改良Ivor-Lewis术在食管癌根治术中的应用

Application of modified Ivor-Lewis procedure in radical operation of esophageal carcinoma

目的探讨改良Ivor-Lewis食管癌根治术治疗食管癌的疗效及安全性,以及对患者预后的影响。方法前瞻性选取乐山市人民医院胸心外科于2010年1月-2013年1月收治的120例手术治疗的食管癌患者,根据手术方式将其分为两组,对照组行颈胸腹三切口食管癌根治术,研究组行改良Ivor-Lewis食管癌根治术,对比分析两组患者手术时间、术中出血量、淋巴结清扫数目、住院时间、并发症发生率以及预后情况。结果研究组手术时间、出血量、补液量均少于对照组(P<0.05),术中淋巴结清扫数明显多于对照组(P<0.05),术后住ICU时间、带鼻胃管时间、经口进食时间、住院时间均明显短于对照组(P<0.05);研究组切缘阳性率明显低于对照组(χ2=4.1379,P=0.0419);研究组患者术后心律失常、肺部感染、喉返神经损伤、吻合口瘘、乳糜胸、胃潴留、切口感染、脓胸、呼吸衰竭等并发症发生率明显低于对照组(χ2=4.4829,P=0.0342);随访期间,对照组3例死亡,2例肝转移、1例两肺转移、1例纵膈及腹膜后淋巴结转移,研究组1例死亡,1例肝转移、1例腹膜后转移,其余患者均无瘤生存。结论改良Ivor-Lewis食管癌根治术手术时间短、减少术中出血量、促进患者术后早期恢复,降低术后并发症发生率,改善患者的预后,是一种疗效确切且安全性高的手术方式,可作为临床治疗胸中下段食管癌首选术式之一。

Objective To investigate the curative efficacy and safety of modified Ivor-Lewis procedure in radical op- eration of esophageal carcinoma. Methods One hundred and twenty cases of esophageal carcinoma in Department of Cardiothoracic Surgery in Leshan People＇s Hospital of Sichuan from Jan. 2010 to Jan. 2013 were collected, according to the operation mode, they were divided into 2 groups, patients in the control group underwent radical resection of cer- vical and thoracic abdominal three cutting for esophageal carcinoma, patients in study group underwent modified Ivor- Lewis radical operation for esophageal carcinoma. Operation time, amount of bleeding during the operation, the number of lymph node dissection, time, complications and prognosis of inpatients were compared between two groups. Results Operation time, intraoperative bleeding volume of fluid infusion, intraoperative volume were less those in study group than those in the control group （P 〈 0.05） , intraoperative lymph node dissection was higher in study group than that in control group （P 〈 0.05） , postoperative length of stay in ICU, with a nasogastric tube time, oral feeding time, hospi- talization time were significantly shorter in study group than those in the control group （P 〈 0.05） ; margin positive rate was significantly lower in study group than taht in the control group （X^2 =4. 1379, P =0. 0419） ; includence of compli- cations was significantly lower than that of 43.33% in the control group （X^2 =4. 4829, P =0. 0342） in cluded postoper- ative arrhythmia, pulmonary infection, recurrent laryngeal nerve injury occurred, anastomotie fistula, ehylothorax, gas- tric retention, incision infection, empyema, respiratory. During the follow-up period, there were 3 patients died, 2 ca- ses of liver metastasis, 1 case of pulmonary metastasis, 1 case of mediastinal and retroperitoneal lymph node metastasis in control group, there were 1 cases of death, 1 case of metastatic liver metastasis, 1 case of retroperitoneal, other pa- tients tumor free survival in study group. Conclusion The modified Ivor-Lewis radical operation for esophageal carcino- ma can shorten operation time, reduce intraoperative bleeding, and promote early recovery of patients, reduce the inci- dence of postoperative complications, improve the prognosis of patients, is a definite curative effect and high safety, can be used as one of the clinical treatments of middle and lower thoracic esophageal carcinoma surgical choice.