改良Ivor-Lewis手术治疗62例胸中下段食管鳞癌的疗效分析

Clinical Efficacy of Modified Ivor-Lewis Operation for Middle and Lower Thoracic Esophageal Squamous Cell Carcinoma

目的探讨改良Ivor-Lewis手术治疗胸中下段食管鳞癌的临床疗效。方法回顾性分析62例采用改良Ivor-Lewis手术治疗的胸中下段食管鳞癌患者的临床资料。生存率计算采用Kaplan-Meier方法。结果术后10例出现并发症,占16.1%。死亡2例,占3.2%。淋巴结转移率58.0%,上纵隔转移率最低(16.5%),下纵膈转移率最高(40.9%)。全组平均生存时间为(52.06±3.21)个月,3、5年生存率分别为52.2%、24.5%。Ⅰ、Ⅱ、Ⅲ期患者3、5年生存率分别为93.4%和70.5%、49.3%和27.5%、36.2%和12.6%。结论改良Ivor-Lewis手术具有良好的手术视野,淋巴结清扫彻底的优点,可减少术后并发症,提高患者生存期,是治疗胸中下段食管鳞癌较理想的手术方式。

Objective To study the clinical efficacy of modified Ivor-Lewis operation for middle and lower thoracic esophageal squamous cell carcinoma. Methods Clinical data of 62 patients with middle and lower thoracic esophageal squamous cell carcinoma, who underwent the modified Ivor-Lewis operation, were retrospectively analyzed. Survival rate were calculated using Kaplan-Meier. Results Postoperative complications occurred in 10 patients （ 16. 1% ） and death occurred in 2 patients （ 3.2% ）. The lymph node metastasis rate was 58.0% ;the metastasis rate of the upper mediastinal nodes was 16.5% ,the metastasis rate of the lower mediastinal lymph node metastasis rate was 40.9%. The survival time was （52.06 ±3.21 ） months, 3-year and 5-year survival rates were 52.2% and 24.5% ,The 3-year and 5-year survival rates of the stage I , II , 111 patients were 93.4% ,70.5% ,49.4% ,27.5% and 36.2%, 12.6%, respectively. Conclusion The modified Ivor-Lewis operation has good operation view, can cut lymph node thoroughly, reduce the postoperative complications, and improve patient survival. It is an ideal operation treatment for middle and lower thoracic esophageal squamous cell carcinoma.