食管鳞癌胸腹腔镜Ivor-Lewis术与McKeown术近期疗效对比研究

Control study of the short-term efficacy of Ivor-Lewis and McKeown operation by thoracoscopy and laparoscopy in esophageal squamous cell carcinoma

目的比较食管鳞癌胸腹腔镜Ivor-Lewis术与McKeown术的近期疗效。方法回顾性分析本院2012年2月至2015年1月收治的158例食管鳞癌手术患者的临床资料,其中行Ivor-Lewis术(IvorLewis组)81例,行McKeown术(McKeown组)77例。比较两组患者各项围术期指标(手术用时、术中出血量、术后拔管时间、淋巴结清扫数)、术后并发症发生情况以及术后6个月肿瘤复发情况。结果Ivor-Lewis组患者手术用时显著长于McKeown组(P<0.05),淋巴结清扫数及术中出血量均明显多于McKeown组(P<0.05),两组患者术后拔管时间比较无显著差异(P>0.05);Ivor-Lewis组患者术后吻合口瘘、喉返神经损伤发生率均显著低于McKeown组(P<0.05),术后肺部感染发生率显著高于McKeown组(P<0.05),两组患者术后心律失常及总并发症发生率比较差异均无显著性(P>0.05);两组患者术后6个月肿瘤复发情况比较无显著差异(P>0.05)。结论胸腹腔镜IvorLewis术与McKeown术均可作为食管鳞癌患者的候选术式,临床中应根据患者术前的个体情况选择合适的手术方式。

Objective To observe the clinical effect of Ivor-Lewis and McKeown operation by thoracoscopy and laparoscopy in the treatment of esophageal squamous cell carcinoma.Method A retrospective analysis of 158 surgical patients with esophageal squamous cell carcinoma in our hospital from February 2012 to January 2015 was made and there were 81 cases in Ivor-Lewis group and 77 cases in McKeown group.The operation time,intraoperative bleeding volume,postoperative extubation time,number of dissected lymph nodes,postoperative complications and tumor recurrence after 6 months were observed between the two groups.Result The operation time,number of dissected lymph nodes and the intraoperative bleeding volume in Ivor-Lewis group was significantly more than McKeown group（P〈0.05）.Postoperative extubation time showed no significant difference between the two groups（P〉0.05）.The incidence of anastomotic fistula and recurrent laryngeal nerve injury in Ivor-Lewis group was significantly lower than McKeown group（P〈0.05）,while the incidence of pulmonary infection in Ivor-Lewis group was significantly higher than McKeown group（P〈0.05）.There was no significant differences between the two groups in the incidence of total postoperative complications and tumor recurrence after 6 months（P〉 0.05）.Conclusion Ivor-Lewis and McKeown operation by thoracoscopy and laparoscopy have respective advantages and the appropriate surgical treatment should be chosen according to the different individual condition of patients.