空肠造瘘术联合Ivor-Lewis或McKeown术治疗中下段食管癌效果评价的回顾性队列研究  

Efficacy of jejunostom y combined with Ivor-Lewis or McKeown operation in the treatment of middle and lower esophageal cancer:A retrospective cohort study

作　　者：徐琛 陶夏[1] 蒋莉[1] 李俊[1] XU Chen;TAO Xia;JIANG Li;LI Jun(Shanghai Chest Hospital,Shanghai Jiao Tong University,Shanghai,200030,P.R.China)

机构地区：[1]上海交通大学附属胸科医院,上海200030

出　　处：《中国胸心血管外科临床杂志》2021年第10期1216-1221,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(8197020543)。

摘　　要：目的探究空肠造瘘术联合Ivor-Lewis术或McKeown术治疗中下段食管癌的效果。方法回顾性分析2018年6月至2019年10月上海市胸科医院收治的127例中下段食管癌患者临床资料,其中男89例、女38例,年龄(62.82±8.65)岁。按微创术式将患者分为Ivor-Lewis组(IL组,72例)与McKeown组(MK组,55例)。IL组行空肠造瘘术联合Ivor-Lewis术进行治疗,MK组行空肠造瘘术联合McKeown术进行治疗,比较两组患者手术时间、术后床旁电阻抗成像(EIT)参数、炎症因子水平、术后并发症及康复情况。结果 IL组患者手术时间[(262.65±49.78)min vs.(303.04±60.13)min]、术后进食时间[(10.54±2.22)d vs.(11.47±2.49)d]及术后住院时间[(14.78±2.47)d vs.(15.72±2.36)d]均显著短于MK组(P<0.05);IL组患者术中失血量[(156.13±52.43)mL vs.(158.87±48.47)mL]、淋巴结清扫数目[(29.47±8.88)个vs.(30.17±9.80)个]少于MK组,但差异无统计学意义(P>0.05)。两组患者术后不同时间点炎症因子肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、IL-8的变化有统计学意义(F时点=520.543、272.379、147.688,均P<0.05);而手术方式以及时点和手术方式交互效应均不会影响TNF-α、IL-6、IL-8水平(P>0.05)。两组间术后1 d、3 d、5 d、7 d的EIT影像数据呼气末肺阻抗差值(△EELI)差异有统计学意义(P<0.05)。与MK组相比,IL组患者喉返神经损伤、心律失常、肺部感染及肺不张、吻合口瘘、胃壁坏死及残端瘘、二次开胸及腹止血、肠梗阻发生率均低于MK组,但差异无统计学意义(P>0.05)。IL组患者6个月内复发率较MK组略低,差异无统计学意义(8.33%vs. 9.09%,P>0.05)。结论空肠造瘘术联合Ivor-Lewis术或McKeown术对中下段食管癌患者疗效相当。Objective To investigate the effect of jejunostomy combined with Ivor-Lewis or McKeown operation on the treatment of middle and lower esophageal cancer. Methods The clinical data of 127 patients with middle and lower esophageal cancer admitted to our hospital from June 2018 to October 2019 were retrospectively analyzed, including89 males and 38 females, aged 62.82±8.65 years. The patients were divided into an Ivor-Lewis group(IL group, 72 patients) and a McKeown group(MK group, 55 patients) according to surgical methods. Patients in the IL group received jejunostomy combined with Ivor-Lewis operation, and patients in the MK group received jejunostomy combined with McKeown operation. The operation time, postoperative bedside electrical impedance tomography(EIT) parameters,postoperative inflammatory factor levels, postoperative complications and rehabilitation of the two groups were compared. Results The operation time(262.65±49.78 min vs. 303.04±60.13 min), postoperative eating time(10.54±2.22 d vs. 11.47±2.49 d) and postoperative hospital stay(14.78±2.47 d vs.15.72±2.36 d) in the IL group were significantly shorter than those in the MK group(P<0.05). The blood loss(156.13±52.43 mL vs. 158.87±48.47 mL) and the number of lymph node dissection(29.47±8.88 vs. 30.17±9.80) in the IL group were less than those in the MK group, but the differences were not statistically significant(P>0.05). The repeated measurement analysis of variance showed that the time point could significantly affect tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), and IL-8 levels(Ftime point=520.543, 272.379,147.688, all P<0.05), but the surgical methods and the interactive effect of time point and surgical methods did not affect the levels of TNF-α, IL-6 and IL-8(P>0.05). Postoperative bedside EIT image parameters were statistically different on the postoperative 1 d, 3 d, 5 d and 7 d between the two groups(P<0.05). Compared with the MK group, the incidences of recurrent laryngeal nerve injury, arrhythmia, pulmonary infection and

关 键 词：Ivor-Lewis术 McKeown术 中下段食管癌 疗效 

分 类 号：R735.1[医药卫生—肿瘤]