Huang Z N, Liu C Q, Guo M F, Xu M Q, Sun X H, Wang G X, Xie M R
Department of Thoracic Surgery, Anhui Provincial Hospital Affiliated with Anhui Medical University, Hefei 230000, China.
Department of Thoracic Surgery, the First Affiliated Hospital of University of Science and Technology of China, Hefei 230000, China.
Zhonghua Wai Ke Za Zhi. 2023 Jan 1;61(1):48-53. doi: 10.3760/cma.j.cn112139-20220612-00265.
To examine the safety and effectiveness of inflatable video-assisted mediastinoscopic transhiatal esophagectomy (IVMTE). Totally 269 patients admitted to the Anhui Provincial Hospital of Anhui Medical University who underwent IVMTE (IVMTE group, =47) or thoracoscopy combined with minimally invasive Mckeown esophageal cancer resection (MIME group, =222) from September 2017 to December 2021 were analyzed retrospectively. There were 31 males and 16 females in IVMTE group, aged (68.6±7.5) years (range: 54 to 87 years). There were 159 males and 63 females in MIME group, aged (66.8±8.8) years (range: 42 to 93 years). A 1∶1 match was performed on both groups by propensity score matching, with 38 cases in each group. The intraoperative conditions and postoperative complication rates of the two groups were compared by test, Wilcoxon rank, test, or Fisher exact probability method. Patients in IVMTE group had less intraoperative bleeding ((96.0±39.2) ml (123.8±49.3) ml, =-2.627, =0.011), shorter operation time ((239.1±47.3) minutes (264.2±57.2) minutes, =-2.086, =0.040), and less drainage 3 days after surgery (85(89) ml 675(573) ml, =-7.575, <0.01) compared with that of MIME group. There were no statistically significant differences between the two groups in terms of drainage tube-belt time, postoperative hospital stay, and lymph node dissection stations and numbers (all >0.05). The incidence of Clavien-Dindo grade 1 to 2 pulmonary infection (7.9%(3/38) 31.6%(12/38), ²=6.728, =0.009), total complications (21.1%(8/38) 47.4%(18/38), ²=5.846, =0.016) and total lung complications (13.2%(5/38) 42.1%(16/38), ²=7.962, =0.005) in the IVMTE group were significantly lower. Inflatable video-assisted mediastinoscopic transhiatal esophagectomy combined with laparoscopic esophagectomy is safe and feasible, which can reach the same range of oncology as thoracoscopic surgery.
探讨充气式电视辅助纵隔镜经裂孔食管切除术（IVMTE）的安全性和有效性。回顾性分析2017年9月至2021年12月在安徽医科大学附属安徽省立医院接受IVMTE（IVMTE组，n = 47）或胸腔镜联合微创McKeown食管癌切除术（MIME组，n = 222）的269例患者。IVMTE组男31例，女16例，年龄（68.6±7.5）岁（范围：54至87岁）。MIME组男159例，女63例，年龄（66.8±8.8）岁（范围：42至93岁）。通过倾向得分匹配对两组进行1∶1匹配，每组38例。采用t检验、Wilcoxon秩和检验、χ²检验或Fisher确切概率法比较两组的术中情况和术后并发症发生率。IVMTE组患者术中出血量少于MIME组（（96.0±39.2）ml比（123.8±49.3）ml，t = -2.627，P = 0.011），手术时间短于MIME组（（239.1±47.3）分钟比（264.2±57.2）分钟，t = -2.086，P = 0.040），术后3天引流量少于MIME组（85（89）ml比675（573）ml，t = -7.575，P <0.01）。两组在引流管留置时间、术后住院时间以及淋巴结清扫站数和个数方面差异均无统计学意义（均P>0.05）。IVMTE组Clavien-Dindo 1至2级肺部感染发生率（7.9%（3/38）比31.6%（12/38），χ² = 6.728，P = 0.009）、总并发症发生率（21.1%（8/38）比47.4%（18/38），χ² = 5.846，P = 0.016）和总肺部并发症发生率（13.2%（5/38）比42.1%（16/38），χ² = 7.962，P = 0.005）均显著低于MIME组。充气式电视辅助纵隔镜经裂孔食管切除术联合腹腔镜食管切除术安全可行，肿瘤学切除范围与胸腔镜手术相当。
