A novel method for lymphadenectomy along the left laryngeal recurrent nerve during thoracoscopic esophagectomy for esophageal carcinoma
A novel method for lymphadenectomy along the left laryngeal recurrent nerve during thoracoscopic esophagectomy for esophageal carcinoma
复制标题
胸腔镜食管癌切除术中沿左喉返神经淋巴结清扫的新方法
DOI：
10.3978/j.issn.2072-1439.2016.01.11
复制
发表时间：
2016-01-01
影响因子：
2.5
通讯作者：
Wang, Qun
中科院分区：
文献类型：
--
作者：
Xi, Yong;Ma, Zhenkai;Wang, Qun
背景资料：由于左上纵隔空间有限，沿着左喉返神经（RLN）的淋巴结（LN）很难完全清除。我们在此提出了一种新的方法，在半俯卧位食管癌胸腔镜食管切除术中，沿沿着左侧RLN进行淋巴结清扫。该方法，暂停食管和推开气管，允许整块淋巴结清扫术沿着左喉返神经从主动脉弓下到胸腔inlet.Methods：2014年9月至2015年9月，共有110例食管癌患者接受了半俯卧位胸腹腔镜食管切除术与颈部吻合。结果：50例患者接受了新方法手术，60例患者接受了传统手术。新方法更容易探查左侧喉返神经周围的手术野。估计失血量较少（23.7 ± 8.2 vs. 34.2 ± 10.3 g，P=0.001），沿着左侧RLN采集的LN数量较多（6.4 +/- 3.2 vs. 4.1 +/- 2.8 min，P=0.028），新方法组，而新方法组沿着左侧RLN进行淋巴结清扫的时间较长（28.2 +/- 3.9 vs 20.3 +/- 2.8 min，P=0.005）。新型组和传统组的声音嘶哑发生率分别为10%和16.7%。术后发病率相关的左喉返神经之间没有显着差异groups.Conclusions：在半俯卧食管切除术的食管癌的新方法是与更好的外科医生的人体工程学和手术暴露。
Background: Due to limited space in the left upper mediastinum, complete dissection of lymph nodes (LN) along left recurrent laryngeal nerve (RLN) is difficult. We herein present a novel method for lymphadenectomy along the left RLN during thoracoscopic esophagectomy in the semi-prone position for esophageal carcinoma. The method, suspension the esophagus and push aside trachea, allows en bloc lymphadenectomy along the left RLN from the below aortic arch to the thoracic inlet.Methods: Between September 2014 and September 2015, a total of 110 consecutive patients with esophageal carcinoma were treated with thoraco-laparoscopic esophagectomy with cervical anastomosis in the semi-prone position. Outcomes between those who received surgery with the novel method and conventional surgery were compared.Results: Fifty patients underwent the novel method and sixty received conventional surgery. The operative field around the left RLN was easier to explore with the novel method. The estimated blood loss was less (23.7 +/- 8.2 vs. 34.2 +/- 10.3 g, P=0.001), and the number of harvested LNs along the left RLN was greater (6.4 +/- 3.2 vs. 4.1 +/- 2.8 min, P=0.028) in the novel method group, while the duration of lymphadenectomy along left RLN was longer in the novel method group (28.2 +/- 3.9 vs. 20.3 +/- 2.8 min, P=0.005). The rate of hoarseness in the novel and conventional groups was 10% and 16.7%, respectively. No significant difference in postoperative morbidity related to the left RLN was noted between the groups.Conclusions: The novel method during semi-prone esophagectomy for esophageal carcinoma is associated with better surgeon ergonomics and operative exposure.