Efficacy And Safety Of Mediastinoscopy Combined With Laparoscopy Or Thoracoscopy Combined With Laparoscopy In The Treatment Of Esophageal Cancer

Objective: To use Meta analysis to objectively evaluate the differences between intraoperative and postoperative indicators and complications of mediastinoscopy combined with/synchronous laparoscopy(VAMS)or thoracoscopy combined with laparoscopy(VATS)in the treatment of esophageal tumors,so as to determine mediastinoscopy or thoracoscopy to compare the differences in the safety and effectiveness in the treatment of esophageal cancer,at the same time,the combined use of inflatable mediastinoscopy combined with/synchronous laparoscopic radical esophageal cancer surgery was applied clinically to evaluate its effectiveness and safety.Methods: 1.Formulate search formulas according to PICO principles,use computer search to publicly publish in Pubmed,CBM,Embase,Cochrane Library,Science Direct,CNKI,Wanfang Data and VIP for all Chinese and English literatures on the comparative study of mediastinoscopy combined with laparoscopy resection of esophageal tumors and thoracoscopy combined with laparoscopic resection of esophageal tumors,retrieved from 1990 to December 2019,according to the confirmed inclusion and the exclusion criteria select the acquired documents again,evaluate the quality of the selected documents,and finally perform a meta-analysis onthe outcome indicators of the selected documents(using RevMan 5.3).2.By statistically analyzing the clinical data,related intraoperative and postoperative indicators and complications of patients undergoing the inflation mediastinoscopy combined with laparoscopic esophageal cancer radical surgery in the affiliated hospital of Zunyi Medical University,preliminary analysis of the inflation mediastinoscopy combined with laparoscopic esophageal cancer radical resection the advantages and disadvantages.Results: 1.Finally,8 articles were included,including 8 cohort studies,with a total of 565 patients.Meta analysis results showed that the time required for surgery in the mediastinoscopy group was(MD=-075.23,95%CI[-103.57,-46.90],P<0.05),and the result of intraoperative blood loss was(MD=-93.04,95% CI[-154.72,-31.36],P<0.05),the total postoperative hospital stay results(MD=-2.52,95% CI[-3.16,-1.87],P<0.05),and the pain score on the first postoperative day was(MD=-1.04,95%CI[-1.49,0.58],P<0.05).The results of postoperative gastric emptying delay were(RR=0.14,95%CI[0.03,0.77],P<0.05).The above operation effect of the mediastinoscopy group is better than the other group.However,compared with the two,the number of lymph node dissections was(MD=-4.19,95%CI[-8.52,0.13],P>0.05),and the result of the total drainage volume three days after surgery was(MD=-569.09,95%CI[-1231.45,93.27],P>0.05),postoperative complications of lung infection(RR=0.74,95%CI[0.40,1.36],P>0.05),postoperative complications of recurrent laryngeal nerve injury(RR=1.20,95%CI[0.57,2.53],P>0.05),the result ofpostoperative complicated wound infection was(RR=1.31,95%CI[0.43,3.95],P>0.05),the result of postoperative complicated chylothorax was(RR=0.46,95%CI[0.14,1.46],P>0.05),postoperative complications of anastomotic fistula(RR=1.22,95%CI[0.61,2.44],P>0.05),postoperative complications of arrhythmia(RR= 1.80,95%CI[1.00,3.26],P=0.05),the result of re-opening the chest after surgery was(RR=0.93,95%CI[0.22,3.92],P>0.05),there was no significant statistical difference between the two.2.Four patients underwent inflatable mediastinoscopy combined with laparoscopic esophagectomy.One patient had anastomotic leakage and two patients had a small amount of unilateral pleural effusion.There was no long-term complication after one and a half years of follow-up.Conclusion: 1.Mediastinoscopy combined with laparoscopic resection of esophageal tumors compared with thoracoscopy combined with laparoscopic resection of esophageal tumors,the operation time is short,the amount of blood loss during operation is short,the postoperative hospital stay is short,the degree of pain on the first postoperative day is mild,and the postoperative complications there are few cases of delayed gastric emptying.2.Analyze the results of inflatable mediastinoscopy combined with laparoscopic radical esophageal cancer radical resection in 4 patients with inflatable mediastinoscopy: this method is beneficial to protect nerves,and mediastinal inflation makes the operation space significantly increase;intraoperative double lung ventilation reduces postoperative pulmonary complications;the left recurrent laryngeal nerve is well exposed,and the lymph nodesof the recurrent laryngeal nerve are completely cleared;patients with poor lung function,or severe tuberculosis in the chest cavity,patients with dense chest adhesions can still be operated,and the surgical indications are appropriately expanded;the operation time is significantly shortened;at present,the effect is better recently;it is more minimally invasive than traditional thoraco-laparoscopy.