Tokairin Yutaka, Nakajima Yasuaki, Kawada Kenro, Hoshino Akihiro, Okada Takuya, Ryotokuji Tairo, Matsui Toshihiro, Nagai Kagami, Kawano Tatsuyuki, Kinugasa Yusuke
Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
Department of Surgery, Soka Municipal Hospital, 2-21-1 Soka, Soka, 340-8560, Saitama, Japan.
Gen Thorac Cardiovasc Surg. 2019 Oct;67(10):884-890. doi: 10.1007/s11748-019-01179-3. Epub 2019 Jul 25.
We investigated the merits and demerits of right cervical open surgery with right trans-cervical pneumomediastinal approach in mediastinoscopic esophagectomy.
Ten thoracic esophageal cancer patients were treated using this approach. Under pneumomediastinum via a right neck incision, the right cervical and upper mediastinal paraesophageal lymph nodes were dissected. The left recurrent nerve lymph nodes were dissected using a left trans-cervical pneumomediastinal approach. The subaortic arch to the left tracheobronchial lymph nodes was dissected with a combined right and left trans-cervical crossover approach.
The average number of dissected lymph nodes among the right cervical and upper mediastinal paraesophageal lymph nodes identified with a right cervical open/right trans-cervical mediastinoscopic/right thoracoscopic approach was 3.2/4.0/0.6, respectively. The average number of dissected lymph nodes among the subaortic arch to the left tracheobronchial lymph nodes with a right trans-cervical mediastinoscopic/right thoracoscopic approach was 1.5/0.6, respectively. These findings indicate that, without using the right trans-cervical pneumomediastinal approach, it might be impossible to successfully remove some of the right cervical and upper mediastinal paraesophageal lymph nodes and the subaortic arch to the left tracheobronchial lymph nodes lymph nodes. Regarding surgical complications, one case of bilateral recurrent nerve palsy as well as two cases on the right and two cases on the left were noted.
Although the rate of recurrent nerve palsy should still be reduced, a bilateral (especially right-sided) trans-cervical pneumomediastinal approach is an available option for achieving sufficient upper mediastinal lymph node dissection and esophagectomy.
我们研究了右颈开放式手术联合右经颈纵隔气肿入路在纵隔镜食管癌切除术中的优缺点。
10例胸段食管癌患者采用该入路进行治疗。经右颈部切口建立纵隔气肿后，清扫右颈及上纵隔食管旁淋巴结。采用左经颈纵隔气肿入路清扫左喉返神经淋巴结。采用左右经颈交叉入路清扫主动脉弓下至左气管支气管淋巴结。
采用右颈开放式/右经颈纵隔镜/右胸腔镜入路识别的右颈及上纵隔食管旁淋巴结平均清扫数目分别为3.2/4.0/0.6枚。采用右经颈纵隔镜/右胸腔镜入路清扫的主动脉弓下至左气管支气管淋巴结平均清扫数目分别为1.5/0.6枚。这些结果表明，不采用右经颈纵隔气肿入路，可能无法成功清扫部分右颈及上纵隔食管旁淋巴结以及主动脉弓下至左气管支气管淋巴结。关于手术并发症，发现1例双侧喉返神经麻痹，右侧2例，左侧2例。
虽然仍应降低喉返神经麻痹的发生率，但双侧（尤其是右侧）经颈纵隔气肿入路是实现充分的上纵隔淋巴结清扫和食管癌切除术的一种可行选择。
