微创McKeown与Ivor-Lewis手术治疗中下段食管癌临床分析

摘要

目的：分析比较微创McKeown与Ivor-Lewis手术治疗中下段食管癌的临床疗效，为中下段食管癌患者选择合适的手术方案提供临床依据。方法：回顾性分析于本院进行微创McKeown手术（26例）与Ivor-Lewis手术（21例）患者的临床资料，比较两种手术方式患者的围手术期资料及术后并发症情况。结果：Ivor-Lewis组手术时间短于McKeown组，术后拔管时间长于McKeown组，比较差异均有统计学意义（P<0.05）；两组术中出血量、淋巴结清扫个数、住院时间比较，差异均无统计学意义（P>0.05）。两组总并发症发生率比较，差异无统计学意义（P>0.05）；McKeown组吻合口瘘及肺部感染发生率均高于Ivor-Lewis组，比较差异均有统计学意义（P<0.05），但两组吻合口狭窄、喉返神经损伤、反流症状发生情况比较，差异均无统计学意义（P>0.05）。结论：微创McKeown与Ivor-Lewis手术均为治疗中下段食管癌的理想术式，但微创Ivor-Lewis手术与微创McKeown手术相比其手术时间相对缩短，并且具有较低的吻合口瘘及术后肺部感染发生率，具有更好的临床应用价值。%Objective:To analyze and compare the clinical effect of minimal invasive McKeown and Ivor-Lewis surgery in the treatment of middle-lower section esophageal cancer in order to provide clinical basis for the middle-lower section esophageal cancer patients to choose the appropriate operation plan.Method:The clinical data of patients with minimal invasive McKeown surgery(26 cases)and patients with Ivor-Lewis surgery(21 cases)were retrospectively analyzed.The perioperative data and the incidence of postoperative complications were compared in patients with different operation methods.Result:The operation time of the Ivor-Lewis group was less than that of the McKeown group,the extubated time of the Ivor-Lewis group was longer than that of McKeown group,the differences were statistically significant(P<0.05).The differences in the blood loss,number of lymph node cleaning,hospital stays and total incidence rate of complications between the two groups were not statistically significant(P>0.05). The incidence rates of anastomotic fistula and lung infection in the McKeown group were higher than those in the Ivor-Lewis group,the differences were statistically significant(P<0.05).The differences in the incidence of anastomotic stenosis, injury of recurrent nerve and reflux symptoms were not statistically significant(P>0.05).Conclusion:Both minimal invasive McKeown and Ivor-Lewis surgery are the ideal operation for the treatment of middle-lower section esophageal cancer.But minimal invasive Ivor-Lewis surgery has less operation time,lower incidence rates of anastomotic fistula and lung infection,which has a good clinical application value.