【摘要】 目的：探究充气式纵隔镜同步腹腔镜食管癌根治术与腔镜辅助麦克基翁（minimally invasive esophagectomy-McKeown,MIE-McKeown）术式对食管癌患者术后恢复、肺功能及术后肺部并发症的影响，比较两种术式的临床疗效。方法：回顾性分析2018年5月至2020年5月就诊于河南大学淮河医院168例食管癌患者临床资料，按照手术策略分为同步组（联合术式86例）与McKeown组（传统术式82例），对两组患者的初始临床资料、手术相关参数、肺功能（FEV1、FVC、MVV）、免疫检测指标（CD3~+、CD4~+、CD8~+）、并发症及生存数据进行比对。结果：两组患者术前基线资料可比（P>0.05）。围手术期指标上，同步组手术时间（114.53±18.34）min、术中出血量（44.73±13.45）mL、术后3 d引流总量（104.26±4.23）mL、术后首次下床时间（2.34±0.32）d、术后住院时间（12.21±1.78）d，均显著优于McKeown组（P<0.001）。在肺功能指标方面，充气式纵隔镜同步腹腔镜食管癌根治术组（同步组）在术后1周、2周及1个月，FEV1、FVC、MVV恢复更显著，差异具有统计学意义（P<0.05）。免疫功能方面，同步组术后1、7、14天CD3~+、CD4~+和CD8~+水平显著高于对照组（P<0.001）。同步组的总并发症发生率显著低于McKeown组（P<0.001）。近远期生存率上，同步组1、3、5年局部复发率及远处转移率均低于McKeown组，其中3年远处转移率（P=0.027）和5年远处转移率（P=0.019）差异具有统计学意义，其余组间差异无统计学意义（P>0.05）。Log-rank检验结果显示，两组患者的生存曲线差异具有统计学意义（P=0.007 8）。分层生存分析显示，Ⅰ～Ⅱ期患者中同步组生存率显著高于McKeown组（P=0.002 3），Ⅲ～Ⅳ期患者中同步组生存率亦优于McKeown组（P=0.021 8），进一步证实充气式纵隔镜同步腹腔镜术式在不同病理分期食管癌患者中的临床优势。结论：食管癌患者采用MIE-McKeown术式治疗，有利于改善肺功能恢复、减少术后机体应激与术后肺部并发症发生，可改善免疫功能与预后，是一种更安全、有效的微创手术方式，值得临床推广。更多还原

【Abstract】 Objective: We investigated the effects of pneumatic mediastinoscopic synchronous laparoscopic radical esophageal cancer surgery and luminal-assisted McKeown(minimally invasive esophagectomy-McKeown, MIE-McKeown) procedure on postoperative recovery,pulmonary function, and postoperative pulmonary complications in patients with esophageal cancer, and compared the clinical efficacy of the two procedures. Methods: A total of 168 patients with esophageal cancer at Huaihe Hospital of Henan University were assigned into a synchronous group from May 2018 to May 2020(combined procedure, n=86) and a McKeown group(traditional procedure, n=82), and initial clinical data, surgery-related parameters, lung function(FEV1, FVC, and MVV), immunoassay indices(CD3~+, CD4~+, and CD8~+), complications, and survival data were compared. Results: Preoperative baseline data were comparable between the two groups(P>0.05). Operation time [(114.53±18.34) min], intraoperative bleeding [(44.73±13.45) mL], total drainage [(104.26±4.23) mL] in the 3d postoperative period, first time out of bed in the postoperative period [(2.34±0.32) d], and postoperative hospitalization time [(12.21±1.78) d] were significantly better in the synchronous group than in the McKeown group(P<0.001). The pneumatic mediastinoscopic synchronous laparoscopic radical esophageal cancer surgery group(synchronous group) exhibited significantly greater(P<0.05) recovery of FEV1, FVC, and MVV at 1 and 2 weeks and1 month postoperatively. CD3~+, CD4~+, and CD8~+ levels were significantly higher in the synchronous group than in the control group one day,seven days, and 14 days post-surgery(P<0.001). The overall complication rate in the synchronous group was significantly lower than that in the McKeown group(P<0.001). The synchronous group exhibited lower rates of local recurrence and distant metastasis at 1-, 3-, and 5-years compared to the McKeown group. The differences in 3-year(P=0.027) and 5-year(P=0.019) distant metastasis rates were statistically significant, whereas other intergroup differences did not reach statistical significance(P>0.05). The Log-rank test revealed a statistically significant difference in survival curves between the two groups(P=0.007 8). Stratified survival analysis revealed significantly higher survival rates in the synchronous group than in the McKeown group among patients with stage Ⅰ-Ⅱ disease(P=0.002 3). Similarly, stage Ⅲ-Ⅳ patients in the synchronous group demonstrated superior survival outcomes compared with those in the McKeown group(P=0.021 8). These findings further validate the clinical advantages of the pneumatic mediastinoscopy-guided concurrent laparoscopic approach across different pathological stages of esophageal cancer. Conclusions: Treatment of esophageal cancer patients with pneumatic mediastinoscopic synchronous laparoscopic radical esophageal cancer surgery is conducive to improving lung function recovery and reducing postoperative organ stress and pulmonary complications, which can improve immune function and prognosis. It is a safer and more effective minimally invasive surgical procedure worthy of clinical promotion.更多还原