三切口食管癌根治术：胸腔镜与开放手术的回顾性研究  

A retrospective study for Ivor.Lewis and McKeown esophagectomy：mininally invasive versus open esophagectomy

作　　者：李京沛[1] 谭黎杰[1] 王群[1] 汪灏[1] 冯明祥[1] 范虹[1] 徐松涛[1] 蒋伟[1] 钱成[1] 葛棣[1] 徐正浪[1] 沈亚星[1] 张毅[1] 

机构地区：[1]复旦大学附属中山医院胸外科,上海200032

出　　处：《中华胸心血管外科杂志》2013年第6期339-341,361,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的比较胸腔镜和开胸三切口食管癌根治术的围手术期并发症及中期疗效。方法回顾性分析2005年1月至2012年6月间复旦大学附属中山医院胸外科收治827例接受三切口食管癌根治术患者的临床资料，其中胸腔镜482例和常规开胸345例。比较两组的围手术期相关指标及中期生存情况。结果与开胸组相比，胸腔镜手术组平均淋巴结清扫个数更多[（28．3±5．1）个对（27．4±5．6）个，P=0．017]，术后住院时间短[（14．6±5．6）天对（16．9±9．3）天，P=0．000]，再入ICU率低（5．6％对10．1％，P=0．014），围手术期病死率低（1．0％对3．2％，P=0．027），围手术期总体并发症少（37．6％对44．9％，P=0．033），呼吸系统并发症少（9．3％对13．9％，P=0．040）。胸腔镜组术后1年、2年、3年生存率略优于开胸组，但组间差异均无统计学意义。结论胸腔镜与开胸手术与三切口食管癌根治术相比，围手术期疗效优势比较明显，中期疗效的优势尚有待于进一步验证。Objective To determine if thoracoscopic minimally invasive esophagectomy enables greater perioperative and medium-term clinic outcome than open thoracic esophagectomy for esophageal carcinoma. Methods From January 2005 to June 2012, 482 patients with esophageal carcinoma received thoracoscopic minimally invasive esophagectomy （ MIE group）, while 322 patients underwent conventional open thoracic esophagectomy （ OE group）. Perioperative and medium-term clinic outcome were compared between the two groups. Results The clinical data were comparable, and no significant difference was found in demographics between the two groups. Compared with OE group, MIE group has more retrieved lymph nodes （28.3 ＋ 5.1 vs. 27.4 ＋ 5.6, P = 0.017 ）, less postoperative hospital stay [ （ 14.6 ＋ 5.6 ） days vs. （ 16.9 ＋ 9.3 ） days, P = 0. 000 ], less rate of readmission to ICU （5.6% vs. 10.1% , P =0. 014） , less total perioperative complications（37.6% vs. 44.9% , P = 0. 033 ） and less pulmonary complication （ 9.3 % vs. 13.9% , P = 0. 040 ）. Lower mortality rate was also found in MIE group than OE group （1.0% vs. 3.2%, P = 0. 027 ）. No statistical significance in pathologic staging was found between the OE and MIE groups. Generally, no statistically significant difference was found between the OE and MIE groups for survival within each time interval （ 1, 2, and 3 years） , although the difference favored the MIE group. Conclusion Tberacoscopic minimally invasive esophagectomy has some advantages than open procedure in the aspect of surgical safety, while the medium- term outcome benefits fail to reach statistic advantage.

关 键 词：食管肿瘤 胸外科手术 电视辅助 微创食管切除术 总体生存率 

分 类 号：R735.1[医药卫生—肿瘤]