改良式Ivor-Lewis术治疗中下段食管癌的临床应用价值

Value of modified Ivor-Lewis surgical procedure in the treatment of middle and lower esophageal cancer

目的探讨改良式上腹及右胸两切口(改良Ivor-Lewis)治疗中下段食管癌的临床效果。方法回顾性分析147例中下段食管癌患者的临床资料,按手术方式不同分为两组,72例患者(观察组)采用改良式上腹及右胸两切口径路手术,75例患者(对照组)采用左胸一切口主动脉弓上吻合或左胸左颈两切口颈部吻合术,两组均以胃代替食管。比较两组围术期指标和术后生存质量。结果观察组患者手术时间、住院时间均长于对照组(P<0.01),纵膈和腹部淋巴结清扫数目均多于对照组(P<0.01),吻合口瘘、喉返神经损伤发生率均低于对照组(P<0.05),术后6、12个月SF-36生活质量各项评分均高于对照组(P<0.01)。结论改良式上腹及右胸两切口径路手术治疗中下段食管癌,暴露术野好、术中清扫淋巴结彻底、术后并发症少,生活质量较高。

Objective To investigate the clinical effect of a cervical anastomosis via a modified two-incisional approach with right thoracic and mid-abdominal incisions(modified Ivor-Lewis)in treating middle and lower esophageal cancer.Methods The clinical data of 147 patients with middle and lower esophageal cancer were retrospectively assessed.Of them,72 patients(observation group)underwent a cervical anastomosis via a modified two-incisional approach and 75 patients(control group)did left thoracic anastomosis above aortic arch via a left thoracic incision or a left thoracic incision and left cervicothoracic incisions,using the denervated stomach as esophageal substitute.The perioperative indicators and the quality of life were compared in the two groups.Results The observation group achieved significantly longer operation time and hospitalization time,and significantly higher numbers of harvested mediastinal lymph node and abdominal lymph node than those of the control group(P<0.01).The incidences of recurrent laryngeal nerve injury and anastomotic fistula of the observation group were significantly lower than those of the control group(P<0.05).The post-operation 6-and 12-month scores of the SF-36 quality of life scale of the observation group were significantly higher than those of the control group(P<0.01).Conclusion The modified Ivor-Lewis surgical procedure of this paper had significantly advantageous for exposing operative field,harvesting lymph node,improving the quality of life and prognosis in treating middle and lower esophageal cancer.