Ivor-Lewis手术在老年中下段食管癌患者中的应用  

Application of Ivor-Lewis esophagectomy in elderly patients with carcinoma in middle and lower esophagus

作　　者：刘向明[1] 于振涛[1] 赵锡江[1] 张熙曾[1] 

机构地区：[1]天津医科大学肿瘤医院胸外科,300060

出　　处：《中华胃肠外科杂志》2011年第9期699-701,共3页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨Ivor-Lewis手术治疗老年中下段食管癌患者的安全性。方法前瞻性人组2009年6月至2010年6月天津医科大学肿瘤医院老年（60岁以上）中下段食管癌患者232例．按随机数字表法分为Ivor-Lewis手术组（116例．取右胸后外侧及上腹正中切口）和Sweet手术组（116例，取左胸后外侧切口），比较两组术中及术后情况。结果Ivor—Lewis手术组与Sweet手术组根治性切除率分别为95．7％（111／116）和92．2％（107／116）（P〉0．05）；开胸手术时间分别为（47．2±5．2）min和（105．4±9．3）min（P=0．000）。术后呼吸衰竭发生率分别为1．7％（2／116）和6．9％（8／116）（P=0．049）；室上性心律失常发生率分别为3．4％（4／116）和10．3％（12／116）（P=0．035）；总并发症发生率分别为22．4％（26／116）和34．5％（40／116）（P=O．004）；围手术死亡率分别为1．7％（2／116）和3．4％（4／116）（P〉O．05）。两组术后下床活动时间分别为（4．0±2．0）d和（4．8±3．7）d（P＝0．046）；术后住院时间分别为（11．5±4．7）d和（13．7±7．8）d（P=0．008）。结论Ivor—Lewis手术具有不损伤膈肌、胸腔内手术时间短、对心肺功能影响小、术后并发症少、恢复快的优势，可考虑作为老年中下段食管癌的首选手术方式。Objective To evaluate the safety of Ivor-Lewis procedure for middle and lower esophageal carcinoma in the elderly. Methods From June 2009 to June 2010, 232 cases aged over 60 years were diagnosed as esophageal carcinoma. These cases were randomly divided into two groups using table of random digits. One group underwent abdominal and right chest approaches for middle and lower esophageal carcinoma （Ivor-Lewis procedure, n=116）. The other group underwent posterolateral left thoracal incisions （Sweet procedure,n =116）. Intraoperative and postoperative parameters were compared. Results The radical resection rates in Ivor-Lewis and Sweet procedure were 95.7% and 92.2% respectively （P〉0.05）. The time required for opening the thorax was （47.2±5.2） min and （105.4±9.3） min（P=0.000）, respectively. The respiratory failure rates were 1.7% and 6.9%（P=0.049）. The incidences of supraventricular tachyarrhythmia were 3.4% and 10.3% , respectively. The overall complication rates were 22.4% and 34.5%（P=0.004）. The perioperative mortalities were 1.7% and 3.4%（P〉0.05）. The postoperative ambulation time was （4.0±2.0） d and （4.8±3.7） d（P=0.046）. The postoperative time in hospital was （11.5±4.7） d and （13.7±7.8） d （P=0.008）. Conclusions Ivor-Lewis procedure is associated with little damage to diaphragm, shorter intrathoracic operative time, minimal influence on cardiopulmonary function, less postoperative complications, and quicker recovery. This procedure should be considered as the first choice for middle and lower esophageal carcinoma in the elderly.

关 键 词：食管肿瘤 老年人 外科手术 术后并发症 

分 类 号：R735.1[医药卫生—肿瘤]