Comparasion Of Video-assisted Thoracoscopic Esophagectomy With Artificial Pneumothorax And Traditional Video-assisted Thoracoscopic Esophagectomy

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.