老年食管癌患者不同术式的选择和术后并发症比较  

Comparison of postoperative complications between four surgery models in elderly esophageal cancer patients

作　　者：丁清清 薛磊 周文颖 薛一波 韩笑 尹丹丹 束永前 唐金海 陈琪[3] 骆金华 Ding Qingqing;Xue Lei;Zhou Wenyin;Xue Yibo;Han Xiao;Yin Dandan;Shu Yongqian;Tang Jinhai;Chen Qi;Luo Jinhua(Department of Geriatric Oncology, the First Affiliated Hospital, Nanjing Medical University, People's Hospital of Jiangsu Province, Nanjing, 210029, China;Department of Thoracic Surgery, the First Affiliated Hospital, Nanjing Medical University, People's Hospital of Jiangsu Province, Nanjing, 210029, China;School of Basic Medical Science, Nanjing Medical University, Nanjing, 211166, China)

机构地区：[1]南京医科大学第一附属医院,江苏省人民医院老年肿瘤科,南京210029 [2]南京医科大学第一附属医院,江苏省人民医院胸外科,南京210029 [3]南京医科大学基础医学院,南京211166

出　　处：《中华老年医学杂志》2019年第3期292-295,共4页Chinese Journal of Geriatrics

基　　金：南京市科技局项目( 201611005 );江苏省科教强卫工程青年医学人才项目(QNRC2016591);江苏省科技厅基础研究计划(自然科学基金XBK20161591)。

摘　　要：目的探讨60岁及以上老年食管癌患者不同手术方式的选择和术后并发症的差异。方法收集2010年1月至2016年12月江苏省人民医院胸外科60岁及以上食管癌手术患者542例,将患者分为4组:左胸一切口(Sweet)202例,上腹右胸(Ivor-Lewis)251例,颈胸腹三切口(McKeown术)29例,微创手术(微创McKneown)60例,回顾性分析各组患者的临床资料,包括术后住院天数、淋巴结清扫数目、肺部感染、浆膜腔积液、心律失常、乳糜漏、胃排空障碍、吻合口瘘等。结果4种手术方式患者术后住院天数、浆膜腔积液、心律失常、乳糜漏、胃排空障碍、吻合口瘘等方面的差异均无统计学意义(P>0.05)。淋巴结清扫数目Sweet组、Ivor-Lewis组、McKeown术组和微创McKneown组分别为(12.9±7.4)个、(19.3±8.6)个、(14.3±6.9)个和(15.4±7.3)个。淋巴结清扫数目Ivor-Lewis组明显高于其他组(F=23.915,P=0.000);肺部感染Sweet组、Ivor-Lewis组、McKeown术组和微创McKneown组分别为31.7%、40.2%、24.1%和50.0%,肺部感染微创McKneown组明显高于其他组(χ2=9.941,P=0.019)。结论Ivor-Lewis术式清扫老年食管癌患者的淋巴结更彻底,且并发症不高于其他手术方式,微创McKneown肺部感染发生高于其他组,考虑与腔镜技术较开放手术尚不够成熟有关。Objective To investigate the surgical methods and the differences of postoperative complications in esophageal cancer patients aged 60 years and over undergoing different operation models. Methods A total of 542 elderly esophageal cancer patients who underwent thoracic surgery at our hospital between January 2010 and December 2016 were enrolled. Patients were divided into 4 groups: left thoracic incision operation group (n=202), Ivor-Lewis two incisions operation group (right chest posterolateral and upper abdomen median)(n=251), three incision operation group (left neck-right chest-abdominal midian (n=29), and McKneown under-endoscope minimally invasive operation group (n=60). Clinical data, including the postoperative days, numbers of lymph nodes dissection, pulmonary infection, serous membrane fluid, arrhythmia, chylous fistula, gastric emptying dysfunction and anastomotic leakage, were retrospectively compared between the four groups. Results There was no significant difference in the postoperative days, serous membrane fluid, arrhythmia, chylous fistula, gastric emptying dysfunction and anastomotic leakage (P>0.05). The number of lymph nodes dissection in Sweet group, Ivor-Lewis group, Mckeown operation group and minimally invasive Mckneown group were (12.9±7.4)、(19.3±8.6)、(14.3±6.9)and(15.4±7.3)respectively.The number of lymph nodes dissection was more in the Ivor-Lewis group than in the other three groups (F=23.915, P=0.000). Sweet group, Ivor-Lewis group, Mckeown group and minimally invasive Mckneown group were 31.7%、40.2%、24.1% and 50.0% respectively.The incidence of pulmonary infection was higher in the minimally invasive surgery group than in the other three groups (χ2=9.941, P = 0.019). Conclusions Ivor-Lewis surgery is more effective in lymph nodes dissection and has a lower incidence of complications in elderly esophageal cancer patients.The minimally invasive surgery group has a higher incidence of pulmonary infection than in the other surgical groups, which may be related with the imm

关 键 词：食管肿瘤 外科乎术 手术厉并发症 

分 类 号：R735.1[医药卫生—肿瘤]