微创McKeown食管癌根治术与Ivor-Lewis手术治疗食管癌的近期疗效对比

Comparison of short-term outcomes between minimally invasive McKeown esophagectomy and Ivor-Lewis esophagectomy for esophageal cancer

目的:总结74例微创Mc Keown食管癌根治术(minimally invasive Mc Keown esophagectomy,MIE-Mc Keown)经验及体会,并与经典Ivor-Lewis食管癌手术(Ivor-Lewis esophagectomy,ILE)比较,探讨二者手术的近期疗效。方法:回顾性分析2014年11月至2016年7月期间在中南大学湘雅医院胸外科接受MIE-Mc Keown的74例患者的临床资料,选择同期接受ILE的食管癌患者85例作为对照,比较二者近期疗效。结果:与ILE组相比,MIE-Mc Keown组患者术中出血量更少,术后肺部感染发生率更低,手术切除食管长度更长,淋巴结清除组数及个数更多,但手术时间和术后住院时间更长,术后吻合口瘘和吻合口狭窄发生率更高,差异均有统计学意义(P<0.05)。两组整体淋巴结转移率52.8%,MIE-Mc Keown组的颈部淋巴结转移率9.5%。两组共发现食管多中心病灶16例,次瘤位于主瘤上方者7例,次瘤远侧缘距主瘤中心的距离(D)为20~85(50.7±23.0)mm,次瘤位于主瘤下方者9例,D值为30~90(57.8±20.5)mm。结论:MIEMc Keown病灶切除更彻底,淋巴结清除度较高,安全、创伤小、短期效果好,是治疗食管癌的适合术式,但吻合口瘘及吻合口狭窄发生率较高,需进一步优化。

Objective： To summarize the outcomes of 74 patients with minimally invasive McKeown esophagectomy （MIE-McKeown）, and to discuss the short-term outcomes by comparing with Ivor- Lewis esophagectomy （ILE） procedure.Methods： A total of 74 patients with esophageal carcinoma underwent MIE-McKeown in Xiangya Hospital from November 2014 to.July 2016 were retrospectively reviewed, and 85 patients underwent ILE procedure were selected as a control group. Perioperative and short-term outcomes were analyzed. Results： Compared with the ILE group, patients underwent MIE-McKeown had less blood loss, less pulmonary infection, longer resection length and more harvested lymph nodes （P〈0.05）, but they had more anastomotic leakage and stricture rate, longer operation time and hospital stay as well （P〈0.05）. The total rate of lymph node metastatic in all patients was 52.8%, and the rate of cervical lymph node metastases was 9.5% in the MIE-McKeown group. Multiple carcinomas were found in 16 cases, and 7 were proximally located. The distance from the distal margin of the second lesion to the center of the main lesion was 20-85 （50.7±23.0） mm, while the distance in 9 second carcinomas distally located was 30-90 （57.8±20.5） mm. Conclusion： Compared with Ivor-Lewis esophagectomy procedure, MIE-McKeown procedure has a more complete lesion dissection and more harvested lymph nodes with smaller incisions, better short-term outcomes and more safety. It is an appropriate procedure for esophagectomy. However, it should be optimized for its high rate of anastomotic leakage and stricture.