充气式纵隔镜食管癌切除术和胸腹腔镜联合微创Mckeown食管癌切除术治疗早期食管癌的效果分析  

Analysis of the effect of inflatable mediastinoscopy esophagectomy and minimally invasive Mckeown esophagectomy combined with thoracoscopy and laparoscopy in the treatment of early esophageal cancer

作　　者：黄志宁 柳常青 梅新宇 王高祥 吴明胜 崔世军 孙效辉 徐美青 解明然 Huang Zhining;Liu Changqing;Mei Xinyu;Wang Gaoxiang;Wu Mingsheng;Cui Shijun;Sun Xiaohui;Xu Meiqing;Xie Mingran(Department of Thoracic Surgery,Anhui Provincial Hospital Affiliated with Anhui Medical University,Hefei 230001,China)

机构地区：[1]安徽医科大学附属省立医院胸外科,合肥230001

出　　处：《中华外科杂志》2025年第2期114-123,共10页Chinese Journal of Surgery

基　　金：国家自然科学基金(81973643);安徽省重点研究与开发项目基金(202004j07020017)。

摘　　要：目的探讨充气式纵隔镜食管癌切除术(IVMTE)和胸腹腔镜联合微创Mckeown食管癌切除术(MIME)治疗早期食管癌的近、远期临床效果。方法本研究为回顾性队列研究。回顾性分析2017年4月至2019年4月安徽医科大学附属省立医院胸外科收治的176例接受IVMTE或MIME的cT1N0M0期食管癌患者的临床资料。其中男性128例, 女性48例, 年龄(66.4±7.7)岁(范围:45~87岁)。记录患者的一般资料、围手术期情况、肿瘤的病理学资料及并发症情况。采用独立样本t检验、χ^(2)检验、Wilcoxon秩和检验等进行组间比较, 以性别、年龄、肿瘤部位、分化程度、pT分期、pN分期、美国麻醉医师协会(ASA)分级、吸烟史及饮酒史为协变量, 采用1∶2最邻近匹配法将IVMTE组和MIME组进行倾向性评分匹配, 卡钳值取0.02。通过Kaplan-Meier法绘制生存曲线, 采用Log-rank检验进行生存分析, 采用Cox比例风险模型分析总体生存的预后因素, 并对pT分期患者进行亚组分层分析。结果匹配后MIME组54例, IVMTE组27例。两组患者在性别、年龄、吸烟史、饮酒史、ASA分级、肿瘤部位等方面的差异均无统计学意义(P值均>0.05)。IVMTE组的手术时间[M(IQR), 220(45)min 比 245(56)min, Z=2.950, P=0.003]及术中出血量[100(50)ml 比 125(100)ml, Z=2.193, P=0.028]优于MIME组。两组患者淋巴结清扫的站数及数量(包括喉返神经旁淋巴结清扫数量)均无差异(P值均>0.05)。两组患者的1、3、5年总体生存率及无复发生存率无差异(P值均>0.05)。亚组分析结果显示, pT1亚组与pT2亚组的总体生存率及无复发生存率的差异亦无统计学意义(P值均>0.05)。多因素COX回归分析结果提示, ASA分级(HR=2.516, 95%CI:1.126~5.624, P=0.025)、pN分期(HR=2.485, 95%CI:0.984~6.274, P=0.046)及是否接受术后辅助治疗(HR=2.915, 95%CI:1.304~6.515, P=0.009)是患者5年总体生存率的独立预后因素。pT分期(HR=0.403, 95%CI:0.194~0.838, P=0.011)、pN分�Objective To explore the operioperative and long-term outcomes of inflatable mediastinoscopic resection of esophageal carcinoma(IVMTE)and minimally invasive Mckeown resection of esophageal carcinoma(MIME)in early esophageal cancer.Methods This is a retrospective cohort study.A retrospectively analysis was conducted on 176 patients with cT1NOM0 esophageal cancer who underwent IVMTE or MIME at the Department of Thoracic Surgery,Anhui Provincial Hospital Affiliated with Anhui Medical University from April 2017 to April 2019.There were 128 males and 48 females,aged(66.4±7.7)years(range:45 to 87 years).General data,perioperative outcomes,pathological data of the tumors,and complications were recorded.Independent sample t-test,x’test,or Wilcoxon rank-sum test was used to compare the data between the two groups.Propensity score matching was performed with gender,age,tumor location,differentiation degree,pT stage,pN stage,American Society of Anesthesiologists(ASA)classification,smoking history,and alcohol history were considered as covariates.The IVMTE group and MIME group were matched in a 1:2 ratio using nearest neighbor match method with a caliper value of 0.o2.Kaplan-Meier method was used to plot survival curves,with Log-rank test for univariate survival analysis.The Cox proportional hazards model was applied to analyze prognostic factors for overall survival,and subgroup stratification analysis was performed for pT stage.Results After matching,the MIME group consisted of 54 cases,and the IVMTE group consisted of 27 cases.There were no statistically significant differences between the two groups in terms of gender,age,smoking history,alcohol history,ASA classification,tumor location,and other factors.The IVMTE group had shorter surgery time(M(IQR),220(45)minutes vs.245(56)minutes,Z=2.950,P=0.003)and less intraoperative blood loss(100(50)ml vs.125(100)ml,Z=2.193,P=0.028)compared to the MIME group.There were no differences between the two groups in the number and quantity of lymph node stations dissected,and the IVM

关 键 词：食管肿瘤 食管癌切除术 充气式纵隔镜 近期疗效 生存分析 

分 类 号：R735.1[医药卫生—肿瘤]