Ivor-Lewis与左胸一切口治疗食管中下段癌的近期疗效

Ivor-Lewis esophagectomy versus one-incision esophagectomy via the left thoracic approach in the treatment of middle and lower thoracic esophageal carcinoma

目的:比较Ivor-Lewis手术与经左胸一切口手术治疗中下段食管癌的优缺点及术后并发症发生的差异.方法:回顾性分析2010-01/2012-12收治的269例中下段食管癌手术资料,Ivor-Lewis 114例,左胸一切口155例,比较两组患者手术相关参数以及围手术期并发症.结果:Ivor-Lewis手术组和经左胸组淋巴结清扫平均数分别是16.5枚±3.5枚和11.6枚±2.2枚(P<0.001);上纵隔淋巴结转移率分别是15.72%、8.14%(2=6.32,P<0.05);上切缘阳性率分别为0%、1.9%(P<0.05);术后两组并发症发生率分别是23.7%、27.7%(P>0.05),呼吸衰竭及心律失常发生率低于左胸组;术后住院日低于左胸组.结论:Ivor-Lewis手术治疗中下段食管癌,在淋巴结清扫及上切缘阳性率,术后患者恢复方面有一定优势,术后心肺并发症少.

AIM： To compare the short-term efficacy and postoperative complications of Ivor-Lewis esophagectomy and one-incision esophagectomy via the left thoracic approach in the treatment of middle and lower thoracic esophageal carcinoma. METHODS： Clinical data for 269 patients with middle or lower thoracic esophageal carcinoma who underwent surgical treatment between January 2010 and December 2012 were analyzed retrospectively, of whom 114 received Ivor-Lewis esophagectomy and 155 received one-incisionesophagectrny via the left thoracic approach. The data regarding surgical procedures and periop- erative complications were compared between the two groups. RESULTS： The number of resected lymph nodes was significantly less in the Ivor-Lewis esophagectorny group than in the one-incision esophagectomy group （16.5 ＋3.5 vs 11.6 ＋2.2, P 〈 0.001）. The rate of lymph node metastasis （15.72% vs 8.14%, 2 = 6.32, P 〈 0.05） and the positive rate of surgical margins （0% vs 1.9%, P 〈 0.05） were statistically significant between the two groups. There was no significant difference in the rate of perioperative complications （23.7% vs 27.7%, P 〉 0.05）, but the rates of respiration failure and arrhythmia were lower and the length of post- operative hospital stay were shorter in the Ivor- Lewis esophagectomy group. CONCLUSION： Ivor-Lewis esophagectomy is superior to one-incision esophagectomy via the left thoracic approach in the treatment of middle and lower thoracic esophageal carcinoma in terms of lymph node dissection, the positive rate of surgical margin, postoperative recovery, and the rates of respiration failure and arrhythmia.