单中心连续280例微创Mckeown术治疗食管癌经验

A Single center experience in the treatment of esophageal cancer with 280 cases of minimally invasive mckeown

目的分析胸腹腔镜联合下经右胸-上腹-左颈三切口(微创Mckeown)食管癌根治术的临床治疗的可行性及安全性。方法连续纳入本中心2014年1月至2017年10月280例微创Mckeown术食管癌患者的临床资料为研究对象,按手术开展时间先后平均分为4组,其中第三、第四组采用术后早期经口进食加速康复外科管理模式。收集4组患者围手术期临床资料,并随访至2018年10月。组间比较采用χ~2检验。结果纳入研究的280例患者中,完成微创Mckeown术257例,完成率91.79%。四组患者手术时间、术中出血、术中中转开胸或开腹率逐步下降,P<0.05。淋巴结清扫站数及枚数上,组间比较,无统计学差异,P>0.05。术后胸管引流量、引流时间、术后住院日呈现下降趋势,有统计学差异,P<0.05。术后总住院费用逐步升高,四组患者比较,有统计学差异,P<0.05。术后并发肺部感染、术后出现声嘶、吻合口瘘逐渐减少,P<0.05。全组患者围手术期死亡3例,非计划出院7例,平均随访时间(17±10)个月。随访期间丢失样本71例,随访率74.64%,随访期间87例局部复发,53例死亡。全组患者12m无瘤生存率(DFS)为73.5%,12m年总体生存率(OS)为80.3%。结论经过严格学习曲线学习,有序开展微创Mckeown手术及术后早期经口进食加速康复外科管理安全可行,微创Mckeown手术短期随访效果良好。

Objective To analyze the feasibility and safety of thoracic laparoscopic combined with minimally invasive Mckeown for esophageal cancer. Methods Studied the clinical data of 280 patients with minimally invasive Mckeown esophageal cancer from January 2014 to October 2017 in our medical center. The patients were divided into 4 groups according to the operation time. The third and fourth groups were used accelerated rehabilitation surgery management. These patients followed up until October 2018. The χ~2 test was used for comparison between groups. Results 257 of the 280 patients had completed minimally invasive Mckeown,with a completion rate of 91.79%. The operation time,intraoperative hemorrhage,intraoperative transfer or open laparotomy rate of the four groups were gradually decreased,and there were statistical differences,P<0.05. There were no statistical differences in the lymph node dissection in the four groups,P >0.05. Postoperative chest drainage,drainage time,and postoperative hospital stay showed a downward trend,P<0.05. The total hospitalization cost increased gradually after surgery,P<0.05. Postoperative pulmonary infection,postoperative hoarseness,and anastomotic leakage were gradually reduced,with statistical significance,P<0.05. 3 people died during the perioperative period,and the average follow-up time was 17±10 m. 71 patients were lost during the follow-up period,the follow-up rate was 74.64%. During the follow-up period,87 patients had local recurrence and 53 patients died. The 12 m disease free survival(DFS) was 73.5% and the overall survival rate(OS) was 80.3%. Conclusion After a rigorous learning curve learning,it is safe and feasible to carry out minimally invasive Mckeown surgery and early postoperative oral feeding accelerated surgical management. The short-term follow-up of minimally invasive Mckeown surgery is effective.