微创三野淋巴结清扫治疗胸段食管癌的疗效

目的 探讨胸腹腔镜联合进行选择性三野淋巴结的食管癌根治术治疗胸段食管癌的安全性、有效性及经济性。方法 回顾性分析安徽省肿瘤医院2012年8月至2016年2月接受胸腹腔镜联合微创手术或者开放手术进行选择性三野淋巴结的食管癌根治术的患者103例临床资料，其中微创组手术患者48例，开放组手术患者55例。比较两组患者心律失常发生率、死亡率、吻合口瘘发生率、肺部感染发生率、喉返神经损伤发生率、淋巴结清扫数目及住院费用等资料。结果 心律失常发生率、肺部感染发生率、术中出血量及手术时间、声音嘶哑发生率等指标微创组较开放组均低，差异有统计学意义（P均<0.05），而手术死亡、乳糜胸发生、腹部切开裂开、术后大出血、吻合口瘘发生率等，微创组与开放组比较，差异无统计学意义（P均>0.05）。微创组的淋巴结清扫数目显著多于开放组，差异有统计学意义（τ=2.281，P=0.039）。但治疗费用方面，微创组患者较开放组花费更大。结论 胸腹腔镜联合微创进行三野淋巴结的食管癌根治术治疗食管癌是安全的，但是其治疗费用较高。

Minimally invasive three-field lymphadenectomy in treatment of thoracic esophageal carcinoma

Objective To explore the safety, effectiveness and economy of combined thoracoscopic and laparoscopic selective three-field lymphadenectomy with radical resection of esophageal carcinoma in the treatment of thoracic esophageal carcinoma. Methods The clinical data of 103 esophagectomy patients ever treated in our hospital from Jul 2012 to Feb 2016, with selective three-field lymphadenectomy by combined thoracoscopic and laparoscopic minimally invasive operation or open operation were retrospectively analyzed. The mortality rate, incidence of anastomotic leak, incidence of pulmonary infection, incidence of recurrent laryngeal nerve injury, number of harvested lymph nodes, and hospitalization costs between the patients with minimally invasive operation (minimal invasion group, 48 cases) and the patients with open operation (open operation group, 55 cases) were compared. Results There were statistically significant differences between the two groups in the incidence of arrhythmia, incidence of pulmonary infection, blood loss and operation time, incidence of hoarseness, while in the incidence of intraoperative death, chylothorax, dehiscence of abdominal incision, postoperative hemorrhoea and anastomotic leak, no significant difference was found. The minimal invasion group had a greater number of harvested lymph nodes with significant difference, and patients in the group cost more in the hospitalization expense. Conclusion It is safe to apply combined thoracoscopic and laparoscopic minimally invasive three-field lymphadenectomy with radical resection of esophageal carcinoma in the treatment of thoracic esophageal carcinoma, but the hospitalization expense would be higher.