两种胸腔镜下食管癌Ivor Lewis手术方式的初步研究

The comparison study of two surgical approach of thoracoscopic Ivor Lewis esophagectomy

目的对照两组不同胸腔内食管胃吻合术式的胸腔镜食管癌根治术患者的临床资料,研究胸腔镜下Ivor Lewis手术的改进方式。方法采用回顾性研究方法,选取厦门大学附属成功医院胸心外科2009年至2014年行胸腔镜Ivor Lewis术式的食管癌根治术患者18例,其中采用经口输送钉砧的Orvil吻合器术式的12例（Orvil吻合器组）,采用经常规圆形吻合器胸内吻合术式的6例（常规吻合器组）。对照分析两组的TNM分期、手术时间、术中出血、住院时间、并发症发生情况、住院费用等资料,采用卡方检验进行统计分析。结果所有患者无围手术期死亡,两组各有中转开胸1例。手术时间、TNM分期、住院时间均无显著性差异。Orvil吻合器组的术中出血少于常规吻合器组（193 ml vs 235 ml,P〈0.05）;Orvil吻合器组发生肺部感染2例,无吻合口瘘发生。常规吻合器组发生吻合口瘘1例,肺部感染1例。常规吻合器组住院费用少于Orvil吻合器组（69 522元vs 78 662元,P〈0.05）。随访6~36个月,未出现吻合口狭窄及吻合口复发等情况。结论胸腔镜下Ivor Lewis手术是下段食管癌及食管胃接合部癌的适合术式,近期效果良好,Orvil吻合器术式具有相对安全、创伤更小,但医疗花费较高的特点,如何进一步优化术式是值得探讨的问题。

Objective To improve the thoracospic Ivor Lewis esophagectomy, the clinic data of two groups of patient that underwent different approche of thoraeoscopic Ivor Lewis esophageetomy was compared and studied. Methods 18 cases of thoracospic Ivor Lewis esophageetomy was studied retrospectively during 2009 to 2014. Among them, the oral delivery nail anvil Orvil stapler anastomosis in the 12 cases, the regular circular stapler intrathoraeic anastomosis in 8 cases. Comparative analysis of the two groups with TNM stage, operative time, blood loss, ICU and hospital stay, incidence of complications, hospital costs, etc. , using the chi - square test was used for statistical analysis. Results There were no perioperative deaths in all cases, and two cases in the 1 groups were converted to thoracotomy. There was no significant difference in operation time, TNM stage and length of hospital stay. Intraoperative bleeding volume Orvil group less than conventional stapler group （ 193 ml vs 235 ml, P 〈 0.05 ）. Orvil group occurred pulmonary infection in 2 cases, no anastomotic fistula occurred. The regular stapler group anastomotic fistula occurred in 1 cases, 1 cases of pulmonary infection. The hospitalization expenses less compared with regular stapler group than in Orvil group （69 522 vs 78 662, P 〈 0.05 ）. No anastomotic stricture and anastomotie recurrence occurred in the follow-up of 6-36 months. Conclusions Thoraeoscopic Ivor Lewis operation in lower segment of esophagus and esophagogastric junction cancer show good short - term effect, Orvil stapling technique is relatively safe, less invasive but medical costs higher. How to further optimize the operation is worth exploring.