腔镜与开胸食管癌切除术围术期并发症的比较  

Comparative study of perioperative complication between minimally invasive esophagectomy and open thoracotomy for esophageal carcinoma

作　　者：宋宇[1] 张真铭[1] 陈龙奇[1] 刘伦旭[1] 赵雍凡[1] 林一丹[1] 伍伫[1] 寇瑛莉[1] 车国卫[1] 胡杨[1] 王允[1] 

机构地区：[1]四川大学华西医院胸外科,成都610041

出　　处：《中华胸心血管外科杂志》2013年第6期346-348,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：四川省科技厅科技攻关项目（004020531678）

摘　　要：目的比较腔镜食管肿瘤切除与Sweet、Ivor—Lewis和McKeown3种开胸食管肿瘤切除术式的围术期并发症发生率。方法2012年2月至2013年2月，四川大学华西医院822例食管癌切除手术，经左胸（Sweet）673例，上腹右胸（Ivor—Lewis）37例，颈胸腹三切口（McKeown）19例，腔镜辅助（MIE）93例，回顾性分析患者的临床资料。结果4种手术组患者年龄、腹腔及中下纵隔淋巴结清扫数目、术后并发症肺部感染、吻合口瘘、膈疝、乳糜胸、胃排空障碍、死亡的发生率等方面的差异均无统计学意义（P〉0．05）。上纵隔淋巴结清扫数目McKeown组（4.05±4．29）枚和MIE组（3．16±2．34）枚高于Sweet组（1．40±2．28）枚和Ivor-Lewis组（1．11±1．82）枚，P〈0．001。手术时间MIE组（363．63±98．27）min明显高于Sweet组（199．51±46．75）min、Nor-Lewis组（241．76±71．88）min及McKeown组（271．05±92．30）min，P〈0．001。术后患者呼吸衰竭的发生率McKeown组（10．5％，2／19）高于Sweet组（1．3％，9／673）、Ivor-Lewis组（2．7％，1／37）和MIE组（3．2％，3／93），P=0．046；声音嘶哑MIE组（4．3％，4／93）高于Sweet组0．3％（2／673）、Ivor-Lewis组（0）和McKeown组（0），P〈0．001。MIE小手术量组的手术时间高于大手术量组[（418．10±133．42）min对（337．70±62．31）min，P〈0．001]。结论三切口食管癌切除能够获得较左开胸、上腹右胸更彻底的上纵隔淋巴结清扫，腔镜的应用可能有助于降低术后呼吸道并发症发生率。Objective To compare the differences of the incidence of perioperative complication between minimally in- vasive esophageetomy and three open thoracotomy（ Sweet, Ivor-Lewis, McKeewn） for esophageal carcinoma. Methods Clini- cal data of 822 esophageal cancer patients in West China hospital of sichuan university between February 2012 and February 2013 dissected by eight surgeons were analyzed retrospectively, including 673 cases completed through Sweet, 37 cases comple- ted through Ivor-Lewis,19 cases completed through McKeown, 93 cases completed through MIE. Results There is no statisti- cally significant difference in age , numbers of dissection for celiac lymph nodes and the middle-lower mediastinal lymph nodes, the morbidty of postoperative complications including pulmonary infection anastomotic leakage, diaphragmatic hernia, chylotho- rax, gastric emptying dysfunction and death, pathological stage （ P 〉0.05 ）. However,the numbers of dissection for upper me- diastinal lymph nodes in MeKeown （4.05 ± 4.29 ） and MIE （ 3.16 ± 2.34 ） were significantly higher than that in Sweet （ 1.40 ± 2.28 ） and Ivor-Lewis （ 1.11 ± 1.82 ）, P 〈 0. 001 . The operative times for McKeown [ （363.63 ± 98.27 ） rain ] was significant- ly higher than that for Sweet [ （ 199.51 ± 46.75 ） min] , Ivor-Lewis [ （ 241.76 ± 71.88 ） min] and McKeown [ （ 271.05±92.30） mini, P 〈0. 001. The morbidity of respiratory failure in McKeown（ 10.5% ,2/19） was significantly higher than Sweet （1.3% ,9/673）, Ivor-Lewis（ 2.7% ,1/37） and MIE （3.2% ,3/93）, P =0. 046. The morbidty of hoarseness in MIE （4.3 %, 4/93 ） was significantly higher than Sweet 0.3 % （2/673）, Ivor-Lewis （0） and McKeown （0）, P 〈 0. 001. While the operative times for small groups was significantly higher than that for big groups in MIE. Conclusion The dissection of medi- astinal lymph node in the three-hole esophagectomy may be more thorough than that in Sweet and Ivor-Lewis, the application of minimally inv

关 键 词：食管肿瘤 食管切除术 并发症 胸外科手术 电视辅助 

分 类 号：R735.1[医药卫生—肿瘤]