微创Ivor-Lewis食管切除术在食管胃结合部腺癌中的应用

Clinical Application of Minimally Invasive Ivor-Lewis Esophagectomy for Adenocarcinoma of Esophagogastric Junction

目的探讨微创Ivor-Lewis食管切除术(minimally invasive Ivor-Lewis esophagectomy,MI-ILE)治疗食管胃结合部腺癌的可行性。方法回顾性分析2018年1月~2019年6月MI-ILE治疗食管胃结合部腺癌48例资料。SiewertⅠ型11例,Ⅱ型31例,Ⅲ型6例。病灶距门齿距离(38.8±2.5)cm。结果手术时间(250.8±42.0)min,术中出血(120.3±67.0)ml。均行R0切除。27例术前新辅助治疗,26例(96%)术后病理显示部分缓解。清扫淋巴结(28.6±10.6)枚,36例淋巴结转移(8.0±5.0)枚。术后吻合口漏2例(4%),1例手术治疗,1例保守治疗,均痊愈。术后住院日(9.7±3.2)d。平均随访14个月(5~22个月),肿瘤均无复发,无死亡。结论MI-ILE治疗食管胃结合部腺癌可以保证满意的上下切缘和足够的淋巴结清扫范围,手术安全可靠。

Objective To explore the feasibility of minimally invasive Ivor-Lewis esophagectomy(MI-ILE)in the treatment of adenocarcinoma of esophagogastric junction(AEG).Methods The data of 48 cases with AEG who received MI-ILE from January 2018 to June 2019 were analyzed retrospectively.There were 11 cases of Siewert typeⅠ,31 cases of typeⅡand 6 cases of typeⅢ.The distance between the lesion and the incisors was(38.8±2.5)cm.Results The operation time was(250.8±42.0)min,and the intraoperative bleeding was(120.3±67.0)ml.All the patients underwent R0 resection.Twenty-seven cases received preoperative neoadjuvant therapy,and postoperative pathology of twenty-six cases(96%)showed partial remission.The number of lymph nodes dissected was(28.6±10.6),and the number of metastasis was(8.0±5.0)in 36 cases.Postoperative anastomotic leakage happened in 2 cases(4%),one of which was cured with operation and the other with conservative treatment.The postoperative hospital stay was(9.7±3.2)days.The average follow-up period was 14 months(range,5-22 months).There was no recurrence or death.Conclusion Ivor-Lewis esophagectomy for AEG can ensure satisfactory upper and lower incision margins and sufficient dissecting range of lymph nodes,which shows the operation is safe and reliable.