本文選題：胸腔鏡 + 食管癌�。� 參考：《安徽醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的：對(duì)比分析改進(jìn)后的淋巴結(jié)清掃技術(shù)對(duì)全腔鏡食管癌根治術(shù)中區(qū)域淋巴結(jié)清掃的價(jià)值。其價(jià)值主要體現(xiàn)在：胸部手術(shù)時(shí)間(胸部食管游離+淋巴清掃時(shí)間)、胸部出血量、術(shù)后住ICU時(shí)間、清掃縱隔淋巴結(jié)數(shù)目、并發(fā)癥發(fā)生率(主要包括左喉返神經(jīng)損傷發(fā)生率、胸腔出血、氣管及胸導(dǎo)管損傷發(fā)生率以及肺部感染等)。方法：1.將符合入組條件的87例按胸腔部分單肺通氣方式不同分為實(shí)驗(yàn)組(即單腔氣管插管+人工氣胸+食管懸吊方法,42例)和對(duì)照組(雙腔氣管插管,45例)。2.對(duì)比分析2組胸部手術(shù)時(shí)間：包括：左喉返神經(jīng)旁淋巴結(jié)清掃數(shù)量(分別記錄完整淋巴結(jié)數(shù)目及破碎淋巴結(jié)數(shù)目)、左喉返神經(jīng)旁淋巴結(jié)清掃時(shí)間(回顧手術(shù)錄象計(jì)時(shí))、胸部手術(shù)出血量、左喉返神經(jīng)損傷發(fā)生率(術(shù)后聲音嘶啞)其他并發(fā)癥的發(fā)生率(氣管損傷、胸導(dǎo)管損傷、肺部感染等)。結(jié)果：實(shí)驗(yàn)組手術(shù)時(shí)間明顯少于對(duì)照組[(128.3±21.5)min vs (151.7±27.1)min, t=2.467,P=0.016],淋巴結(jié)清掃枚數(shù)更多(19.8±8.8vs17.2±7.5, t=2.184, p=0.032),在術(shù)中出血量、術(shù)后住ICU天數(shù)、住院天數(shù)等方面2組無明顯差別。實(shí)驗(yàn)組喉返神經(jīng)損傷[0 vs 5(11.11%), t=4.951,p=0.026]、肺部感染[1(2.38%) vs 7(15.56%), t=4.516,p=0.034]并發(fā)癥少于對(duì)照組,而其他并發(fā)癥發(fā)生率無明顯區(qū)別。結(jié)論：1、實(shí)驗(yàn)組(即單腔氣管插管+人工氣胸+食管懸吊方法)胸部較對(duì)照組(雙腔氣管插管)節(jié)省手術(shù)時(shí)間,喉返神經(jīng)損傷、肺部感染等并發(fā)癥發(fā)生率低,淋巴結(jié)清掃數(shù)目多；2、在保證淋巴結(jié)清掃數(shù)量前提下,單腔氣管插管+人工氣胸+食管懸吊帶來的手術(shù)技法與操作習(xí)慣的改變,可以降低并發(fā)癥發(fā)生率,并能提高手術(shù)質(zhì)量,增加淋巴結(jié)清掃的徹底性,使患者獲益。
[Abstract]:Objective: to compare and analyze the value of improved lymph node dissection technique for regional lymph node dissection in total endoscopic radical resection of esophageal carcinoma. Its value is mainly reflected in the time of thoracic operation (thoracic esophagus free lymph node dissection time, chest bleeding, postoperative ICU time, the number of mediastinal lymph nodes dissected, the incidence of complications (including the incidence of left recurrent laryngeal nerve injury). Thoracic hemorrhage, trachea and chest duct injury, and pulmonary infection. Method 1: 1. 87 patients who were in accordance with the conditions of admission were divided into experimental group (42 cases) and control group (45 cases with double lumen endotracheal intubation) according to the different ventilation mode of thoracic part of pneumothorax (42 cases with single cavity tracheal intubation) and control group (45 cases with double lumen endotracheal intubation). Comparison and analysis of the time of thoracic surgery in two groups: the number of lymph nodes dissected by the left recurrent laryngeal nerve (including the number of complete lymph nodes and the number of broken lymph nodes and the time of dissection of the left recurrent laryngeal nerve lymph nodes were recorded respectively). Timing, chest surgery, blood loss, Incidence of left recurrent laryngeal nerve injury (postoperative hoarseness) other complications (tracheal injury, thoracic duct injury, pulmonary infection, etc.) Results: the operative time in the experimental group was significantly shorter than that in the control group [128.3 鹵21.5)min vs 151.7 鹵27.1 min, 2.467 21.5)min, 0.016], the number of lymph node dissection was 19.8 鹵8.8vs17.2 鹵7.5, the volume of intraoperative bleeding, the days of postoperative ICU, and the length of hospitalization were not significantly different between the two groups. In the experimental group, the complications of recurrent laryngeal nerve injury [0 vs 5: 11.11, t 4. 951 P 0. 026], pulmonary infection [1 2. 38) vs 7 15. 56%, t 5. 516% p 0. 034] were less than those in the control group, but there was no significant difference in other complications. Conclusion the operation time of the experimental group (single cavity tracheal intubation artificial pneumothorax esophageal suspension method) was less than that of the control group (double lumen tracheal intubation). The incidence of complications such as recurrent laryngeal nerve injury and pulmonary infection was lower in the experimental group than in the control group. The number of lymph node dissection is more than 2. Under the premise of ensuring the number of lymph node dissection, the change of operation technique and operation habit caused by single cavity tracheal intubation artificial pneumothorax esophageal suspension can reduce the incidence of complications and improve the quality of operation. Increase the thoroughness of lymph node dissection to the benefit of patients.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R735.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 陳遂;陳椿;鄭煒;郭朝暉;朱勇;;側(cè)俯臥位全腔鏡食管癌手術(shù)淋巴結(jié)清掃的臨床分析[J];中國微創(chuàng)外科雜志;2013年09期

2 吳奇勇;童繼春;王勇;翟光地;袁衛(wèi)東;毛小亮;張明;張科;陳棟;朱征;袁凱;袁俊強(qiáng);;胸、腹腔鏡聯(lián)合手術(shù)治療食管癌的臨床對(duì)比[J];中國微創(chuàng)外科雜志;2012年12期

3 陳煥文;杜銘;吳慶琛;王顯平;唐文風(fēng);李鋼;;人工氣胸在腔鏡食管癌切除術(shù)中的臨床分析[J];第三軍醫(yī)大學(xué)學(xué)報(bào);2012年08期

4 張琨;許起榮;王文憑;王康寧;苗振軍;陳龍奇;;食管癌淋巴結(jié)清掃數(shù)目與術(shù)后并發(fā)癥的關(guān)系[J];中華胃腸外科雜志;2012年04期

5 郭明;胡蒙;孫曉雁;雷云宏;楊清杰;葉冬青;;全胸腔鏡聯(lián)合非氣腹腹腔鏡輔助食管癌根治術(shù)與常規(guī)手術(shù)的對(duì)比研究[J];中國微創(chuàng)外科雜志;2012年01期

6 邵龍龍;相加慶;;食管癌腔鏡手術(shù)現(xiàn)狀[J];中國癌癥雜志;2011年07期

7 方文濤;陳文虎;;食管癌手術(shù)治療原則和淋巴結(jié)清掃[J];中國癌癥雜志;2011年07期

8 葉中瑞;朱成楚;葉加洪;張銳利;陳保富;葉敏華;馬德華;吳春雷;王春國;;胸、腹腔鏡聯(lián)合微創(chuàng)治療食管癌的應(yīng)用體會(huì)[J];腹腔鏡外科雜志;2011年02期

9 朱坤壽;王楓;張德榮;應(yīng)敏剛;;腹腔鏡聯(lián)合胸腔鏡輔助小切口食管癌根治術(shù)的臨床應(yīng)用[J];腹腔鏡外科雜志;2010年12期

10 陳海泉;相加慶;繆瓏升;胡鴻;羅曉陽;;胸、腹腔鏡聯(lián)合Ivor Lewis食管癌根治術(shù)[J];中國微創(chuàng)外科雜志;2009年08期

，

本文編號(hào)：1851107