微创Ivor-Lewis术与McKeown术治疗胸中下段食管癌近期疗效比较  

A retrospective study of short-term outcomes of minimally invasive Ivor-Lewis esophagectomy and McKeown esophagectomy for thoracic middle-lower esophageal carcinoma

作　　者：吴汉然 解明然[1] 柳常青[1] 徐美青[1] 郭明发[1] 

机构地区：[1]安徽医科大学附属安徽省立医院胸外科,合肥230001

出　　处：《中华胸心血管外科杂志》2014年第11期649-652,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 评价胸腹腔镜联合食管癌切除荷包钳法右胸内吻合的安全性、可行性和近期疗效.方法 回顾性分析2011年10月至2014年3月接受微创食管癌手术的357例患者资料,其中219例患者施行微创lvor-Lewis术（minimally invasive Ivor-Lewis esophagectomy,MIILE）,138例施行微创McKeown术（Minimally invasive McKeown esophagectomy,MIME）.比较分析两组患者的临床和围手术期相关资料、术后并发症和肿瘤复发情况.结果 两组在性别、年龄、肿瘤部位和术后TNM分期方面无明显差异.手术时间、术中出血、术后住院时间、术后引流时间和住院费用方面施行MIILE的患者与施行MIME的患者无明显差异（P＞0.05）.两组患者术后总并发症发生率亦无明显差异（24.7％对30.4％,P＞ 0.05）;但吻合口瘘、喉返神经损伤、吻合口狭窄方面的发生率低（P＜0.05）.结论 微创Ivor-Lewis术治疗胸中下段食管癌是安全可行的,相对于微创McKeown术有一定优势,近期结果满意.Objective To investigate the feasibility,safety and curative effect of combined laparoscopic and thoracoscopic esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity.Methods We retrospectively evaluated 357patients with esophageal carcinoma who received minimally invasive esophagectomy（MIE） in our center between October 2011 and March 2014.Of those 357 patients,219 underwent MIILE and 138 underwent MIME.The clinicopathologic factors,operational factors,postoperative complications and postoperative recurrence were compared.Results The 2 groups were similar in terms of age,sex,American Society of Anesthesiologists grade,tumor location,preoperative staging.The MILLE approach was associated with no significant decrease in surgical blood loss.Duration of operation,chest tube duration,hospitalization expenses and postoperative stay relative to the MIME approach（P 〉 0.05）.There was no significant difference between the 2 groups in postoperative complications（P 〉0.05）.The MIILE approach was associated with significantly fewer anastomotic fistula,RLN injury,anastomotic stensis than the MIME approach（P 〈0.05）.Conclusion Our MIILEtechnique can be safely and effectively performed for intrathoracic anastomosis during esophageal surgeries with favorable early outcomes.

关 键 词：食管肿瘤 食管切除术 胸腔镜 腹腔镜 胸内吻合 

分 类 号：R735.1[医药卫生—肿瘤]