Ivor-Lewis术联合胸腹腔镜食管癌切除术治疗食管下段癌的临床研究  

Clinical application of Ivor-Lewis combined with thoracic-laparoscopy for esophageal carcinoma resection in patients with esophageal lowest cancer

作　　者：王宏卫[1] 

机构地区：[1]山西省肿瘤医院放疗科,山西省太原030013

出　　处：《中国基层医药》2015年第8期1149-1151,共3页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的：对比观察Ivor-Lewis术联合胸腹腔镜食管癌切除术治疗食管下段癌的临床效果和预期预后。方法连续选取68例食管下段癌患者，根据简单数字表法将患者随机分为观察组和对照组，每组34例。观察组采用Ivor-Lewis术联合胸腹腔镜术，对照组采用左胸后外侧切口，并行胸内胃食管吻合术，对比分析两组患者的临床效果、不良反应及复发率的差异。结果两组患者均完成手术，无中转开腹病例。观察组手术时间、术中出血量、住院时间和术后胸腔引流量均显著优于对照组，差异均有统计学意义[手术时间：（165.3±53．7）比（214．3±71．5）min，t ＝3．814，P＝0．037；术中出血量：（153．6±23．1）mL 比（312．3±48．6）mL，t＝3．413，P＝0．042；住院时间：（7．4±1．2）比（10．5±2．3）d，t＝3．256，P＝0．043；术后胸腔引流量：（635.6±34．2）比（831．3±45．6）mL，t＝2．594，P＝0．039]。观察组术后的并发症发生率（主要包括肺部感染、胃排空障碍、吻合口瘘和膈疝）和随访6个月的复发率（包括原位复发、淋巴转移和血液转移）均显著低于对照组，差异均有统计学意义（并发症发生率：17．65％比38．24％，χ^2＝4．012，P＜0．01；复发率：20．59％比47.06％，χ^2＝4．825，P＜0．01）。结论 Ivor-Lewis术联合胸腹腔镜食管癌切除术治疗食管下段癌效果显著，安全性及患者耐受度较高，值得临床推广。Objective To study the clinical application effect of Ivor-Lewis combined with thoracic-lapa-roscopy for esophageal carcinoma resection in patients with esophageal lowest cancer.Methods A total of 68 patients with esophageal lowest cancer were individed into the observation group and control group by the random number method,each of 34 cases.The patients in the observation group received Ivor-Lewis combined with thoracic-lapa-roscopy,and the patients in the control group received intrathoracic esophagogastrostomy by left chest posterolateral incision,then to compare the differences of clinical effect and complications.Results The operation time,blood loss in-operation,in-hospital time,thoracic drainage after operation in the observation group were all significantly less than those of the control group[operation time：（165.3 ±53.7）vs （214.3 ±71.5）min,t=3.814,P=0.037;blood loss in-operation：（153.6 ±23.1）vs （312.3 ±48.6）min,t=3.413,P=0.042;in-hospital time：（7.4 ±1.2）vs （10.5 ±2.3）d,t=3.256,P=0.043;thoracic drainage after operation：（635.6 ±34.2）vs （831.3 ±45.6）mL,t=2.594,P=0.039].The total rate of complications including pulmonary infection,gastric emptying,anastomotic fistula and diaphragmatic hernia and the recurrence rate after 6 months including recurrence in situ,lymph node and hema-togenous metastasis were all significantly lower in the observation group（complication：17.65%vs 38.24%,χ^2 =4.012, P〈0.001;recurrence：20.59% vs 47.06%,χ^2 =4.825,P〈0.001）.Conclusion Ivor-Lewis combined with tho-racic-laparoscopy for esophageal carcinoma resection in patients with esophageal lowest cancer is safe and effective.

关 键 词：Ivor-Lewis术 胸腹腔镜 食管癌 下段癌 

分 类 号：R735.1[医药卫生—肿瘤]