全腔镜McKeown术和Sweet术治疗中下段食管鳞癌的比较  

Total endoscopy McKeown surgery versus Sweet surgery in the treatment of middle and lower esophageal squamous cell carcinoma

作　　者：张宏飞[1] 褚红军[1] ZHANG Hong-Fei;CHU Hong-Jun(Department of Thoracic Surgery,The Third Hospital Affiliated to Nantong University,Nantong,Jiangsu 226000,China)

机构地区：[1]南通大学附属南通第三医院胸心外科,江苏南通226000

出　　处：《中国临床研究》2018年第8期1064-1068,共5页Chinese Journal of Clinical Research

摘　　要：目的比较全腔镜McKeown手术与Sweet手术治疗中下段食管鳞癌的近期疗效,探讨全腔镜颈胸腹三切口手术是否较传统左胸开放手术具有优势。方法回顾性分析2012年1月至2017年11月行手术治疗的食管中下段癌66例患者的临床资料,其中20例患者行微创颈胸腹三切口入路(McKeown手术)为观察组,46例食管癌患者行经左胸开放入路(Sweet手术)为对照组。比较两组的手术时间、术中出血量、手术清扫淋巴结数目、术后住院时间、术后并发症发生率。结果两组均无死亡病例。观察组手术时间长于对照组[(278.5±75.8)min vs(220.2±89.5)min,t=2.162,P=0.047],术中出血量明显少于对照组[(170.4±80.7)ml vs(350.6±110.3)ml,t=5.092,P=0.000],总体淋巴结和胸部淋巴结清扫数目多于对照组[(20.8±10.6)枚vs(19.3±9.3)枚,t=2.178,P=0.030;(12.6±5.5)枚vs(9.8±2.0)枚,t=2.076,P=0.046],术后住院时间明显短于对照组[(11.5±1.2)d vs(14.9±2.1)d,t=8.653,P=0.000]。两组腹部淋巴结清扫数目差异无统计学意义(P>0.05)。两组除术后肺部并发症发生率比较有统计学差异(5.00%vs 31.82%,χ2=4.118,P=0.042)外,总术后并发症及其他相关并发症均无统计学差异(P>0.05)。结论对于上纵膈无明显淋巴结转移的胸中下段食管鳞癌患者,全腔镜McKeown术是微创、安全及有效的,具有术中出血少、术后肺部并发症少、淋巴结清扫更彻底、术后恢复快优点,是目前食管癌微创治疗的方向。Objective To compare the recent curative effect of total endoscopic McKeown and Sweet operation in the treatment of esophageal squamous cell carcinoma located in the middle and lower segment of the esophagus and explore whether the total endoscopic surgery of three-incision in neck,chest and abdomen（McKeown operation） is superior to the traditional left open thoracic surgery（Sweet operation）. Methods The clinical data of 66 patients with the middle and lower esophageal cancer operated from January 2012 to November 2017 were analyzed retrospectively,including 20 patients with McKeown operation（observation group） and 46 patients with Sweet operation（control group）. The surgical time,the intraoperative blood volume,the number of lymph nodes removed during surgery,the postoperative hospitalization time and the incidence of postoperative complications were compared between two groups. Results There were no deaths in both groups. Compared with control group,the operating time was longer [（278. 5 ± 75. 8） min vs（220. 2 ± 89. 5） min,t =2. 162,P = 0. 047]; the intraoperative blooding was obviously less [（170. 4 ± 80. 7） ml vs（350. 6 ± 110. 3） ml,t = 5. 092,P = 0. 000]; total lymph nodes dissection number [（20. 8 ± 10. 6） vs（19. 3 ± 9. 3）,t = 2. 178,P = 0. 030] and chest lymph nodes dissection number [（12. 6 ± 5. 5） vs（9. 8 ± 2. 0）,t = 2. 076,P = 0. 046] were significantly more; the postoperative hospitalization time obviously shortened [（11. 5 ± 1. 2） d vs（14. 9 ± 2. 1） d,t = 8. 653,P = 0. 000]in observation group. There was no significant difference in the dissection number of abdominal lymph nodes between two groups（P〉0. 05）. There was a significant difference in the incidence of pulmonary complications（5. 00% vs 31. 82%,χ2= 4. 118,P = 0. 042）,but there were no statistical differences in the postoperative complications and other related complications between two groups（P〉0. 05）. Conclusions The total endoscopic McKeown is a minimally inva

关 键 词：食管鳞癌 食管切除术 全腔镜 McKeown术 Sweet术 

分 类 号：R735.1[医药卫生—肿瘤]