【作者】 张勇；

【导师】 喻东亮；

【作者基本信息】 南昌大学 ， 临床医学硕士（专业学位）， 2020， 硕士

【摘要】 目的验证人工气胸应用于胸腔镜下食管癌切除术的安全性,评价其短期疗效。方法筛选出我院2018年2月至2019年6月收治的食管癌病例78例,根据是否应用了人工气胸,把这些实施了胸腔镜食管癌切除术的患者分为两组(人工气胸组36例,传统胸腔镜组42例)。收集两组患者一般资料(性别、年龄、肿瘤位置、病理类型)、术中(胸部手术开始后30分钟)和术后(胸部手术结束后30分钟)监测指标(心率、平均动脉压、血氧饱和度、中心静脉压、气道压、呼气末CO2分压、血气分析PH值)、手术短期疗效评价指标(手术时间、术中出血量、术后第一天胸腔引流量、拔管时间、术后住院时间、淋巴结清扫数目、术后并发症(肺部感染、乳糜胸、喉返神经损伤、吻合口瘘))等情况再进行统计学分析。结果纳入实验的78例病人无中转开胸者,均获得手术成功。人工气胸组术中和术后心率均比传统胸腔镜组快(94.6±6.5 VS 86±4.9)、(98.5±5.6 VS 90.8±6.7);人工气胸组术中气道压比传统胸腔镜组高(22.7±1.9 VS 20.9±1.8);呼气末CO2分压比传统胸腔镜组高(38.8±5.6 VS 30.2±4.4);PH值比传统胸腔镜组低(7.27±0.18 VS 30.2±7.38±0.25);术中出血量比传统胸腔镜组少(134.0±46.2 VS184.3±65.8);胸部淋巴结清扫总数目明显比传统胸腔镜组多(18.5±4.2 VS14.6±3.8);清扫的喉返神经旁淋巴结数目比传统胸腔镜组多(4.7±2.4 VS2.8±1.9);喉返神经旁淋巴结阳性数目也比传统胸腔镜组多(1.2±0.4 VS 0.3±0.1);术后喉返神经损伤发生率比传统胸腔镜组低(5.6%VS 21.4%)且有统计学差异。结论人工气胸辅助下胸腔镜食管癌切除术是安全的,较传统胸腔镜方法在减少术中出血、清扫喉返神经旁淋巴结方面有显著优势。更多还原

【Abstract】 Objective:To verify the safety of artificial pneumothorax in thoracoscopic resection of esophageal cancer and evaluate its short-term efficacy..Methods:A total of 78 cases of esophageal cancer admitted to our hospital from February 2018 to June 2019 were screened.These patients who underwent thoracoscopic esophagectomy were divided into two groups according to whether or not they were treated with artificial pneumothorax.Among them 36 cases were in the artificial pneumothorax group and 42 cases were in the traditional thoracoscopic group.Observe and count two groups of patients with general information(gender,age,tumor location,pathological types),intraoperative(chest surgery after 30 minutes)and postoperative(30 minutes after chest surgery)monitoring indicators(heart rate(HR),mean arterial pressure(MAP),blood oxygen saturation(SpO2),central venous pressure(CVP),the end of the airway pressure(Paw),end-tidal CO2 partial pressure(PETCO2),blood gas analysis,PH),surgical short-term curative effect evaluation index(number of the lymph node operation time,intraoperative blood loss,postoperative hospital stay,postoperative chest tube drainage days,extubation time,length of hospital stay,and lymph nodes,postoperative complications(pulmonary infection,chylothorax,recurrent laryngeal nerve injury,anastomotic fistula),etc.Then analysis these data.Results:The 78 patients included in the experiment did not switch to thoracotomy.The heart rates of the artificial pneumothorax group were both faster(94.6±6.5 VS 86±4.9)and(98.5±5.6 VS 90.8±6.7)than those of the traditional thoracoscopic group.The intraoperative airway pressure in the artificial pneumothorax group was higher than that in the conventional thoracoscopic group(22.7±1.9 VS 20.9±1.8).The intraoperative partial expiratory CO2 pressure in the artificial pneumothorax group was higher than that in the traditional thoracoscopic group(38.8±5.6 VS 30.2±4.4).The intraope-ra-tive PH value of the artificial pneumothorax group was lower than that of the traditional thoracoscopic group(7.27±0.18 VS 30.2±7.38±0.25).The intraoperative blood loss in the artificial pneumothorax group was less than that in the traditional thoracoscopic group(134.0±46.2 VS 184.3±65.8).The total number of lymph nodes dissected in the artificial pneumothorax group was significantly higher than that in the traditional thoracoscopic group(18.5±4.2 VS 14.6±3.8).The number of lymph nodes of recurrent laryngeal nerve dissected in the artificial pneumothorax group was higher than that in the traditional thoracoscopic group(4.7±2.4 VS 2.8±1.9).The number of positive paralyngeal lymph nodes in the artificial pneumothorax group was also higher than that in the traditional thoracoscopic group(1.2±0.4 VS 0.3±0.1).The incidence of postoperative recurrent laryngeal nerve injury in the artificial pneumothorax group was lower than that in the conventional thoracoscopic group(5.6% VS 21.4%),and there were statistical differences.Conclusion:Thoracoscopic esophagectomy assisted by artificial pneumothorax is safe and has significant advantages over traditional thoracoscopic method in reducing intraoperative hemorrhage and removing the lymph nodes adjacent to recurrent laryngeal nerve.更多还原