腔镜下食管癌Ivor-Lewis手术的临床疗效及预后影响因素

Clinical Factors Influencing the Endoscopic Esophageal Ivor-Lewis Surgery for Esophageal Cancer Patients

目的探讨腔镜下食管癌Ivor-Lewis手术临床疗效及预后影响因素。方法收集2006年8月至2011年8月行腔镜下食管癌Ivor-Lewis手术的120例食管癌患者临床资料,应用KaplanMeier法计算食管癌患者生存率,Cox风险模型分析影响腔镜下食管癌Ivor-Lewis手术后远期疗效的相关因素。结果所有患者均顺利完成手术,术中出血量为30~80 ml,平均（52.2±3.8）ml,清扫胸部淋巴结5~15枚,腹部淋巴结1~12枚。术后发生吻合口瘘2例,肺炎5例。对患者随访5年,共110例获得随访,患者5年存活率为35.00%。经单因素分析显示,腔镜下食管癌Ivor-Lewis手术患者术后生存率与年龄、病变部位、肿瘤长度、分化程度、淋巴结转移、NCCN分期及辅助化疗有关（P〈0.05）。经Cox多因素分析,患者年龄≥60岁、肿瘤长度〉5 cm、术后分期为Ⅲa、淋巴结转移是影响远期预后的独立危险因素,而术后辅助化疗是患者预后的保护因素。结论腔镜下食管癌Ivor-Lewis手术对食管癌患者创伤小,安全可行。年龄、肿瘤长度、浸润程度、分化程度、淋巴结转移是影响腔镜下食管癌Ivor-Lewis手术远期预后的独立危险因素,而术后辅助化疗是患者预后的保护因素。临床应根据患者实际情况选择合适的治疗方法,以提高食管癌患者远期生存率。

Objective To explore the clinical effects and analyze the factors influencing radical treatment of endoscopic esophageal Ivor-Lewis surgery for esophageal cancer patients. Methods The clinical data of 120 patients with esophageal cancer underwent thoracoscopic and laparoscopic esophageal Ivor-Lewis surgery were retrospectively studied from August 2006 to August 2011. The survival rate of esophageal cancer were calculated with KaplanMeier. The influence factors of Ivor-Lewis surgery were analyzed with Cox risk model. Results All patients were successfully operated. The blood loss was 30 ~ 80 ml,with（ 52. 2 ± 3. 8） ml in average. The chest lymph node dissection number was 5 to 15,and the abdominal lymph node dissection number was 1 to 12. There were 2 cases of anastomotic leakage and 5 cases of pneumonia. Patients were followed up for five years with a total of 110 cases completed. The 5-year survival rate was 35. 00%. The 5-year survival rate was related with age,tumor pathological staging,degree of differentiation,the length of the lesion,lymph node metastasis and adjuvant chemotherapy（ P 〈 0. 05）.Age ≥60 years,tumor length 〉5 cm,pathological staging Ⅲa and lymph node metastasis were independent risk factors of the 5-year survival rate and the adjuvant chemotherapy was a protective factor. Conclusion It is safe and feasible of the thoracoscopic and laparoscopic esophageal Ivor-Lewis surgery for esophageal cancer patients with less trauma. Age,length of tumor,infiltration,differentiation and lymph node metastasis are independent risk factors for the long-term prognosis. Appropriate treatments should be chosen according to the actual situation of the patients.