胸腔镜食管切除术中沿左喉返神经清扫淋巴结的新方法。
Novel technique for lymphadenectomy along left recurrent laryngeal nerve during thoracoscopic esophagectomy.
机构信息
Department of Thoracic Surgery, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China.
出版信息
World J Gastroenterol. 2020 Mar 28;26(12):1340-1351. doi: 10.3748/wjg.v26.i12.1340.
BACKGROUND
In esophageal squamous carcinoma, lymphadenectomy along the left recurrent laryngeal nerve (RLN) is recommended owing to its highly metastatic potential. However, this procedure is difficult due to limited working space in the left upper mediastinum, and increases postoperative complications.
AIM
To present a novel method for lymphadenectomy along the left RLN during thoracoscopic esophagectomy in the semi-prone position.
METHODS
The fundamental concept of this novel method is to exfoliate a bilateral pedicled nerve flap, which is a two-dimensional membrane, which includes the left RLN, lymph nodes (LNs) along the left RLN, and tracheoesophageal vessels, by suspending the esophagus to the dorsal side and pushing the trachea to the ventral side (named "bilateral exposure method"). Then, the hollow-out method is performed to transform the two-dimensional membrane to a three-dimensional structure, in which the left RLN and tracheoesophageal vessels are easily distinguished and preserved during lymphadenectomy along the left RLN. This novel method was retrospectively evaluated in 116 consecutive patients with esophageal squamous carcinoma from August 2016 to February 2018.
RESULTS
There were 58 patients in each group. No significant difference was found between the two groups in terms of age, gender, postoperative pneumonia, anastomotic fistula, and postoperative hospitalization. However, the number of dissected LNs along the left RLN in this novel method was significantly higher than that in the conventional method (4.17 ± 0.359 2.93 ± 0.463, = 0.0447). Moreover, the operative time and the rate of postoperative hoarseness in the novel method were significantly lower than those in the conventional method (306.0 ± 6.774 335.2 ± 7.750, = 0.0054; 4/58 12/58, = 0.0312).
CONCLUSION
This novel method for lymphadenectomy along the left RLN during thoracoscopic esophagectomy in the semi-prone position is much safer and more effective.
背景
在食管鳞癌中，由于左喉返神经（RLN）具有高度转移潜能，因此建议沿 RLN 进行淋巴结清扫。然而，由于左胸上段的操作空间有限，该手术难度较大，并会增加术后并发症。
目的
介绍一种在半俯卧位胸腔镜食管切除术中沿左 RLN 进行淋巴结清扫的新方法。
方法
该新方法的基本理念是通过将食管悬挂至背部、将气管推向腹部，使包含左 RLN、左 RLN 旁淋巴结（LNs）和气管食管血管的双侧带蒂神经瓣（一种二维膜）游离，然后采用镂空方法将二维膜转化为三维结构，从而在清扫左 RLN 旁淋巴结时，更容易区分和保护左 RLN 和气管食管血管。本研究回顾性分析了 2016 年 8 月至 2018 年 2 月间连续收治的 116 例食管鳞癌患者的临床资料。
结果
每组 58 例患者。两组患者的年龄、性别、术后肺炎、吻合口瘘和术后住院时间无显著差异。然而，与常规方法相比，该新方法清扫的左 RLN 旁淋巴结数量显著更多（4.17 ± 0.359 个 vs. 2.93 ± 0.463 个， = 0.0447）。此外，该新方法的手术时间和术后声音嘶哑发生率明显低于常规方法（306.0 ± 6.774 分钟 vs. 335.2 ± 7.750 分钟， = 0.0054；4/58 例 vs. 12/58 例， = 0.0312）。
结论
该新方法在半俯卧位胸腔镜食管切除术中清扫左 RLN 旁淋巴结更安全、更有效。
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