微创McKeown术与左胸径路食管切除术治疗胸中下段食管癌的比较

Comparison of modified McKeown minimally invasive approach and the left chest-neck incision approach esophagecto. my to treat cancer of mid-to-distal thoracic esophagus

目的比较微创McKeown术与常规左侧开胸食管切除颈部吻合术治疗食管胸中下段癌手术效果的差异。方法回顾性分析2009年3月至2012年3月接受微创McKeown术的128例食管胸中下段癌患者的l临床资料，同期150例行常规经左胸食管切除颈部吻合术的食管胸中下段癌患者作为对照。结果微创McKeown手术组均顺利完成手术，无手术死亡病例，两组手术时间相似。微创McKeown手术组与常规左开胸切I=I组相比，术中出血量减少[（88．1±41．8）ml对（360．5±80．6）ml]，术后住院时间缩短[（11．7±3．6）天对（13．9±6．5）天]，淋巴结清扫数目多[（22．9±5．7）枚对（16．8±4．5）枚]，差异均有统计学意义，P〈0．05；术后呼吸系统并发症（10．9％对20．7％）、肺炎（4．7％对11．3％）、肺不张（3．9％对12．O％）和需要处理的胸腔积液（3．1％对10．0％）的发生率下降，胃排空障碍（8．6％对1．3％）发生率增高，差异均有统计学意义，P〈0．05。两组术后并发症总发生率、急性呼吸窘迫、心律失常、吻合口瘘、脓胸、乳糜胸、活动性出血二次手术和声带麻痹发生率及病死率的差异均无统计学意义，P〉0．05。结论微创McKeown术治疗食管癌在技术上是安全可行的，在减少术中出血量、缩短住院时间、降低术后呼吸系统并发症上具有优势，但术后胃排空障碍发生率较高。以右胸路径为基础的微创食管切除术更符合肿瘤学根治与微创原则的食管癌主流手术方向。

Objective To compare the outcomes between modified McKcown minimally invasive approach and open left chest-neck incision approach esophagectomy for treatment cancer of mid-to-distal thoracic esophagns..Methods We retrospec- tively analyzed clinical data from 128 patients with mid-to-distal thoracic esophageal cancer who underwent thoracescopic and lap- aroacopic esophagectomy from March 2009 to March 2012. One hundred and fifty patients were served as control that underwent open left chest-neck incision approach osophagectomy in the same period. Results All the operations were performed successful- ly. There was significant difference between modified McKeown minimally invasive approach and open left chest-neck incision ap- prcach esophagectomy with regard to respiratory complications （ 10.9 % vs. 20.7% ）, pneumonia （4.7% vs. 11.3% ）, atelectasis （ 3.1% vs. 10.5 %, ）, pleural effusion （3.1% vs. 10.0% ） and delayed gastric emptying （ 8.6% vs. 1.3 % ） （ P 〈 0.05 ）. Hospi- tal stay was significantly shorter in the minimally-invasive group than the open group [ （11.7 ± 3.6） days vs. （13.9 ± 6.5 ） days, P 〈 0.05 ], and had significantly less blood loss [ （88.1 ± 41.8 ） ml vs. （360.5 ± 80.6 ） ml, P 〈 0.05 ] and the number of lymph nodes harvested （22.9 ：l： 5.7 vs. 16.8 ±4.5, P 〈 0.05 ）. No significant differences were observed on the operative time, mortality and other complication between the two groups. Conclusion Modified McKeown minimally invasive approach esoph- agectomy is techeniqually feasible and safely which have lower blood loss, lower respiratory complication, shorter hospital stay and more number of lymph nodes harvested comparing to open left chest-neck incision approach.