微创McKeown术与左后外切口路径手术治疗胸中下段食管癌的疗效及安全性研究

Efficacy and Safety of Mc Keown Minimally Invasive Esophagectomy and Left Rear Outer Incision Surgery in the Treatment of Esophageal Cancer of Thoracic Middle- lower Segment

目的比较微创Mc Keown术与左后外切口路径手术治疗胸中下段食管癌的效果及安全性。方法选取2010年4月—2013年4月河北省沧州市中心医院收治的220例胸中下段食管癌患者,根据手术方法分为试验组100例,行微创Mc Keown术;对照组120例,行传统的左后外切口路径手术。对比两组患者围术期情况、术后并发症发生率及淋巴结转移情况。结果试验组患者术中出血量、术后住院时间较对照组减少(P<0.05);试验组患者淋巴结清扫数量较对照组增多(P<0.05)。试验组患者呼吸系统并发症、肺炎、肺不张、胸腔积液发生率较对照组降低(P<0.05);试验组患者胸胃坏死穿孔、胃排空障碍发生率较对照组升高(P<0.05)。试验组患者上纵隔及左、右侧喉返神经旁淋巴结转移率较对照组升高(P<0.05)。结论采用微创Mc Keown术治疗胸中下段食管癌,能减少术中出血量及术后住院时间,符合微创手术要求;但术后胸胃坏死穿孔、胃排空障碍发生率及上纵隔、左侧和右侧喉返神经旁淋巴结转移率较高。

Objective To compare the curative effect of McKenzie minimally invasive esophagectomy and left rear outer incision surgery in the treatment of esophageal cancer in thoracic middle-lower segment. Methods Enrolled 220 patients with esophageal cancer in thoracic middle-lower segment who were admitted into Cangzhou Central Hospital from April 2010 to April 2013. According to surgical method,assigned 100 patients who received McKenzie minimally invasive esophagectomy into trial group and 120 patients who received conventional left rear outer incision surgery into control group. Comparison was made between the two groups in perioperative condition, incidence of complications after operation and condition of lymphatic metastasis. Results The trial group was lower（P〈0. 05）than control group in the amount of bleeding and length of stay after operation;the trial group was higher（P〈0. 05）than the control group in the number of lymph node cleaning. The trial group was lower（P〈0. 05）than control group in the incidence rates of respiratory complication,pneumonia,pulmonary atelectasis and pleural effusion;the trial group was higher（P 〈0. 05）than the control group in the incidence rates of thoracic gastric necrosis and perforation and delayed gastric emptying. The trial group was higher（P〈0. 05）than control group in the incidence rates of recurrent laryngeal nerve lymph node metastasis in superior mediastinum, on the left side and on the right side. Conclusion McKeown minimally invasive esophagetomy for the treatment of esophageal cancer in thoracic middle-lower segment can reduce the amount of bleeding and length of hospital stay after surgery,and it accords with the standard of minimally invasive surgery, while the incidence rates of thoracic gastric necrosis and perforation and delayed gastric emptying and the incidence rates of recurrent laryngeal nerve lymph node metastasis in superior mediastinum,on the left side and on the right side are high.