微創(chuàng)McKeown食管癌手術(shù)中氣管免牽拉優(yōu)先處理左喉返神經(jīng)旁淋巴結(jié)的經(jīng)驗(yàn)分享

Experience sharing of clearing the leftrecurrent laryngeal nerve lymph nodeas priority without tracheal traction in minimally invasive McKeown esophagectomy

YangGenrong，WangHan，ZhaoMingli

Department of Thracic Surgery，theFirst Hospital of Henan University of Traditional Chinese Medicine，

Zhengzhou 450000， China

【Abstract】ObjectiveTo summarize the experience of clearing the left recurrent laryngeal nerve lymph nodeas priority without tracheal traction in minimall invasive McKeown esophagectomy.MethodsA total of12 cases of minimally invasive McKeown esophagectomy from Sep 2023 to Sep 2O24 were selectedand the left recurrent laryngeal nerve （RLN） lymph nodes were removed preferentiallywithout tracheal traction.ResultsAll the operations on chest were successully completed without serious bleeding or other complications.It took （12.8± 3.7）min tocleartheleftrecurrntlaryngealnerve.The timeof chestoperation isabout （63.8±7.3）min，bleeding （47.0±17.3）ml，there were （3.1±0.9）left recurrent laryngeal nerve lymph nodes wereremoved.Hoarseness occurred in1 caseand recovered after 5 weeks，postoperative pulmonary infection occurred in1 case.Conclusion Clearingtheleftrecurrentlaryngeal nervelymph nodesaspriority treatment issafeand feasibleinminimally invasive McKeown esophagectomy.Itcanavoid theviolent injury tothe tracheaand isworthyofclinical promotion.

【Key words】 Esophageal neoplasms; Recurrent larynageal nerve; Lymph node excisionDOI：10.19522/j.cnki.1671-5098.2025.02.019

微創(chuàng)McKeown食管癌根治術(shù)是目前治療食管癌的主要方式之一，具有創(chuàng)傷小、恢復(fù)快、疼痛輕等優(yōu)點(diǎn)，被越來(lái)越多的胸外科醫(yī)生所廣泛開(kāi)展，喉返神經(jīng)旁淋巴結(jié)清掃在食管癌根治術(shù)中意義重大，可以顯著提高患者的術(shù)后生存率，但術(shù)中喉返神經(jīng)旁淋巴結(jié)的清掃難度較大，這主要是因?yàn)樯峡v隔空間狹小、難以顯露，尤其是左喉返神經(jīng)旁淋巴結(jié)的清掃，暴露不清或操作不當(dāng)極易引起神經(jīng)損傷，甚至導(dǎo)致嚴(yán)重的術(shù)后并發(fā)癥[2]。（剩余4536字）