全腔镜Ivor-Lewis术式治疗胸中下段食管癌的临床效果  

Clinical application of total endoscopic Ivor-Lewis surgery in the treatment of middle and lower thoracic esophageal cancer

作　　者：李献帅 陈献国 何淑倩 LI Xianshuai;CHEN Xianguo;HE Shuqian(Department of Cardiothoracic Surgery,Jinhua Hospital Affiliated to Zhejiang University School of Medicine,Zhejiang Province,Jinhua321000,China)

机构地区：[1]浙江大学医学院附属金华医院心胸外科,浙江金华321000

出　　处：《中国医药导报》2022年第34期85-89,共5页China Medical Herald

基　　金：浙江省医药卫生科技计划项目(2018T301-14);浙江省金华市科技计划项目(2020-3-041)。

摘　　要：目的观察全腔镜Ivor-Lewis术式治疗胸中下段食管癌的临床效果。方法选取2020年6月至2022年1月浙江大学医学院附属金华医院心胸外科收治的胸中下段食管癌患者165例,依据随机数字表法将其分为A组、B组、C组,各55例。A组实施开放性Ivor-Lewis术式治疗,B组实施全腔镜Ivor-Lewis术式治疗,C组实施腔镜Mckeown术式治疗。比较三组手术指标、淋巴结清扫及转移情况,观察术前(T_(0))、出院后1个月(T_(1))、3个月(T_(2))、6个月(T_(3))三组患者生活质量(QLQ-C30),统计三组术后并发症及术后6个月复发情况。结果B组、C组术中出血量、术后引流量均少于A组,术后置管时间、住院时间均短于A组(P<0.05),且B组术后引流量少于C组,术后置管时间、住院时间短于C组(P<0.05)。三组胸腔、腹腔淋巴结清扫及转移个数比较,差异无统计学意义(P>0.05)。T_(1)~T_(3)时,B组功能领域评分高于C组、A组,症状领域评分低于C组、A组,健康状况评分高于C组、A组(P<0.05)。B组功能领域评分T_(2)~T_(3)时高于T_(0)时,C组功能领域评分T_(3)时高于T_(0)。三组症状领域评分T_(1)~T_(3)时低于T_(0)时、总健康状况评分高于T_(0)时(P<0.05)。三组术后并发症发生率及术后复发率比较,差异无统计学意义(P>0.05)。结论全腔镜Ivor-Lewis术式治疗胸中下段食管癌安全有效,可提高术后生活质量。Objective To observe the clinical application effects of total endoscopic Ivor-Lewis surgery in the treatment of middle and lower thoracic esophageal cancer.Methods A total of 165 patients with middle and lower thoracic esophageal cancer were treated in Department of Cardiothoracic Surgery,Jinhua Hospital Affiliated to Zhejiang University School of Medicine from June 2020 to January 2022,and they were divided into group A,group B,and group C by random number table method,with 55 cases in each group.Group A carried out open Ivor-Lewis surgery,group B was treated with total endoscopic Ivor-Lewis surgery,and group C performed total endoscopic Mckeown surgery.The surgical indicators,lymph node dissection,and metastasis were compared among the three groups.The quality of life quotient(QLQ-C30)of patients in the three groups were observed before surgery(T_(0))and at one month(T_(1)),three months(T_(2)),and six months(T_(3))after discharge.The postoperative complications and recurrence at six months after surgery were statistically analyzed in the three groups.Results The intraoperative blood loss and postoperative drainage volume in group B and group C were less than those in group A,and the postoperative catheterization time and hospital stay were shorter than those in group A(P<0.05),and the postoperative drainage volume in group B was less and the postoperative catheterization time and hospital stay were shorter than those in group C(P<0.05).There were no statistically significant differences in the number of thoracic and abdominal lymph node dissection and metastasis among the three groups(P>0.05).During T_(1)-T_(3),the functional field scores of group B were higher than that of group C and group A,the symptom field scores were lower than those of group C and group A,and the health status score was higher than that of group C and group A(P<0.05).In group B,functional domain scores during T_(2)-T_(3) were higher than T_(0),and in group C,functional domain scores at T_(3) was higher than T_(0)(P<0.05).Symptom domain

关 键 词：胸中下段食管癌 Ivor-Lewis术 Mckeown术 全腔镜 并发症 生活质量 

分 类 号：R735.1[医药卫生—肿瘤]