微创Ivor-Lewis手术与McKeown手术治疗食管癌的短期疗效比较

摘要

目的 对比观察两种不同术式(Ivor-Lewis和McKeown)下微创食管切除术(minimal invasive esophagectomy,MIE)治疗食管癌的短期疗效.方法 回顾性分析2014年1 1月-2016年5月在本院接受MIE治疗的食管癌患者的临床资料.对比Ivor-Lewis组和McKeown组的术中指标(手术时间、术中出血量、中转开胸、开腹率)和术后结果(严重并发症发生率、死亡率、疼痛评分、住院时间和生活质量).结果 接受Ivor-Lewis手术和McKeown手术的患者数量分别为120例和65例,两组患者的基线资料无统计学差异.但微创Ivor-Lewis组肿瘤位置主要位于胸中下段,微创McKeown组肿瘤位置主要位于胸中上段.两组术中出血量、中转开胸或开腹次数、手术时间、术后住院时间差异无统计学意义.微创Ivor-Lewis组手术时间较微创McKeown组稍长[(314-± 45) min vs (303±37) min],但差异无统计学意义.微创Ivor-Lewis组吻合口瘘和喉返神经损伤发生率明显低于微创McKeown组(2.5％vs 12.3％,0.8％ vs 9.2％,P均＜0.05),而肺部并发症、乳糜胸、胃排空障碍、心律失常、转入ICU例数发生率无统计学差异.180例(97.3％)获得随访,随访1～18(8.4±6.8)个月.两组患者随访期间反酸、吞咽困难、排空障碍、胸部不适等情况均无统计学意义.结论 本研究初步显示,微创McKeown和Ivor-Lewis手术治疗食管癌均具有可行性、安全性和良好的近期临床疗效.%Objective To compare the short-term outcomes of minimal invasive Ivor-Lewis esophagectomy and McKeown esophagectomy in the treatment of esophageal cancer.Methods Clinical data about patients with esophageal cancer who had undergone minimal invasive esophagectomy (MIE) in the department of thoracic surgery of Chinese PLA General Hospital from November 2014 to May 2016 were collected and analyzed.Baseline characteristics were compared for comparability assessment and intra-and post-operative outcomes were analyzed for comparison of minimal invasive Ivor-Lewis esophagectomy and McKeown esophagectomy.Results Totally 120 patients underwent minimal invasive Ivor-Lewis and 65 patients with minimal invasive McKeown.No significant difference was found in baseline data between two groups of patients except tumor location.There was no significant difference between two groups in terms of intra-operative blood loss,rate of transition to thoracotomy or laparotomy,operating time,hospital stay,postoperative pain index and number of resected lymph nodes.The operating time of Ivor-Lewis group was a bit longer than that of McKeown group [(314 ± 450 min vs (303 ± 37) mini,but the difference was not significant.The incidences of anastomotic fistula and laryngeal recurrent nerve injury were significantly lower in the Ivor-Lewis group than those in the McKeown group [2.5％ vs 12.3％ (P=0.02),0.8％ vs 9.2％ (P=0.04)],while there was no significant difference in terms of other complications including pulmonary complications,chylothorax,delayed gastric emptying and cardiac arrhythmia.One hundred and eighty (97.3％) patients were followed up with median follow-up of (8.4 ± 6.8) months (ranging from 1 to 18 months).No statistically significant difference was found in acid reflux,difficulties in swallowing,emptying dysfunction,chest discomfort between patients in two groups during follow-up.Conclusion This study indicates that,though minimally invasive McKeown esophagectomy has a natural advantage of complete resection,Ivor-Lewis surgery has a lower incidence of anastomotic fistula and laryngeal recurrent nerve paralysis.For patients with esophageal cancer located in the middle and the lower part,it still needs to be further studied to assess whether McKeown is the best choice.