Ivor-Lewis手术治疗食管癌安全性和淋巴结清扫效果的评价

Safety Evaluation and Lymph Node Dissection Effect of Ivor-Lewis Esophagectomy for Patients with Esophageal Cancer

目的评价Ivor-Lewis手术治疗食管癌的安全性和区域淋巴结清扫的效果。方法收集2012年9月-2014年3月行Ivor-Lewis手术的78例食管癌患者临床资料,以同一时期行Sweet手术的86例食管癌患者作为对照,对两组患者手术时间、术中出血量,术后主要并发症和不同区域淋巴结转移情况进行比较。结果 Ivor-Lewis组平均手术时间[(254.5±38.4)min]稍长于Sweet组[(216.7±31.3)min],平均术中出血量[(165.5±40.3)m L]高于Sweet组[(148.7±35.4)m L],差异有统计学意义(P<0.05);两组术后住院时间比较差异均无统计学意义(P>0.05);Ivor-Lewis组术后声嘶发生率显著高于Sweet组(P<0.05);其他并发症两组间差异无统计学意义(P>0.05);Ivor-Lewis组患者淋巴结阳性率(60.3%,47/78)显著高于Sweet组(26.7%,23/86),差异有统计学意义(P<0.05);Ivor-Lewis组患者平均淋巴结清扫数[(21.5±5.3)枚]显著高于Sweet组[(10.6±4.1)枚];右喉返神经旁淋巴结是Ivor-Lewis组最常见的淋巴结转移部位,而Sweet组由于难以对该区域淋巴结进行清扫,因此无法明确该区域淋巴结转移情况。结论 Ivor-Lewis手术是一种安全的手术方式,相对Sweet手术而言,在胸、腹腔淋巴结清扫方面具有明显优势。

Objective To evaluate the safety and advantage in lymph node dissection of Ivor-Lewis esophagectomy in patients with esophageal cancer.Methods Clinical and pathological data of 78 patients with esophageal cancer who underwent Ivor-Lewis esophagectomy between September 2012 and March 2014 were collected and analyzed.Another 86 esophageal cancer patients who underwent esophagectomy of Sweet procedure during the same period were regarded as the controls.Duration of surgery,intra-operative blood loss,incidence of main complications and positive rate of lymph node were compared between the two groups.Results The duration of surgery in Ivor-Lewis group [（254.5±38.4） minutes] was longer than that in the Sweet group [（216.7±31.3） minutes]; and the average intraoperative blood loss in Ivor-Lewis group [（165.5±40.3） m L] was higher than that in the Sweet group [（148.7±35.4） m L]; the dif erences were signii cant（P 〈0.01）.Incidence of hoarseness in Ivor-Lewis group was signii cantly higher than that in Sweet group（P 〈0.05）,while incidences of other complications between the two groups were similar（P 〉0.05）.The proportion of patients with positive lymph nodes in Ivor-Lewis group（60.3%,47/78） was signii cantly higher than that in Sweet group（26.7%,23/86）（P 〈0.05）.Average number of lymph nodes dissected in Ivor-Lewis group（21.5±5.3） was signii cantly higher than that in Sweet group（10.6±4.1）.Lymph nodes along the right recurrent laryngeal nerve was the most common metastasis in patients of Ivor-Lewis group,while lymph nodes in that area in Sweet group patients could hardly be dissected.Conclusions Ivor-Lewis esophagectomy is a safe surgical procedure for esophageal cancer.IvorLewis procedure has more advantages in lymph node dissection than Sweet procedure.