无腹部小切口全腔镜Ivor Lewis食管癌切除术治疗胸中、下段食管癌的效果

Effect of totally laparoscopic Ivor Lewis esophagectomy without thoracoscopic small incision on middle and lower thoracic esophageal cancer

目的分析无腹部小切口全腔镜Ivor Lewis食管癌切除术在胸中、下段食管癌患者中的应用效果。方法选择运城市中心医院2013年5月至2016年7月收治的45例胸中、下段食管癌患者作为观察组,采用无腹部小切口全腔镜Ivor Lewis食管癌切除术治疗,并选择同期44例行微创Mc Keown术者作为对照组,观察比较两组手术情况(术中失血量、手术用时、淋巴结清扫数目),术后不同时间点(术后12 h、24 h)疼痛程度[视觉模拟评分法(VAS)评分]及手术前后血清肿瘤恶性生物学行为指标[血清血管内皮生长因子(VEGF)、基质金属蛋白酶-9(MMP-9)、CD44v]变化情况,并统计两组并发症发生情况及复发率。结果两组术中失血量及淋巴结清扫数目比较,差异未见统计学意义(P>0.05),观察组手术用时少于对照组,差异有统计学意义(P<0.05);观察组术后24 h VAS评分,血清VEGF、MMP-9及CD44v水平低于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为[8.89%(4/45)],低于对照组[25.00%(11/44)],差异有统计学意义(P<0.05);观察组复发率为11.11%(5/45),低于对照组[34.09%(15/44)],差异有统计学意义(P<0.05)。结论无腹部小切口全腔镜Ivor Lewis食管癌切除术可缩短胸中、下段食管癌患者手术时间,降低并发症发生率,减轻患者疼痛程度,阻止肿瘤恶性生物学行为,降低术后复发率,且术中淋巴结清扫数目多,值得临床推广应用。

Objective To analyze the effect of total endoscopic resection of esophageal carcinoma with Ivor Lewis without abdominal small incision on patients with middle and lower thoracic esophageal carcinoma . Methods Forty-five patients with middle and lower thoracic esophageal cancer admitted to Yuncheng Central Hospital from May 2013 to July 2016 were selected as the observation group, who were treated by total endoscopic resection of esophageal cancer without abdominal incision. Forty-four patients who underwent minimally invasive Mc Keown operation were selected as the control group. The operation conditions (blood loss, operation time, number of lymph node dissection), VAS scores at different time points (12 h, 24 h after operation) and serum tumor malignant biological behavior indexes[serum vascular endothelial growth factor (VEGF), matrix metalloproteinase-9 (MMP-9), CD44v] were observed and compared between the two groups, the complications and recurrence rates of the two groups were also analyzed. Results There was no significant difference in the intraoperative blood loss or number of lymph hode dissection between the two groups (P>0.05). The operative time of the observation group was lower than that of the control group (P<0.05). The VAS scores at 24 h after operation, serum levels of VEGF, MMP-9 and CD44v were lower in the observation group than those in the control group (P<0.05). The incidence of complications in the observation group was 8.89%(9/45), which was lower than those in the control group [25.00%(11/44)], there was significant difference(P<0.05). The recurrence rate of the observation group was 11.11%(5/45), which was lower than that of the control group [34.09%(15/44)]. The difference was different, P<0.05. Conclusions No small abdominal incision and total endoscopic Ivor Lewis resection of esophageal carcinoma in patients with middle and lower thoracic esophageal carcinoma can shorten the operation time, reduce the incidence of complications, relieve the pain and prevent the malignant biological behavior of tumor, and reduce the recurrence rate. And the number of lymph nodes cleared during operation, so it is worthy of clinical application.