腹腔镜在Ivor-Lewis食管癌根治术中的应用

The application of laparoscopic-assisted modified Ivor-Lewis on esophageal cancer resection

背景与目的:与传统开腹手术相比,腹腔镜手术具有创伤小、疼痛轻、恢复快以及并发症少的优点,目前广泛应用于普外科、妇产科和泌尿科疾病。本文旨在比较腹腔镜辅助改良Ivor-Lewis食管癌根治术与传统的Ivor-Lewis食管癌根治术的临床疗效与应用适应证。方法:回顾分析128例食管癌手术患者的临床资料,观察组行腹腔镜辅助改良Ivor-Lewis食管癌根治术(改良Ivor-Lewis术,64例),对照组行传统Ivor-Lewis食管癌根治术(传统Ivor-Lewis术,64例),比较两组患者的疼痛评分、手术有效性和安全性及远期疗效等临床疗效。结果:在手术时间、术中出血量、术后引流量、食管切除长度、淋巴结清除个数、术后1年复发率和围手术期死亡率等方面观察组与对照组的差异均无统计学意义(P>0.05);在术后住院时间、首次下床时间、肛门排气时间、疼痛程度、肺部感染以及吻合口瘘等临床疗效方面观察组明显优于对照组(P<0.05)。结论:腹腔镜辅助改良Ivor-Lewis食管癌根治术是彻底且安全可靠的微创术式,能减轻术后疼痛,减少术后并发症,值得临床推广,但应严格掌握手术适应证。

Background and purpose： Compared with traditional open surgery, laparoscopic surgery has many advantages, such as small trauma, less pain, rapid recovery and fewer complications. It is widely used in general surgery, obstetrics, and gynecology and urology disease. This study aimed to compare the effect of laparoscopic- assisted modified Ivor-Lewis on esophageal cancer resection, comparing with traditional Ivor-Lewis operation, then to explore the application of indications. Methods： Make a retrospective analysis of 128 esophageal cancer patients, the observation group were given laparoscopic-assisted modified Ivor-Lewis on esophageal resection （modified Ivor- Lewis operation, 64 patients）, the control group were given traditional Ivor-Lewis resection on esophageal cancer （traditional Ivor-Lewis operation, 64 patients）, the pain score, and surgical efficacy, safety and long-term effect were compared between the 2 groups. Results： There were no significant differences in the operative time, blood loss, postoperative drainage, length of esophageal resection, the number of lymph nodes removed, recurrence rate 1 year after surgery, perioperative mortality, but the postoperative hospital stay, the first bed time, anal exhaust time, pain and pulmonary infection, anastomotic leak of the observation group were significantly better than those in the control group. Conclusion： Laparoscopic-assisted modified Ivor-Lewis resection on esophageal cancer is completely a kind of feasible and safe minimally invasive procedure, and can effectively reduce postoperative pain and reduce postoperative complications, the surgical approach should be promoted, but surgical indications should be strictly controlled.