食管胸中下段癌应用微创McKeown手术与常规左侧开胸路径食管切除术的疗效对比

Comparison of operative effect between McKeown minimally invasive approach and the left chest- neck incision approach esophagectomy in mid-to-distal esophageal cancer

目的比较食管胸中下段癌应用微创McKeown手术与常规左侧开胸食管切除颈部吻合术的手术效果。方法回顾性分析2009年1月至2013年10月收治的148例食管胸中下段癌患者的临床资料，其中78例行微创McKeown手术治疗（观察组），另70例行左胸．左颈切口手术治疗（对照组），观察比较两组围手术期情况、术后并发症及淋巴结转移情况。结果两组均顺利完成手术切除。观察组无死亡病例，对照组1例患者死于急性心肌梗死。观察组术中出血量少于对照组[（89．2±40．7）ml比（361．6±81．5）m1]，淋巴结清扫数目及胸部淋巴结数多于对照组[（22．8±5．6）枚比（15．7±3．4）枚、（14．7±4．6）枚比（9．1±3．6）枚]，术后住院时间少于对照组[（11．6±3．5）d比（14．0±6．6）d]，差异均有统计学意义（P〈0．05）。观察组肺炎、肺不张、需要处理的胸腔积液发生率显著低于对照组[5．1％（4／78）比12．9％（9／70）、3．8％（3，78）比11.4％（8／70）、2．6％（2，78）比10．0％（7／70）]，胃排空障碍发生率高于对照组[9．0％（7／78）比1．4％（1／70）]，差异均有统计学意义（P〈0．05）。观察组右侧喉返神经旁、左侧喉返神经旁及上纵隔淋巴结转移率明显高于对照组，差异有统计学意义（P〈0．05）。结论微创McKeown手术治疗食管胸中下段癌在技术上是安全可行的，且在减少术中出血量、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 outcome between McKeown minimally invasive approach and left chest-neck incision approach esophagectomy in mid-to-distal esophageal cancer. Methods The clinical data of 148 patients with mid-to-distal esophageal cancer from January 2009 to October 2013 were analyzed retrospectively. Seventy-eight patients （observation group ） were performed with McKeown minimally invasive approach esophagectomy and 70 patients （control group） were performed with left chest-neck incision approach esophagectomy. The peroperative period status, postoperative complications and lymph nodes transfer between two groups were compared. Results All the operations were performed successfully. One patient in control group was dead because of acute myocardial infarction. The blood loss in observation group was significantly lower than that in control group [ （ 89.2 ± 40.7 ） ml vs. （ 361.6 ± 81.5 ） ml ] （P 〈 0.05 ）, the number of lymph nodes harvested and lymph node of thorax were significantly higher than those in control group[ （22.8 ± 5.6） lymph nodes vs. （15.7 ± 3.4） lymph nodes, （14.7 ± 4.6） lymph nodes vs. （9.1 ± 3.6） lymph nodes ] （P 〈 0.05 ）, the hospital stay was significantly shorter than that in control group[ （ 11.6 ± 3.5 ） d vs. （14.0 ±6.6） d] （P 〈0.05）. There were significant differences between two groups with regard to pneumonia, atelectasis, pleural effusion and delayed gastric emptying [ 5.1% （4/78 ） vs. 12.9% （ 9/70 ）, 3.8% （3/78） vs. 11.4%（8/70）,2.6%（2/78） vs. 10.0%（7/70）,9.0%（7/78） vs. 1.4% （1/70） ] （P 〈 0.05 ）. The transfer rate at the side of right recurrent laryngeal, left recurrent laryngeal and upper mediastinal lymph node in observation group were significantly higher than those in control group（P 〈 0.05 ）. Conclusion McKeown minimally invasive approach esophagectomy is feasible and safe which has lower blood loss, lower respiratory complication, shorter hospital stay and more number of lymph nodes harvested.