微创Ivor-Lewis手术与微创McKeown手术围手术期并发症的临床观察  

Clinical observation on perioperative complications of minimally invasive Ivor-Lewis and minimally invasive McKeown esophagectomy

作　　者：周建明[1] 靖胜杰[1] 陆启同[1] 楚鑫 薛涛[1] Zhou Jianming;Jing Shengjie;Lu Qitong;Chu Xin;Xue Tao(Department of Cardiothoracic Surgery,Zhongda Hospital Affiliated to Southeast University,Nanjing 210009,China)

机构地区：[1]东南大学附属中大医院胸心外科,南京210009

出　　处：《中华肿瘤杂志》2022年第6期577-580,共4页Chinese Journal of Oncology

摘　　要：目的探讨微创Ivor-Lewis(MIE-Ivor-Lewis)与微创McKeown(MIE-McKeown)术式治疗食管癌的围手术期临床效果。方法选取2018年4月至2019年8月于东南大学附属中大医院接受全腔镜食管癌根治术患者147例, MIE-McKeown手术(McKeown组)患者85例, MIE-Ivor-Lewis手术(Ivor-Lewis组)患者62例。计量资料以(±s)表示, 呈正态分布的计量资料的比较采用独立样本t检验, 计数资料的比较采用χ;检验或Fisher精确检验。结果 McKeown组和Ivor-Lewis组患者手术时间[分别为(219.2±72.4)min和(225.8±65.3)min]、纵隔淋巴结清扫数[分别为(13.3±4.8)枚和(11.6±6.5)枚]、左喉返淋巴结清扫数[分别为(3.5±1.2)枚和(3.1±1.4)枚]、术中出血量[分别为(178.3±41.3)ml和(163.2±64.1)ml]、术后出血再手术患者数(分别为1和0例)、术后胃出血患者数(分别为0和1例)、术后胸管留置时间[分别为(2.8±1.3)d和(3.1±1.2)d]、吻合口瘘患者数[分别为7和1例]、肺部感染患者数(分别为13和5例)和乳糜胸患者数(分别为2和1例)差异均无统计学意义(均P>0.05)。McKeown组和Ivor-Lewis组患者声音嘶哑[分别为11和3例]、总并发症发生率[分别为41.2%(35/85)和17.7%(11/62)]和术后住院时间[分别为(14.7±6.5)d和(12.3±2.3)d]差异均有统计学意义(均P<0.05)。结论 MIE-Ivor-Lewis术与MIE-McKeown术治疗食管癌安全有效, 但MIE-Ivor-Lewis术较MIE-Mckeown术并发症少, MIE-Ivor-Lewis术围手术期临床效果优于MIE-McKeown术。Objective To compare and analyze the perioperative clinical effects of minimally invasive Ivor-Lewis esophagectomy(MIE-Ivor-Lewis)and minimally invasive McKeown esophagectomy(MIE-McKeown).Methods A total of 147 patients who underwent endoscopic esophageal cancer surgery from April 2018 to August 2019 were selected,including 85 patients undergoing MIE-McKeown surgery and 62 patients undergoing MIE-Ivor-Lewis surgery.The measurement data were expressed as(±s),the comparison of normally distributed measurement data was performed by independent sample t-test,and the comparison of count data was performed byχ^(2) test or Fisher′s exact test.Results The operation time of McKeown(M)group and Ivor-Lewis(IL)group were(219.2±72.4)minutes and(225.8±65.3)minutes.The mediastinal lymph node dissection number of M and IL groups were 13.3±4.8 and 11.6±6.5,respectively.The number of left recurrent laryngeal nerve lymph node dissection were 3.5±1.2 and 3.1±1.4,respectively.The intraoperative blood loss were(178.3±41.3)ml and(163.2±64.1)ml,respectively.The number of patients reoperated for postoperative bleeding were 1 and 0,respectively.The number of patients with postoperative gastric bleeding were 0 and 1,respectively.The postoperative chest tube retention time were(2.8±1.3)days and(3.1±1.2)days,respectively.The number of patients with anastomotic leakage were 7 and 1,respectively.The number of patients with lung infection were 13 and 5,respectively,and with chylothorax were 2 and 1,respectively,without statistically significant difference(P>0.05).The number of patients with hoarseness were 11 and 3,respectively.The total incidence of complication were 41.2%(35/85)and 17.7%(11/62),and the postoperative hospital stay were(14.7±6.5)days and(12.3±2.3)days,with statistical difference(P<0.05).Conclusion MIE-Ivor-Lewis and MIE-McKeown are safe and effective in treating esophageal cancer,but the complication of MIE-Ivor-Lewis is less than that of MIE-Mckeown,and the perioperative clinical effect of MIE-Ivor-Lewis is bet

关 键 词：食管肿瘤 微创食管癌根治术 Mckeown术 Ivor-Lewis术 术后并发症 

分 类 号：R735.1[医药卫生—肿瘤]