微创Ivor Lewis食管癌切除术治疗局部进展期食管癌近期结果分析

Short-term outcomes of minimally invasive Ivor Lewis esophagectomy for locally advanced esophageal cancer

目的 探讨完全胸腔镜联合腹腔镜施行微创Ivor Lewis食管癌切除术治疗局部进展期食管癌的可行性、安全性和近期疗效.方法 回顾性分析2011年10月至2013年10月于安徽医科大学附属省立医院胸外科接受Ivor Lewis食管癌切除术的309例局部进展期食管癌患者的临床资料.其中112例接受微创手术,197例接受开放手术.t检验和χ^2检验比较两组患者临床病理特征、术中情况和术后并发症发生率.结果 两组患者在性别、年龄、术前合并症、术前美国麻醉师协会分级、肿瘤位置和术前临床分期方面差异无统计学意义,临床资料具有可比性.两组患者术后临床病理特征、手术时间和淋巴结清扫个数差异无统计学意义（P＞0.05）.微创组术中失血量低于开放组[（186 ±45）ml比（198±47）ml,t=2.086,P=0.039],胸腔引流时间低于开放组[（9±5）d比（11±6）d,t =2.760,P=0.005],术后住院时间低于开放组[（12±6）d比（14±7）d,t=2.932,P=0.005].两组患者术后在院病死率、总并发症发生率和肺部感染发生率差异无统计学意义（P＞0.05）.微创组切口感染率低于开放组,差异有统计学意义（0比4.6％,χ^2=3.779,P=0.029）.结论 完全胸腔镜联合腹腔镜施行微创Ivor Lewis食管癌切除术治疗局部进展期食管癌安全可行,可获得满意的近期疗效.

Objective To describe the technique for minimally invasive Ivor Lewis esophagectomy （MIILE） and to evaluate the feasibility,safety and the short-term clinical outcomes of this approach.Methods The clinical data of 309 patients with locally advanced esophageal cancer who received Ivor Lewis esophagectomy between October 2011 and October 2013 was analyzed retrospectively.Of those 309 patients,112 underwent MIILE and 197 underwent open Ivor Lewis esophagectomy （OILE）.The clinicopathologic factors,operational factors and postoperative complications of the two groups were compared by t test and χ^2 test.Results The two groups were similar in terms of gender,age,American Society of Anesthesiologists grade,tumor location,preoperative staging and incidence of comorbidities （P 〉 0.05）.The MIILE approach was associated with a significant decrease in surgical blood loss （（186 ± 45） ml vs.（198 ± 47） ml,t =2.086,P =0.039）,chest tube duration （（9 ± 5） days vs.（11 ± 6） days,t =2.760,P =0.005） and postoperative stay （（12 ± 6） days vs.（14 ± 7） days,t =2.932,P =0.005） relative to the OILE approach.There was no significant difference between the two groups in the number of total lymph nodes dissected or the stations of the total lymph nodes dissected （P 〉 0.05）.The postoperative in-hospital mortality and total morbidity did not differ between the two groups （P 〉 0.05）.The MIILE approach was associated with significantly fewer wound infections than the OILE approach （0 vs.4.6%,P =0.029）.Conclusion Our MIILE technique for locally advanced esophageal cancer can be safely and effectively performed for intrathoracic anastomosis during esophageal surgeries with favorable early outcomes.