治性切除术。右、左颈部吻合术组的切口分别位于右、左胸锁乳突肌前缘。行食管胃交界部吻合，并在颈部切口放置引流管。比较两组的手术时间、术中出血量、淋巴结清扫情况及术后并发症发生率。
169例食管癌患者中男性101例，女性68例。两组患者在年龄、性别、肿瘤部位、临床分期方面差异均无统计学意义（均P>0.05）。左、右颈部吻合术组的总手术时间分别为（278.3±39.4）分钟和（287.8±39.4）分钟（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）。淋巴结清扫数目分别为（17.45±5.68）枚和（16.47±4.98）枚（t=1.190，P=0.236）。右颈部吻合术组17例（20.7%）发生术后并发症，左颈部吻合术组31例（35.6%）发生术后并发症（χ²=4.609，P=0.032）。与左颈部吻合术组相比，右颈部吻合术组胃排空障碍发生率较低（0% vs. 6.9%，P=0.029）、吻合口瘘发生率较低（7.3% vs. 18.4%，χ²=4.572，P=0.033）、肺炎发生率较低（18.3% vs. 32.2%，χ²=4.294，P=0.038）及ICU管理率较低（4.9% vs. 16.1%，χ²=4.726，P=0.030）。
胸腔镜及腹腔镜食管癌切除术中右颈部吻合术安全有效，能完整切除肿瘤，同时并发症较左颈部吻合术少，可提高生活质量。
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