Li Feng, Zhang Fan, Liu Weixin, Zheng Qingfeng, Zhang Moyan, Wang Zhen, Zhang Xuefeng, Qi Ling, Li Yong
Department of Cardiothoracic Surgery, Neijiang Hospital of Traditional Chinese Medicine, Neijiang, China.
Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Front Surg. 2023 Oct 9;10:1214175. doi: 10.3389/fsurg.2023.1214175. eCollection 2023.
To investigate the feasibility of laparoscopic abdominal mobilization in patients with cancers of the esophagus or gastroesophageal junction who have a history of abdominal surgery.
A total of 132 patients who underwent resection for cancers of the esophagus or gastroesophageal junction from August 2018 to March 2022 in the Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, were selected (66 patients with a history of abdominal surgery (observation group) and 66 patients without a history of abdominal surgery (control group)). All patients were treated with preoperative neoadjuvant therapy, based on the clinical stage. Thoracoscopic and laparoscopic resection was performed under general anesthesia. The intraoperative and postoperative conditions and surgical complications were compared between the two groups.
No significant differences were found in baseline data between the observation group and the control group (> 0.05). Laparoscopic abdominal mobilization was completed in both groups, and there were no significant differences between the two groups in the total operation time [(272.50 ± 86.45) min vs. (257.55 ± 67.96) min], abdominal mobilization time [(25.03 ± 9.82) min vs. (22.53 ± 3.88) min], blood loss [(119.09 ± 72.17) ml vs. (104.39 ± 43.82) ml], and postoperative time to first flatus [(3.44 ± 0.73) d vs. (3.29 ± 0.60) d] (> 0.05). The abdominal mobilization time was longer in observation group than that in control group (= 0.057). After excluding the patients (31/66) with a history of simple appendectomy from the observation group, the abdominal mobilization time was significantly longer in observation group than that in control group [(27.97 ± 12.16) min vs. (22.53 ± 3.88) min] (< 0.05). There were significantly fewer dissected abdominal lymph nodes in the observation group than in the control group [(18.44 ± 10.87) vs. (23.09 ± 10.95), < 0.05]. After excluding the patients (15/66) with a history of abdominal tumor surgery from the observation group, there was no significant difference in the number of dissected abdominal lymph nodes between the two groups [(20.62 ± 10.81) vs. (23.09 ± 10.95)] (> 0.05).In addition, no postoperative complications, such as intestinal obstruction, abdominal infection and bleeding, occurred in either group.
Patients with cancers of the esophagus or gastroesophageal junction who have a history of abdominal surgery are suitable for minimally invasive laparoscopic mobilization.
探讨有腹部手术史的食管癌或食管胃交界部癌患者行腹腔镜腹部游离术的可行性。
选取2018年8月至2022年3月在中国医学科学院肿瘤医院胸外科接受食管癌或食管胃交界部癌切除术的132例患者（66例有腹部手术史患者（观察组）和66例无腹部手术史患者（对照组））。所有患者根据临床分期接受术前新辅助治疗。在全身麻醉下进行胸腔镜和腹腔镜切除术。比较两组患者的术中、术后情况及手术并发症。
观察组与对照组基线数据无显著差异（>0.05）。两组均完成腹腔镜腹部游离术，两组在总手术时间[（272.50±86.45）分钟 vs.（257.55±67.96）分钟]、腹部游离时间[（25.03±9.82）分钟 vs.（22.53±3.88）分钟]、失血量[（119.09±72.17）毫升 vs.（104.39±43.82）毫升]及术后首次排气时间[（3.44±0.73）天 vs.（3.29±0.60）天]方面均无显著差异（>0.05）。观察组腹部游离时间长于对照组（=0.057）。观察组排除单纯阑尾切除术史患者（31/66）后，观察组腹部游离时间显著长于对照组[（27.97±12.16）分钟 vs.（22.53±3.88）分钟]（<0.05）。观察组清扫的腹部淋巴结明显少于对照组[（18.44±10.87） vs.（23.09±10.95），<0.05]。观察组排除腹部肿瘤手术史患者（15/66）后，两组清扫的腹部淋巴结数量无显著差异[（20.62±10.81） vs.（23.09±10.95）]（>0.05）。此外，两组均未发生肠梗阻、腹腔感染及出血等术后并发症。
有腹部手术史的食管癌或食管胃交界部癌患者适合行微创腹腔镜游离术。
