微创Ivor-Lewis食管切除术与Sweet手术治疗SiewertⅡ型食管胃结合部腺癌的前瞻性对比研究

Minimally Invasive Ivor-Lewis Esophagectomy and Sweet Surgery for Siewert TypeⅡAdenocarcinoma of Esophagogastric Junction:Prospective Comparative Study

目的探讨微创Ivor-Lewis食管切除术(minimally invasive Ivor-Lewis esophagectomy,MI-ILE)与Sweet手术治疗SiewertⅡ型食管胃结合部腺癌(adenocarcinoma of esophagogastric junction,AEG)的疗效。方法选择2017年12月~2019年3月SiewertⅡ型AEG 82例,按照前瞻性非随机方法分为2组,行MI-ILE手术41例,Sweet手术41例,2组术前一般资料差异无显著性(P>0.05)。比较2组手术指标、术后并发症及短期生存和复发率。结果MI-ILE组手术时间长于Sweet组[(244.0±39.5)min vs.(186.9±24.8)min,t=7.840,P=0.000],但术中出血量少[(88.9±34.1)ml vs.(107.7±42.4)ml,t=-2.211,P=0.030],术后第1天胸腔引流量少[(205.9±73.3)ml vs.(287.7±126.3)ml,t=-3.587,P=0.001],胸腔引流时间短[(6.2±2.2)d vs.(8.8±2.8)d,t=-4.666,P=0.000],术后排气早[(3.0±1.0)d vs.(3.7±1.3)d,t=-2.739,P=0.008],术后住院时间短[(9.2±3.2)d vs.(11.2±2.6)d,t=-2.982,P=0.004]。MI-ILE组清扫淋巴结(28.6±10.0)枚,其中胸腔清扫(7.2±4.4)枚,腹腔清扫(21.4±8.9)枚,均高于Sweet组的(22.2±7.3)、(4.8±4.0)、(17.4±7.3)枚(P均<0.05)。2组胸腔、腹腔淋巴结转移数目差异无显著性(P>0.05)。随访1年,2组均无死亡;MI-ILE复发1例(2.5%),Sweet组复发3例(7.3%)(χ^2=1.051,P=0.305)。结论MI-ILE治疗SiewertⅡ型AEG安全、可行,与Sweet手术比较,不增加风险,近期疗效满意。

Objective To explore the curative effects of minimally invasive Ivor-Lewis esophagectomy(MI-ILE)and Sweet surgery for Siewert typeⅡadenocarcinoma of esophagogastric junction(AEG).Methods From December 2017 to March 2019,82 patients with SiewertⅡAEG were chosen and divided into two groups with the prospective non-random method,including 41 cases in MI-ILE group and 41 cases in Sweet group.The differences of general preoperative characteristics were not significant(P>0.05).The operation data,incidence of complications,and short-term survival rate and recurrence were compared between the two groups.Results The operation time of the MI-ILE group was longer than that of the Sweet group[(244.0±39.5)min vs.(186.9±24.8)min,t=7.840,P=0.000].The MI-ILE group had less intraoperative blood loss[(88.9±34.1)ml vs.(107.7±42.4)ml,t=-2.211,P=0.030],less postoperative first day chest drainage[(205.9±73.3)ml vs.(287.7±126.3)ml,t=-3.587,P=0.001],shorter duration of chest drainage[(6.2±2.2)d vs.(8.8±2.8)d,t=-4.666,P=0.000],earlier postoperative exhaust time[(3.0±1.0)d vs.(3.7±1.3)d,t=-2.739,P=0.008],and shorter postoperative hospital stay[(9.2±3.2)d vs.(11.2±2.6)d,t=-2.982,P=0.004].The number of lymph nodes dissected in the MI-ILE group(28.6±10.0),including in chest cavity(7.2±4.4)and abdominal cavity(21.4±8.9),was all higher than those in the Sweet group[(22.2±7.3),(4.8±4.0),and(17.4±7.3),all P<0.05].There was no difference in the number of thoracic and abdominal lymph node metastases between the MI-ILE group and the Sweet group(P>0.05).After 1-year follow-up,no death occurred in both groups.There were 1 recurrence in the MI-ILE group(2.5%)and 3 recurrences(7.3%)in the Sweet group(χ^2=1.051,P=0.305).Conclusions MI-ILE is safe and feasible in treating SiewertⅡAEG.As compared with Sweet surgery,it has no increase in risk and satisfactory short-term curative effect.