Ivor-Lewis术式与传统左开胸入路治疗食管胃交界腺癌的临床效果分析  

Clinical effect analysis of Ivor-Lewis surgery and traditional left thoracotomy in treatment of adenocarcinoma of esophagogastric junction

作　　者：朱建福 张玉景 周峰 肖海波[3] 李森 何爱敏 张召辉 Zhu Jianfu;Zhang Yujing;Zhou Feng;Xiao Haibo;Li Sen;He Aimin;Zhang Zhaohui(Department of Cardiothoracic Surgery,Huaihai Hospital Affiliated to Xuzhou Medical University,the 71st Army Group Military Hospital,Jiangsu Xuzhou 221000,China;Department of General Surgery,Huaihai Hospital Affiliated to Xuzhou Medical University,the 71st Army Group Military Hospital,Jiangsu Xuzhou 221000,China;Department of Thoracic Surgery,Xinhua Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200092,China;Department of Pain Rehabilitation,Huaihai Hospital Affiliated to Xuzhou Medical University,the 71st Army Group Military Hospital,Jiangsu Xuzhou 221000,China)

机构地区：[1]徐州医科大学附属淮海医院陆军第七十一集团军医院心胸外科,江苏徐州221000 [2]徐州医科大学附属淮海医院陆军第七十一集团军医院普通外科,江苏徐州221000 [3]上海交通大学附属新华医院胸外科,上海200092 [4]徐州医科大学附属淮海医院陆军第七十一集团军医院疼痛康复科,江苏徐州221000

出　　处：《中国医刊》2023年第3期287-290,共4页Chinese Journal of Medicine

基　　金：徐州市科技项目(KC19172);2021年徐州市推动科技创新专项资金资助项目(KC21212)。

摘　　要：目的探讨Ivor-Lewis术式与传统左开胸入路治疗食管胃交界腺癌的临床效果。方法选取2015年1月至2020年10月徐州医科大学附属淮海医院陆军第七十一集团军医院和上海交通大学附属新华医院收治的食管胃交界腺癌患者88例,采用随机数表法分为观察组(采用Ivor-Lewis术式治疗)和对照组(采用传统左开胸入路手术治疗),每组44例。比较两组患者的围术期指标、术中淋巴结清扫数、血清炎症因子水平、术后并发症发生情况及术后1年和2年的生存率。结果观察组术中出血量、术后第1天引流量、胸腔引流时间及胃管拔出时间均明显低于对照组,差异有显著性(P<0.05),而两组手术时间比较差异无显著性(P>0.05)。观察组术中清扫淋巴结总数及腹腔清扫淋巴结数均明显多于对照组(P<0.05),而胸腔清扫淋巴结数两组比较差异无显著性(P>0.05)。两组术前血清C反应蛋白(C-reactive protein,CRP)和白细胞介素-6(interleuking-6,IL-6)水平比较差异无显著性(P>0.05);术后两组CRP和IL-6水平均明显高于术前,且术后1d时观察组明显低于对照组(P<0.05),而术后7d时两组比较差异无显著性(P>0.05)。观察组术后并发症发生率(6.82%)与对照组(11.36%)比较差异无显著性(P>0.05)。两组术后1年及2年生存率比较差异无显著性(P>0.05)。结论采用Ivor-Lewis术式治疗食管胃交界腺癌可显著改善围术期指标,淋巴结清扫数更多,术后炎症反应较轻,值得临床应用。Objective To compare the clinical effect of Ivor-Lewis surgery and traditional left thoracotomy in treatment of adenocarcinoma of esophagogastric junction(AEG).Method A total of 88 patients with AEG admitted to the Huaihai Hospital Affiliated to Xuzhou Medical University,the 71st Army Group Military Hospital and Xinhua Hospital Affiliated to Shanghai Jiaotang University from January 2015 to October 2020 were randomly divided into the observation group(treated with Ivor-Lewis surgery)and the control group(treated with traditional left thoracotomy).The perioperative indexes,number of intraoperative lymph nodes dissection,level of serum inflammatory factors,incidence of postoperative complications and one-year and two-year survival rates were compared between the two groups.Result There was no significant difference in operation time between the two groups(P>0.05).The intraoperative blood loss,drainage volume on the first day after surgery,thoracic drainage time and gastric tube extraction time in the observation group were significantly shorter than those in the control group(P<0.05).The total number of intraoperative lymph nodes dissected and the number of abdominal lymph nodes dissected in the observation group were significantly higher than those in the control group(P<0.05),and there was no significant difference in the number of pleural lymph nodes dissected(P>0.05).There was no significant difference in the levels of C-reactive protein(CRP)and interleuking-6(IL-6)between the two groups before surgery(P>0.05).The levels of CRP and IL-6 after surgery in the two groups were significantly higher than those before surgery,and the two indexes in the observation group were significantly lower than those in the control group on the first day after surgery(P<0.05).There was no significant difference between the two groups on the seventh day after operation(P>0.05).There was no significant difference in the incidence of postoperative complications between the observation group(6.82%)and the control group(11.36%)(P>0.05

关 键 词：食管胃交界腺癌 IVOR-LEWIS手术 传统左开胸入路 炎症因子 胸腔镜 腹腔镜 

分 类 号：R735.1[医药卫生—肿瘤]