手工荷包缝合Ivor-Lewis术治疗中下段食管癌近期疗效的病例对照研究

Short-term efficacy of purse-string Ivor-Lewis approach in minimally invasive esophagectomy for middle and lower esophageal cancer: A case control study

目的对比分析微创荷包钳法Ivor-Lewis术与手工荷包缝合Ivor-Lewis术治疗中下段食管癌的近期疗效,探讨手工荷包缝合技术行胸腹腔镜Ivor-Lewis术的安全性和可行性。方法回顾性分析我院胸外科2014年1月至2017年1月151例胸腹腔镜中、下段食管癌根治术患者的临床资料。根据荷包缝合方式将患者分为两组:荷包钳组(术中采用荷包钳荷包缝合法)和手工组(采用手工荷包缝合法)。其中荷包钳组65例,男49例、女16例,年龄51~80(67.98±7.07)岁;手工组86例,男61例、女25例,年龄52~83(67.76±8.18)岁。对两组患者围术期资料进行比较。结果手工组荷包缝合时间短于荷包钳组,术后胸腔引流量少于荷包钳组(P均<0.05)。两组总手术时间、术中出血量、术后住院时间差异无统计学意义(P>0.05)。两组管状胃或吻合口瘘、吻合口狭窄、肺部感染、切口感染发生率差异亦无统计学意义(P>0.05)。结论微创治疗中下段食管癌,手工荷包缝合技术和荷包钳法Ivor-Lewis食管切除术同样具有安全性,术后并发症无明显增加,无需专业器械,缝合方法简便易学,容易掌握,易于推广。

Objective To compare the short-term efficacy of Ivor-Lewis via hand-sewn purse-string approach and purse-string forceps approach in minimally invasive esophagectomy for middle and lower esophageal cancer, and to discuss the safety and feasibility of hand-sewn purse-string anastomosis technique for minimally invasive Ivor-Lewis esophagectomy （MIILE）. Methods The clinical data of 151 patients undergoing thoracoscopic and laparoscopic esophageal cancer surgery from lanuary 2014 to lanuary 2017 in our hospital were retrospectively analyzed. According to the different methods of purse string making, the patients were divided into a purse-string forceps group including 49 males and 16 females with a mean age of 67.98±7.07 years ranging from 51 to 80 years treated with forceps to make purse- string and a handcraft group including 61 males and 25 females with a mean age of 67.76±8.18 years ranging from 52 to 83 years using hand-sewn way. The perioperative data of two two groups were compared. Results The purse-string making time and postoperative total volume of chest drainage were less in the handcraft group than those in the purse-string forceps group （P〈0.05）. There was no significant difference between the two groups in hemorrhage during operation, the operation duration or postoperative hospital stay （P〉0.05）. There was also no statistical difference between the two groups in the rate of anastomotic or gastric tube fistula, anastomotic stenosis, pulmonary infection or incision infection （P〉0.05）. Conclusion In minimally invasive esophagectomy for middle-lower section, MIILE by hand-sewn purse-string is as safe as purse-string forceps, with no more complications, needing no professional equipments, and easy to learn, master and promote.