目的探讨电视胸腔镜3D模式与2D模式食管癌胸部手术的优缺点。方法2013年7月～2015年5月我科53例食管癌采用3D-VATS（3D组），51例采用2D-VATS（2D组），比较手术时间、出血量、淋巴结清扫数目、术后24 h引流量、总引流量、胸腔闭式引流管带管时间及术后并发症发生情况。结果104食管癌均在胸腔镜下完成胸部手术。3D组手术时间（63．4±3．3）min，明显短于2D组（71．7±5．1）min（t＝－9．891，P＝0．000）；出血量（53．1±5．5）ml，明显少于2D组（66．9±9．4）ml（t＝－9．180，P＝0．000）；淋巴结清扫数目（14．8±2．9）枚，明显多于2D组（13．1±2．0）枚（t＝3．467，P＝0.000）。3D组术后24 h引流量（196．2±34．2）ml，与2D组（205．0±32．4）ml差异无统计学意义（t＝－1．346，P＝0．181）；总引流量（579．2±59．4）ml，与2D组（599．8±56．5） ml差异无统计学意义（t＝－1．811，P＝0．073）；胸腔闭式引流管带管时间（4．7±0．6）d，与2D组（5．1±1．4）d差异无统计学意义（t＝－1．906，P＝0．059）；2组术后心率失常、肺部感染、吻合口漏、喉返神经损伤发生率无统计学差异（P＞0．05）。2组1年生存率无统计学差异（log-rank χ2＝0．435，P＝0．510）。结论电视胸腔镜3D模式下食管癌胸部手在手术时间、出血量、淋巴结清扫数目较2D模式下有一定的优势，在24 h引流量、总引流量、胸腔带管时间和术后并发症上无明显差异。%Objective To study the advantages and disadvantages of 3D and 2D mode in the video-assisted thoracoscopic surgery ( VATS) for esophageal carcinoma . Methods A retrospective analysis was made on 104 cases of esophageal cancer between July 2013 and May 2015 in our hospital.The patients were divided into either 3D-VATS group (53 cases) or 2D-VATS group (51 cases).The operation time, intraoperative bleeding, lymph node resected, drainage volume by the first 24 hours, total drainage volume, chest tube indwelling time and postoperative complications were compared between the two groups . Results All the 104 patients with esophageal cancer underwent chest surgery successfully .The surgery time was shorter in the 3D-VATS group (63.4 ±3.3 min) than that in the 2D-VATS group (71.7 ±5.1 min), with statistical significance (t=-9.891, P=0.000).The intraoperative bleeding was less in the 3D-VATS group (53.1 ±5.5 ml) than that in the 2D-VATS group (66.9 ±9.4 ml), with statistical significance (t=-9.180, P=0.000).The lymph nodes resected were more in the 3D-VATS group (14.8 ±2.9) than in that the 2D-VATS group (13.1 ±2.0), with statistical significance (t=3.467, P=0.000).The drainage volume by the first 24 hours was less in the 3D-VATS group (196.2 ±34.2 ml) than that in the 2D-VATS group (205.0 ±32.4 ml), without statistical difference (t=-1.346, P=0.181).The total drainage volume was less in the 3D-VATS group (579.2 ±59.4 ml) than that in the 2D-VATS group (599.8 ±56.5 ml), without statistical difference (t=-1.811, P=0.073).The chest tube indwelling time was less in the 3D-VATS group (4.7 ±0.6 d) than that in the 2D-VATS group (5.1 ±1.4 d), without statistical difference (t=-1.906, P=0.059).The postoperative complications , such as arrhythmia , pulmonary infection , anastomotic leakage , or recurrent laryngeal nerve injury , had no obvious difference between the two groups (P>0.05).No significant difference was found in the 1-year survival rate between the two groups (log-rankχ2 =0.435, P=0.510). Conclusions Video-assisted thoracoscope thoracic operation of esophagectomy under 3D mode has certain advantages than 2D mode in operation time , intraoperative bleeding , and lymph node resected .While no obvious differences were found in the drainage volume by 24 hours, total drainage volume, chest tube indwelling time and postoperative complications .
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