胸腹腔镜联合食管癌微创Ivor-Lewis手术(附102例报告)  

Thoracolaparoscopic minimally invasive Ivor-Lewis esophagectomy( 102 cases reports )

作　　者：侯晓彬[1] 任志鹏[1] 杨博[1] 李捷[1] 王钰琦[1] 马永富[1] 范开杰[1] 刘阳[1] 

机构地区：[1]解放军总医院胸外科,北京100853

出　　处：《中华腔镜外科杂志（电子版）》2015年第4期14-17,共4页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的探讨胸腹腔镜联合食管癌微创Ivor-Lewis手术的可行性及临床效果。方法对102例食管癌患者进行胸腹腔镜联合食管癌微创Ivor-Lewis手术(胸腹腔镜组),以同期94例行左胸后外侧切口食管癌切除术者为对照(左侧开胸组),对两组患者的治疗效果和围手术期情况进行比较,应用疼痛数字评价量表(NRS)评价患者疼痛程度。结果胸腹腔镜组和左侧开胸组的平均手术时间分别为(236±40)min和(228±44)min,术中出血量分别为(151±45.4)ml和(192.5±58.3)ml,淋巴结平均切除数分别为(19.7±5.4)枚和(9.3±5.7)枚,术后胸腔闭式引流带管时间分别为(5.8±2.1)d和(6.7±2.6)d,术后平均住院时间分别为(12.4±6.1)d和(15.6±7.5)d。两组术中出血量、淋巴结切除数、带管时间和术后平均住院时间比较,差异有统计学意义(t=-5.583,13.116,-2.675,-3.288;P均<0.05)。两组并发症发生情况相当。胸腹腔镜组和左侧开胸组术后第1天平均NRS分别为(3.7±0.9)分和(4.8±2.1)分,术后第3天平均NRS分别为(2.1±0.7)分和(3.0±1.4)分,术后第5天平均NRS分别为(2.0±0.7)分和(2.1±0.5)分。两组术后第1天、第3天平均NRS比较,差异有统计学意义(t=-4.831,-5.759;P均<0.05)。结论胸腹腔镜联合食管癌微创Ivor-Lewis手术与左胸后外侧切口手术相比,并没有增加手术并发症,同时表现出创伤小、出血少、疼痛轻、淋巴结清扫更彻底及住院时间短等优势。Objective To evaluate the feasibility, safety and effectiveness of thoracolaparoscopic Ivor- Lewis esophagectomy. Methods Surgical, oncological and postoperative outcomes were retrospectively analyzed between groups undergoing thoraeolaparoscopic Ivor-Lewis esophagectomy （TLILE） or conventional open Sweet esophagectomy（Sweet） for esophageal, cancer. Results A total of 196 patients undergoing esophagectomy were analyzed （102 TLILE and 94 Sweet）. Baseline characteristics between the two groups were similar. Comparing to patients in the traditional Sweet group, patients in the TLILE group had less blood loss[（151 ± 45.4） m1,（192.5 ± 58.3 ）ml, P〈0.001], less days of hospital stay [（12.4 ± 6.1） d,（15.6 ± 7.5） d, P 〈 0. 001] and less days of postoperative tube drainage [（5.8 ± 2.1 ） d , （6.7 ± 2.6） d, P 〈0.0011. The nμmber of lymph node resection in the TLILE group was higher than the Sweet group [ （ 19.7 5.4）, （ 9.3 ± 5.7 ）, P 〈 0.05 ]. The scores of woundrelated pain in the TLILE group were lower than those in the Sweet group on the first [ （ 3.7 ± 0. 9 ） , （4. g ± 2.1 ） , P 〈 0.05], third [（2.1 ± 0.7）,（3.0 ± 1.4）, P〈0.05] and fifth [（2.0 ± 0.7）,（2.1 ± 0.5）, P〉 0.05 ] postoperative day. Meanwhile, there was no statistical difference between the two groups in the rates of post-operative complications. Conclusions Comparing to the conventional Sweet approach, TLILE appears to provide a new choice for us with advantages of adequate lymph node resection, less post- operative pain, less blood loss and shorter hospital stay.

关 键 词：胸腔镜 腹腔镜 食管肿瘤 食管切除术 微创手术 IVOR-LEWIS手术 

分 类 号：R735.1[医药卫生—肿瘤]