微创Ivor-Lewis食管切除术与传统左开胸手术治疗SiewertⅠ型食管胃交界部腺癌的对比研究  

Comparative Study of Minimally Invasive Ivor-Lewis Esophagectomy and Traditional Left Thoracotomy for Siewert TypeⅠAdenocarcinoma of Esophagogastric Junction

作　　者：赵康超 李国雷 徐志峰 兴伟 王保华[2] 张占学[2] 张亚丽 Zhao Kangchao;Li Guolei;Xu Zhifeng(Department of Surgery,First Affiliated Hospital of Hebei University of Chinese Medicine,Shijiazhuang 050000,China)

机构地区：[1]河北中医学院第一附属医院外一科,石家庄050000 [2]河北医科大学第二医院胸外科,石家庄050000

出　　处：《中国微创外科杂志》2021年第1期9-12,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：河北省重点研发计划项目健康医疗与生物医药专项(18277739D)。

摘　　要：目的探讨微创Ivor-Lewis食管切除术(minimally invasive Ivor-Lewis esophagectomy,MI-ILE)与传统左开胸手术治疗SiewertⅠ型食管胃交界部腺癌(adenocarcinoma of esophagogastric junction,AEG)的疗效。方法回顾性分析2017年10月~2019年6月SiewertΙ型AEG 87例资料,其中行MI-ILE 48例,左开胸手术39例。比较2组手术指标。结果87例均顺利完成手术。与左开胸组相比,MI-ILE组手术时间较长[中位数4.2(3~6)h vs.3.0(2.5~4.5)h,Z=-6.346,P=0.000],但术中出血量少[100(30~200)ml vs.120(20~260)ml,Z=-2.405,P=0.016],术后第1天胸腔引流量少[(190.0±72.9)ml vs.(299.9±116.7)ml,t=-5.362,P=0.000],胸腔引流时间短[8(3~12)d vs.9(6~19)d,Z=-2.170,P=0.030],排气早[3(2~6)d vs.6(2~12)d,Z=-4.849,P=0.000],进流食早[7(4~13)d vs.8(5~19)d,Z=-2.097,P=0.036],胃管拔出时间早[8(5~17)d vs.10(8~18)d,Z=-4.801,P=0.000],术后住院时间短[8(5~17)d vs.11(7~18)d,Z=-2.873,P=0.004]。MI-ILE组淋巴结清扫总数27.5(10~59)枚,其中胸腔清扫8(0~18)枚,腹腔清扫19(4~49)枚,均明显多于左开胸组的21(11~40)、4(0~16)、17(0~32)枚(均P<0.05)。2组术后并发症差异无统计学意义(P>0.05)。随访1年,2组均无死亡,MI-ILE组复发1例,左开胸组复发2例(χ^2=0.034,P=0.855)。结论相对于左开胸手术,MI-ILE治疗SiewertⅠ型AEG安全可行,不增加术后并发症,近期疗效满意。Objective To evaluate the efficacy of minimally invasive Ivor-Lewis esophagectomy(MI-ILE)and traditional left thoracotomy in the treatment of Siewert typeⅠadenocarcinoma of esophagogastric junction(AEG).Methods From October 2017 to June 2019,clinical data of 87 cases diagnosed as Siewert typeⅠAEG in our hospital were retrospectively analyzed.According to the different method of operation,the cases were divided into MI-ILE group(n=48)and left thoracotomy group(n=39).Normal information and clinical effect were compared.Results All the 87 cases of operations were successfully performed.As compared to the left thoracotomy group,the MI-ILE group got longer operation time[4.2 h(range,3-6 h)vs.3.0 h(range,2.5-4.5 h),Z=-6.346,P=0.000],but less intraoperative blood loss[100 ml(range,30-200 ml)vs.120 ml(range,20-260 ml),Z=-2.405,P=0.016],less chest drainage volume in the first day after surgery[(190.0±72.9)ml vs.(299.9±116.7)ml,t=-5.362,P=0.000],shorter chest drainage time[8 d(range,3-12 d)vs.9 d(range,6-19 d),Z=-2.170,P=0.030],earlier exhaust time[3 d(range,2-6 d)vs.6 d(range,2-12 d),Z=-4.849,P=0.000],earlier feeding liquid food time[7 d(range,4-13 d)vs.8 d(range,5-19 d),Z=-2.097,P=0.036],earlier gastric tube extraction time[8 d(range,5-17 d)vs.10 d(range,8-18 d),Z=-4.801,P=0.000],shorter postoperative hospital stay[8 d(range,5-17 d)vs.11 d(range,7-18 d),Z=-2.873,P=0.004].The number of lymph nodes dissected in the MI-ILE group was 27.5(range,10-59),including 8(range,0-18)in chest cavity and 19(range,4-49)in abdominal cavity,and all of them were higher than those in left thoracotomy group[21(range,11-40),4(range,0-16),17(range,0-32),respectively;all P<0.05].There was no significant difference in postoperative complications between the two groups(P>0.05).During the follow-up for 1 year,there was no death in both groups.Recurrence occurred in 1 case of the MI-ILE group and 2 cases in the left thoracotomy group(χ^2=0.034,P=0.855).Conclusion Compared with left thoracotomy,MI-ILE is safe and feasible in the treatment of

关 键 词：SiewertⅠ型 食管胃交界部腺癌 微创Ivor-Lewis食管切除术 左开胸手术 

分 类 号：R735.1[医药卫生—肿瘤]