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目的比较侧俯卧位、俯卧位和左侧卧位胸腔镜下食管切除术治疗食管癌的临床效果。方法 2010年1月至2013年2月在徐州市肿瘤医院胸心外科接受胸腔镜食管切除术、临床分期在T3N1M0以下的121例食管癌患者随机分为3组,其中侧俯卧位组43例[男24例、女19例,年龄(61.5±1.5)岁],俯卧位组39例[男21例、女18例,年龄(63.2±1.7)岁],左侧卧位组39例[男22例、女17例,年龄(60.1±1.6)岁]。结果三组手术平均手术时间分别为232(165~296)min、230(170~310)min和280(190~380)min,差异有统计学意义(P<0.05);术中平均出血量分别为262(185~330)ml、275(100~320)ml和350(120~560)ml,差异无统计学意义(P>0.05);平均清扫淋巴结数分别为为19.1(9~26)枚/例、18.4(11~23)枚/例和10.9(6~21)枚/例,差异有统计学意义(P<0.05)。全组患者无手术期死亡,三组患者术后并发症发生率分别为10例(23.3%)、9例(23.1%)和11例(28.2%),差异无统计学意义(均P>0.05)。侧俯卧位组术后平均随访19.2(6~31)个月,20例死亡;俯卧位组术后平均随访20.7(8~29)个月,18例死亡;左侧卧位组术后平均随访18.5(12~33)个月,21例死亡。三组术后死亡发生率差异无统计学意义(均P>0.05)。结论三种体位下胸腔镜食管癌切除术均安全、可行,但采用侧俯卧位和俯卧位较左侧卧位手术时间较短并有利于淋巴结清扫,而侧俯卧位组具有在中转开胸时能够更迅速简便地改变体位的优点。
Objective To compare the clinical effects of thoracoscopic esophagectomy in prone position, prone position and left lateral position in the treatment of esophageal cancer. Methods From January 2010 to February 2013, thoracoscopic esophagectomy was performed in the thoracic cardiac surgery department of Xuzhou Tumor Hospital. The 121 patients with esophageal cancer whose clinical stage was under T3N1M0 were randomly divided into 3 groups, of which 43 cases were prone to side prone position [ There were 39 males and 24 females, including 19 females and 19 females, with a mean age of (61.5 ± 1.5) years. There were 39 patients in the prone position group [21 males and 18 females (63.2 ± 1.7) years old) Cases, female 17 cases, age (60.1 ± 1.6) years old]. Results The average operative time of the three groups was 232 (165 ~ 296) min, 230 (170 ~ 310) min and 280 (190 ~ 380) min respectively, with statistical significance (P0.05) Were 262 (185-330) ml, 275 (100-320) ml and 350 (120-560) ml, the difference was not statistically significant (P> 0.05). The average number of lymph nodes was 19.1 (9-26) / Cases, 18.4 (11 ~ 23) pieces / 10.9 (6 ~ 21) pieces / case, the difference was statistically significant (P <0.05). There was no operative mortality in all the patients. The incidence of postoperative complications in the three groups were 10 (23.3%), 9 (23.1%) and 11 (28.2%) respectively, with no significant difference (all P> 0.05 ). In the prone-prone group, the average follow-up was 19.2 (range, 6 to 31) months, with 20 deaths. The prone position was followed up for an average of 20.7 months (range, 8-29 months) and 18 died. The average postoperative follow- 18.5 (12 ~ 33) months, 21 patients died. There was no significant difference in the incidence of postoperative death between the three groups (all P> 0.05). Conclusions Thoracoscopic esophageal cancer resection is safe and feasible in all three positions. However, it is shorter and easier to perform lymphadenectomy in lateral prone position and prone position than in left lateral position, The advantage of being able to change position quickly and easily.