Ivor-Lewis手术与Mckeown手术治疗胸中下段食管癌临床疗效比较  

Comparison of clinical outcomes between Ivor-Lewis and Mckeown esophagectomy for middle or lower esophageal cancer

作　　者：袁立功 毛友生 Yuan Ligong;Mao Yousheng(Department of Thoracic Surgery,the First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230001,China;Department of Thoracic Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]中国科学技术大学附属第一医院、安徽省立医院胸外科,合肥230001 [2]国家癌症中心、国家肿瘤临床医学研究中心、中国医学科学院北京协和医学院肿瘤医院胸外科,北京100021

出　　处：《中华肿瘤杂志》2025年第3期262-268,共7页Chinese Journal of Oncology

摘　　要：目的比较胸腹联合食管癌根治术(Ivor-Lewis手术)和颈胸腹三切口食管癌根治术(Mckeown手术)治疗胸中下段食管癌的临床疗效。方法回顾性分析2015年3月至2018年10月于中国医学科学院肿瘤医院胸外科行Ivor-Lewis或Mckeown食管癌根治手术的716例胸中下段食管癌患者的临床资料,比较2种手术方式的围手术期指标、术后并发症和预后情况。结果716例患者中,行Ivor-Lewis手术和Mckeown手术的患者分别为135例和581例。Mckeown组和Ivor-Lewis组在淋巴结清扫总数[分别为27枚(19~37枚)和25枚(18~33枚)]、淋巴结清扫总站数[5站(4~7站)和5站(4~5站)]、喉返神经旁淋巴结清扫数[分别为3枚(1~6枚)和0枚(0~3枚)]方面比较,Mckeown组均显著优于Ivor-Lewis组(均P<0.05),但Mckeown组喉返神经麻痹发生率(10.7%,62/581)显著高于Ivor-Lewis组(1.5%,2/135,P<0.001)。Ivor-Lewis组患者1、3、5年生存率(分别为91.0%、70.5%和52.9%)与Mckeown组比较(分别为89.7%、68.4%和62.4%),差异无统计学意义(P>0.05);Ivor-Lewis组患者1、3、5年无病生存率(分别为77.0%、54.1%和44.0%)与Mckeown组比较(分别为78.3%、59.0%和52.8%),差异无统计学意义(P>0.05)。结论对于胸中下段食管癌,Ivor-Lewis手术和Mckeown手术均具有可行性、安全性和良好的近期疗效和相似的生存率。Ivor-Lewis手术具有更低的喉返神经麻痹发生率,Mckeown手术在淋巴结清扫尤其是喉返神经旁淋巴结清扫方面更具有优势。Objective To compare the short-term and long-term clinical effects of Ivor-Lewis and Mckeown esophagectomy in the treatment of middle or lower thoracic esophageal cancer.Methods The clinical data of 716 patients with middle and lower thoracic esophageal cancer who underwent radical resection of Ivor Lewis or McKeown esophageal cancer in the Department of Thoracic Surgery,Cancer Hospital,Chinese Academy of Medical Science from March 2015 to October 2018 were analyzed retrospectively,and the perioperative indicators,postoperative complications and survival of the two surgical methods were compared.ResultsAmong 716 patients,135 patients underwent Ivor Lewis esophagectomy and 581 patients underwent McKeown esophagectomy.Mckeown group was significantly superior to Ivor Lewis group in terms of total number of lymph node dissection[median number was 27(19~37)vs 25(18~33)],total number of lymph node dissection stations[median number was 5(4~7)vs 5(4~5)],and number of lymph nodes dissection along recurrent laryngeal nerve[median number was 3(1~6)vs 0(0~3),P<0.05].However,the incidence of recurrent laryngeal nerve palsy in Mckeown group was significantly higher than that in Ivor Lewis group[10.7%(62/581)vs 1.5%(2/135),P<0.001].There was no significant difference in the 1-,3-,5-year overall survival between the Ivor Lewis group(91.0%,70.5%,52.9%)and the Mckeown group(89.7%,68.4%,62.4%,P>0.05),and there was also no significant difference in the 1-,3-,5-year disease free survival between the Ivor Lewis group(77.0%,54.1%,44.0%)and the Mckeown group(78.3%,59.0%,52.8%,P>0.05).Conclusions Ivor Lewis esophagectomy and Mckeown esophagectomy are feasible,safe,good short-term efficacy and similar survival rate for middle and lower thoracic esophageal cancer.Ivor Lewis surgery has lower incidence of recurrent laryngeal nerve palsy.Mckeown operation has more advantages in lymph node dissection,especially in lymph node dissection beside the recurrent laryngeal nerve.

关 键 词：食管肿瘤 胸腹联合食管癌根治术 颈胸腹三切口食管癌根治术 疗效 

分 类 号：R73[医药卫生—肿瘤]