微创荷包钳法Ivor-Lewis术与McKeown术治疗中下段食管癌的近期疗效分析  

Short-term efficacy of purse sting forceps Ivor-Lewis approach and Mc Keown approach in minimally invasive esophagectomy for middle-lower section esophageal cancer

作　　者：梅闪闪[1] 刘继先[1] 吴昊[1] 乌达[1] 谢远财[1] 牟志民[1] 

机构地区：[1]安徽医科大学北大深圳医院临床学院胸外科北京大学深圳医院胸外科,深圳518036

出　　处：《重庆医科大学学报》2016年第1期89-93,共5页Journal of Chongqing Medical University

基　　金：深圳市科技创新委员会资助项目(编号:JCYJ20150403091443290;JCYJ20150403091443310)

摘　　要：目的:对比分析微创荷包钳法Ivor-Lewis(minimally invasive Ivor-Lewis esophagectomy,MIILE)术与微创Mc Keown(minimally invasive Mc Keown esophagectomy,MIME)术治疗中下段食管癌近期疗效。方法 :对2012年1月至2015年9月我院胸外科连续106例胸腹腔镜中、下段食管癌根治术患者的临床资料进行回顾性分析,根据手术方法不同将106例患者分为荷包钳法MIILE术组及MIME术组,其中荷包钳法MIILE术41例,MIME术65例。评价指标包括:手术时间、术中出血量、清扫淋巴结数目、术后住院时间、术后放管时间、住院费用,以及术后并发症如切口感染、吻合口狭窄、管胃或吻合口瘘、乳糜胸、肺部感染、喉返神经损伤等。结果:荷包钳法MIILE术组手术时间、术后住院时间、术后放管时间少于MIME术组(P<0.05);而2组间术中出血量、清扫淋巴结数目、手术费用差异无统计学意义(P>0.05)。荷包钳法MIILE术组吻合口瘘、喉返神经损伤和肺部感染发生率均低于MIME术组(P<0.05);2组之间术后切口感染、吻合口狭窄、乳糜胸发生差异无统计学意义(P>0.05)。结论:在微创中下段食管癌治疗方面,荷包钳法MIILE术具有和MIME术一样的安全性,但术后并发症明显少于MIME术组。Objective：To compare the short-term efficacy of purse sting forceps Ivor-Lewis approach and Mc Keown approach in minimally invasive esophagectomy for middle-lower section esophageal cancer. Methods：The clinical data of 106 patients who had middle or lower esophageal cancer and accepted minimally invasive esophagectomy surgeries by our surgical team from January 2012 to September 2015 were analyzed,including 41 patients receiving purse sting forceps minimally invasive Ivor-Lewis esophagectomy（MIILE） and 65 receiving minimally invasive Mc Keown esophagectomy（MIME）. The operation duration,hemorrhage during operation,the number of lymph nodes resected,postoperative hospital stay,extubation time,hospitalization expense were analyzed and compared.Postoperative complications such as incision infection,anastomotic orifice stenosis,anastomotic or tubed stomach fistula,chylothorax,pulmonary infection and recurrent laryngeal nerve injury were also analyzed. Results：The operation duration,postoperative hospital stay and extubation time in the purse sting forceps MIILE group was shorter than those in MIME group（P〈0.05）. There was no significant difference between the two groups in the amount of hemorrhage during operation,the number of lymph nodes resected and inpatient cost（P〉0.05）. The rates of anastomotic fistula,pulmonary infection and recurrent laryngeal nerve injury were lower in MIILE group than in MIME group（P〈0.05）. There are no statistical differences between the two groups in incision infection,anastomotic orifice stenosis and chylothorax（P〉0.05）. Conclusion：In minimally invasive esophagectomy in middle-lower section,purse sting forceps MIILE is as safe as MIME,but with lower complications.

关 键 词：食管癌 Ivor-Lewis术 McKeown术 微创 

分 类 号：R655.4[医药卫生—外科学]