无腹部小切口全腔镜Ivor Lewis食管癌切除术的临床应用

Laparoscopic and thoracoscopic Ivor Lewis esophagectomy without an abdominal small incision

目的 探讨无腹部小切口全腔镜Ivor Lewis食管癌切除术的可行性和临床效果。方法 回顾性分析安徽医科大学附属省立医院胸外2015年1月-2016年2月收治的148例接受胸腹腔镜Ivor Lewis食管癌切除术患者资料，将其中80例行无腹部小切口全腔镜Ivor Lewis食管癌切除术（全腔镜组）病例，与同期行附加腹部小切口胸腹腔镜Ivor Lewis食管癌切除术（小切口组）68例患者进行比较，分析两组患者的围手术期并发症和情况。结果 两组的手术时间［（263.3±71.5） min vs（273.3±73.7）min，t=-0.750，P=0.454］、术中出血量［（246.9±150.4）ml vs （252.9±159.7）ml,t=-0.238, P=0.812］、淋巴结清扫数目［（19.2±4.3）枚 vs （19.0±4.5）枚，t=0.272, P=0.786］、胃肠减压时间［（11.0±3.4）d vs （11.9±3.3）d，t=-1.647，P=0.102］、胸引管留置时间［（6.6±2.7）d vs （6.3±2.6）d, t=0.544, P=0.587］、术后住院时间［（13.2±3.4）d vs （14.0±3.4）d，t=-1.493，P=0.138］及早期胃排空障碍发病率［6.25%（5/80） vs 4.41%（3/68），χ^2=0.016，P=0.898］等方面差异均无统计学意义。全腔镜组术后24 h 视觉模拟评分较小切口组低，差异有统计学意义。两组患者围手术期（术后90 d内）均未出现吻合口瘘、胸胃残端瘘、术后上消化道出血及死亡等严重并发症。结论 无腹部小切口全腔镜Ivor Lewis食管癌切除术治疗中下段食管安全、可行，可以进一步减少腹部创伤、减轻患者术后疼痛程度、腹部切口更加美观。

Objective To investigate the feasibility and clinical effect of laparoscopic and thoracoscopic Ivor Lewis esophagectomy without an abdominal small incision. Methods Compared 80 cases underwent laparoscopic and thoracoscopic Ivor Lewis esophagectomy without an abdominal small incision with 68 patients receivesd laparoscopic and thoracoscopic Ivor Lewis esophagectomy with an abdominal small incision. The peri operative conditions and complications of the two groups were analyzed. Results There were no significant difference in the operation time [（263.3±71.5） min vs （273.3±73.7） min, t=-0.750, P=0.454], intraoperative blood loss [（246.9±150.4） ml vs （252.9±159.7） ml, t=-0.238,P=0.812], the number of lymph node dissection [（19.2±4.3） vs （19±4.5）, t=0.272,P=0.786], gastrointestinal decompression time [（11±3.4） d vs （11.9±3.3） d, t=-1.647,P=0.102], chest tube indwelling time [（6.6±2.7） d vs （6.3±2.6） d, t=0.544, P=0.587], postoperative hospitalization time [（13.2±3.4） d vs （14±3.4） d,t=-1.493, P=0.138] and rate of early gastric emptying dysfunction [6.25%（5/80） vs 4.41%（3/68）, χ^2=0.016, P=0.898]. Comparing to patients in the small incision group, the visual analogue scale evaluation score of postoperative pain was lower in the groups without small incision （P〈0.05）. There were no anastomotic fistula, thoracic gastric fistula, upper gastrointestinal bleeding and death during perioperative periods. Conclusion It is safe and feasible to treat middle and lower esophageal carcinoma with laparoscopic and thoracoscopic Ivor Lewis esophagectomy without an abdominal small incision, which can further reduce abdominal trauma, relieve postoperative pain and make the abdominal incision more beautiful.