BACKGROUND In esophageal squamous carcinoma,lymphadenectomy along the left recurrent laryngeal nerve(RLN)is recommended owing to its highly metastatic potential.However,this procedure is difficult due to limited worki...BACKGROUND In esophageal squamous carcinoma,lymphadenectomy along the left recurrent laryngeal nerve(RLN)is recommended owing to its highly metastatic potential.However,this procedure is difficult due to limited working space in the left upper mediastinum,and increases postoperative complications.AIM To present a novel method for lymphadenectomy along the left RLN during thoracoscopic esophagectomy in the semi-prone position.METHODS The fundamental concept of this novel method is to exfoliate a bilateral pedicled nerve flap,which is a two-dimensional membrane,which includes the left RLN,lymph nodes(LNs)along the left RLN,and tracheoesophageal vessels,by suspending the esophagus to the dorsal side and pushing the trachea to the ventral side(named“bilateral exposure method”).Then,the hollow-out method is performed to transform the two-dimensional membrane to a three-dimensional structure,in which the left RLN and tracheoesophageal vessels are easily distinguished and preserved during lymphadenectomy along the left RLN.This novel method was retrospectively evaluated in 116 consecutive patients with esophageal squamous carcinoma from August 2016 to February 2018.RESULTS There were 58 patients in each group.No significant difference was found between the two groups in terms of age,gender,postoperative pneumonia,anastomotic fistula,and postoperative hospitalization.However,the number of dissected LNs along the left RLN in this novel method was significantly higher than that in the conventional method(4.17±0.359 vs 2.93±0.463,P=0.0447).Moreover,the operative time and the rate of postoperative hoarseness in the novel method were significantly lower than those in the conventional method(306.0±6.774 vs 335.2±7.750,P=0.0054;4/58 vs 12/58,P=0.0312).CONCLUSION This novel method for lymphadenectomy along the left RLN during thoracoscopic esophagectomy in the semi-prone position is much safer and more effective.展开更多
Objectives: This study aimed to evaluate operative benefits of artificial pnuemothorax in thoracoscopic esophagectomy in the left lateral decubitus position. Methods: We retrospectively analyzed short-term surgical ou...Objectives: This study aimed to evaluate operative benefits of artificial pnuemothorax in thoracoscopic esophagectomy in the left lateral decubitus position. Methods: We retrospectively analyzed short-term surgical outcomes including learning curve of 60 consecutive patients who underwent thoracoscopic esophagectomy with artificial pnuemothorax in the left lateral decubitus position between April 2010 and November 2012 in our department. Results: The median operation time and intraoperative blood loss were 443 min and 220 ml, respectively, and these values were 174 min and 95 ml, respectively, in the thoracic phase of surgery. The median number of harvested lymph node was 37. Only 1 patient required conversion to open esophagectomy. The postoperative 30-day mortality rate was 1.7%. The thoracic operation time significantly decreased after an experience of 10 cases and intraoperative blood loss during thoracic phasesignificantly decreased after an experience of 20 cases (p < 0.05), and operation time remained constant for the following cases. The number of harvested lymph nodes did not exhibit significant changes with an increase in the number of case experienced. Conclusions: Artificial pneumothorax provided the shorting of learning curve at the thoracoscopic esophagectomy in the left lateral decubitus position.展开更多
Study Objective: We compared the effects of intraoperative body position on blood gas and fluid balance in patients undergoing a thoracoscopic esophagectomy as well as during operation and postoperative laboratory dat...Study Objective: We compared the effects of intraoperative body position on blood gas and fluid balance in patients undergoing a thoracoscopic esophagectomy as well as during operation and postoperative laboratory data. Design: Prospective study. Setting: Operating room and intensive care unit. Patients: ASA physical status 1 and 2 patients (n = 26), scheduled for elective thoracoscopic esophagectomy and immediate reconstruction under general anesthesia with one-lung ventilation were enrolled. Interventions: Patients were assigned to either the lateral (n = 16) or prone (n = 10) position groups based on the planned intraoperative body position. A pneumothorax procedure was concomitantly performed only in the prone position group. Measurements: Fluid balance, PaO2/FIO2 ratio (P/F ratio), and maximum PaCO2 during the operation and postoperative laboratory data were analyzed. Main Results: There were no significant differences between the groups for amount of blood loss, blood transfusion, fluid infusion, or urine output. The P/F ratio during one-lung ventilation was significantly higher in the prone than the lateral position group (379 ± 122 vs. 297 ± 67 mmHg, p = 0.017), as was maximum intraoperative PaCO2 (72.2 ± 15.6 vs. 48.3 ± 6.3 mmHg, p Conclusions: A thoracoscopic esophagectomy in the prone position performed concomitantly with a CO2 pneumothorax procedure resulted in a significantly better P/F ratio during one-lung ventilation as compared to the lateral position, indicating that the prone position is more advantageous for oxygenation.展开更多
目的 评估经颈、经食管裂孔食管切除术与胸腔镜食管切除术治疗食管癌患者的效果。方法 选取重庆大学附属肿瘤医院2018年9月至2020年10月接受治疗的食管癌患者80例,采用简单随机分组的方法分为观察组和对照组。观察组40例接受经颈、经食...目的 评估经颈、经食管裂孔食管切除术与胸腔镜食管切除术治疗食管癌患者的效果。方法 选取重庆大学附属肿瘤医院2018年9月至2020年10月接受治疗的食管癌患者80例,采用简单随机分组的方法分为观察组和对照组。观察组40例接受经颈、经食管裂孔食管切除术,对照组40例接受胸腔镜食管切除术。比较两组患者术中出血、清扫纵隔淋巴结总数、手术时间、左或右侧喉返神经旁淋巴结清扫数量、入住ICU时间、术后疼痛评分、术后住院时间、PO_(2)/FIO_(2)、术后肺部感染和淋巴结转移等情况。结果 80例患者均顺利完成手术。结果显示,观察组的手术时间少于对照组(200 min vs 235 min,Z=-3.700,P<0.001)。观察组的左侧喉返神经旁淋巴结清扫数量多于对照组(25.0%vs 2.5%,Z=2.568,P=0.010)。两组术后第1天(0%vs 17.5%,Z=-4.292,P<0.001)和第3天(12.5%vs 37.5%,Z=-3.363,P<0.001)疼痛评分、术后48 h PO_(2)/FIO_(2)(290 min vs 255 min,Z=3.747,P<0.001)、住院时间(7 d vs 8 d,Z=-2.119,P=0.034)、并发肺部感染率(χ^(2)=4.114,P=0.043)差异均有统计学意义。结论 经颈、经食管裂孔切除术是治疗食管癌患者一种较好的手术方式,可为不能行开胸手术的患者提供治疗机会。展开更多
目的分析术前肺功能指标与食管癌微创术后肺部感染的关系,为预防和控制医院感染提供研究依据。方法选取2017年10月至2019年10月的198例食管癌患者作为研究对象,患者均行胸腹腔镜食管癌根治术,根据是否发生肺部感染将患者分为感染组和未...目的分析术前肺功能指标与食管癌微创术后肺部感染的关系,为预防和控制医院感染提供研究依据。方法选取2017年10月至2019年10月的198例食管癌患者作为研究对象,患者均行胸腹腔镜食管癌根治术,根据是否发生肺部感染将患者分为感染组和未感染组,经单因素、多因素分析术后肺部感染相关因素。结果198例食管癌患者,36例患者发生肺部感染,感染率为18.18%,感染组患者的年龄、合并糖尿病患者比例、合并冠心病患者比例高于未感染组,术前1秒用力呼气容积(forced expiratory volume in one second,FEV_(1))、术前呼气峰值流量峰值(peak expiratoryflow,PEF)低于未感染组,差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示,合并糖尿病、术前FEV_(1)、术前PEF是影响胸腹腔镜食管癌根治术后肺部感染的主要因素,其中,术前FEV_(1)、术前PEF是保护性因素。结论合并糖尿病、术前FEV_(1)、术前PEF是微创食管癌根治术后感染的主要影响因素,临床医师应重视对于患者术前肺功能的评价和干预,以达到减少术后感染、确保手术效果、改善预后的目的。展开更多
文摘BACKGROUND In esophageal squamous carcinoma,lymphadenectomy along the left recurrent laryngeal nerve(RLN)is recommended owing to its highly metastatic potential.However,this procedure is difficult due to limited working space in the left upper mediastinum,and increases postoperative complications.AIM To present a novel method for lymphadenectomy along the left RLN during thoracoscopic esophagectomy in the semi-prone position.METHODS The fundamental concept of this novel method is to exfoliate a bilateral pedicled nerve flap,which is a two-dimensional membrane,which includes the left RLN,lymph nodes(LNs)along the left RLN,and tracheoesophageal vessels,by suspending the esophagus to the dorsal side and pushing the trachea to the ventral side(named“bilateral exposure method”).Then,the hollow-out method is performed to transform the two-dimensional membrane to a three-dimensional structure,in which the left RLN and tracheoesophageal vessels are easily distinguished and preserved during lymphadenectomy along the left RLN.This novel method was retrospectively evaluated in 116 consecutive patients with esophageal squamous carcinoma from August 2016 to February 2018.RESULTS There were 58 patients in each group.No significant difference was found between the two groups in terms of age,gender,postoperative pneumonia,anastomotic fistula,and postoperative hospitalization.However,the number of dissected LNs along the left RLN in this novel method was significantly higher than that in the conventional method(4.17±0.359 vs 2.93±0.463,P=0.0447).Moreover,the operative time and the rate of postoperative hoarseness in the novel method were significantly lower than those in the conventional method(306.0±6.774 vs 335.2±7.750,P=0.0054;4/58 vs 12/58,P=0.0312).CONCLUSION This novel method for lymphadenectomy along the left RLN during thoracoscopic esophagectomy in the semi-prone position is much safer and more effective.
文摘Objectives: This study aimed to evaluate operative benefits of artificial pnuemothorax in thoracoscopic esophagectomy in the left lateral decubitus position. Methods: We retrospectively analyzed short-term surgical outcomes including learning curve of 60 consecutive patients who underwent thoracoscopic esophagectomy with artificial pnuemothorax in the left lateral decubitus position between April 2010 and November 2012 in our department. Results: The median operation time and intraoperative blood loss were 443 min and 220 ml, respectively, and these values were 174 min and 95 ml, respectively, in the thoracic phase of surgery. The median number of harvested lymph node was 37. Only 1 patient required conversion to open esophagectomy. The postoperative 30-day mortality rate was 1.7%. The thoracic operation time significantly decreased after an experience of 10 cases and intraoperative blood loss during thoracic phasesignificantly decreased after an experience of 20 cases (p < 0.05), and operation time remained constant for the following cases. The number of harvested lymph nodes did not exhibit significant changes with an increase in the number of case experienced. Conclusions: Artificial pneumothorax provided the shorting of learning curve at the thoracoscopic esophagectomy in the left lateral decubitus position.
文摘Study Objective: We compared the effects of intraoperative body position on blood gas and fluid balance in patients undergoing a thoracoscopic esophagectomy as well as during operation and postoperative laboratory data. Design: Prospective study. Setting: Operating room and intensive care unit. Patients: ASA physical status 1 and 2 patients (n = 26), scheduled for elective thoracoscopic esophagectomy and immediate reconstruction under general anesthesia with one-lung ventilation were enrolled. Interventions: Patients were assigned to either the lateral (n = 16) or prone (n = 10) position groups based on the planned intraoperative body position. A pneumothorax procedure was concomitantly performed only in the prone position group. Measurements: Fluid balance, PaO2/FIO2 ratio (P/F ratio), and maximum PaCO2 during the operation and postoperative laboratory data were analyzed. Main Results: There were no significant differences between the groups for amount of blood loss, blood transfusion, fluid infusion, or urine output. The P/F ratio during one-lung ventilation was significantly higher in the prone than the lateral position group (379 ± 122 vs. 297 ± 67 mmHg, p = 0.017), as was maximum intraoperative PaCO2 (72.2 ± 15.6 vs. 48.3 ± 6.3 mmHg, p Conclusions: A thoracoscopic esophagectomy in the prone position performed concomitantly with a CO2 pneumothorax procedure resulted in a significantly better P/F ratio during one-lung ventilation as compared to the lateral position, indicating that the prone position is more advantageous for oxygenation.
文摘目的 评估经颈、经食管裂孔食管切除术与胸腔镜食管切除术治疗食管癌患者的效果。方法 选取重庆大学附属肿瘤医院2018年9月至2020年10月接受治疗的食管癌患者80例,采用简单随机分组的方法分为观察组和对照组。观察组40例接受经颈、经食管裂孔食管切除术,对照组40例接受胸腔镜食管切除术。比较两组患者术中出血、清扫纵隔淋巴结总数、手术时间、左或右侧喉返神经旁淋巴结清扫数量、入住ICU时间、术后疼痛评分、术后住院时间、PO_(2)/FIO_(2)、术后肺部感染和淋巴结转移等情况。结果 80例患者均顺利完成手术。结果显示,观察组的手术时间少于对照组(200 min vs 235 min,Z=-3.700,P<0.001)。观察组的左侧喉返神经旁淋巴结清扫数量多于对照组(25.0%vs 2.5%,Z=2.568,P=0.010)。两组术后第1天(0%vs 17.5%,Z=-4.292,P<0.001)和第3天(12.5%vs 37.5%,Z=-3.363,P<0.001)疼痛评分、术后48 h PO_(2)/FIO_(2)(290 min vs 255 min,Z=3.747,P<0.001)、住院时间(7 d vs 8 d,Z=-2.119,P=0.034)、并发肺部感染率(χ^(2)=4.114,P=0.043)差异均有统计学意义。结论 经颈、经食管裂孔切除术是治疗食管癌患者一种较好的手术方式,可为不能行开胸手术的患者提供治疗机会。
文摘目的分析术前肺功能指标与食管癌微创术后肺部感染的关系,为预防和控制医院感染提供研究依据。方法选取2017年10月至2019年10月的198例食管癌患者作为研究对象,患者均行胸腹腔镜食管癌根治术,根据是否发生肺部感染将患者分为感染组和未感染组,经单因素、多因素分析术后肺部感染相关因素。结果198例食管癌患者,36例患者发生肺部感染,感染率为18.18%,感染组患者的年龄、合并糖尿病患者比例、合并冠心病患者比例高于未感染组,术前1秒用力呼气容积(forced expiratory volume in one second,FEV_(1))、术前呼气峰值流量峰值(peak expiratoryflow,PEF)低于未感染组,差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示,合并糖尿病、术前FEV_(1)、术前PEF是影响胸腹腔镜食管癌根治术后肺部感染的主要因素,其中,术前FEV_(1)、术前PEF是保护性因素。结论合并糖尿病、术前FEV_(1)、术前PEF是微创食管癌根治术后感染的主要影响因素,临床医师应重视对于患者术前肺功能的评价和干预,以达到减少术后感染、确保手术效果、改善预后的目的。
