改良Ivor-Lewis术式与微创MIE McKeown术治疗中下段食管癌的疗效

The efficacy of modified Ivor-Lewis and minimally invasive MIE McKeown in the treatment of middle and lower esophageal cancer

目的探讨改良Ivor-Lewis术及微创MIE Mckeown术治疗中下段食管癌的优点及局限性,以期为临床根据患者不同的病情资料选择最适术式提供参考。方法回顾性分析我院胸外科收治的中下段食管癌患者186例,按照术式选择的不同将其分为改良Ivor-Lewis术组(L组)90例及微创MIE Mckeown术组(M组)96例,对两组患者的一般资料、围手术期指标、术后并发症和随访生存率进行分析。结果L组手术时间、术中出血量、术后ICU时间、术后引流管拔除时间、住院时间均明显低于M组,淋巴结清扫数明显多于M组,组间差异具有统计学意义(P<0.05)。L组术后并发症总发生率21.11%,明显低于M组总发生率47.91%(χ^(2)=14.682,P=0.001)。术后L组总生存率为76.67%(69/90),M组总生存率为75.00%(72/96),两组总生存率比较差异无统计学意义(χ^(2)=2.506,P=0.213)。结论改良Ivor-Lewis术与微创MIE Mckeown术在中下段食管癌的治疗中均可获得理想疗效,但改良Ivor-Lewis术后并发症少,住院时间短,值得优先选择。

Objective To investigate the advantages and limitations of the improved Ivor-Lewis and minimally invasive MIE Mckeown in the radical operation of middle and lower esophageal cancer,and to provide references for clinical operators to choose the best surgical method according to patients'different condition data.Methods A retrospective analysis of 186 patients with middle and lower esophageal cancer admitted to the Department of Thoracic Surgery in our hospital was divided into modified Ivor-Lewis operation group(L group)90 cases and minimally invasive MIE Mckeown operation group(M group)according to different surgical options For 96 cases,the general data,perioperative indicators,postoperative complications and follow-up survival rate of the two groups of patients were statistically compared and analyzed.Results The operation time,intraoperative blood loss,postoperative ICU time,postoperative drainage tube removal time,and hospital stay in group L were significantly lower than those in group M.The number of lymph node dissections was significantly more than that in group M.The difference between the groups was statistically significant(P<0.05).The total incidence of postoperative complications in the L group was 21.11%,which was significantly lower than the total incidence of 48.96%in the M group(χ^(2)=14.682,P=0.001).The overall survival rate during the follow-up period in the L group was 76.67%(69/90),and the overall survival rate in the M group was 75.00%(72/96)during the follow-up period.There was no significant difference in the overall survival rate between the two groups during the follow-up period(Log-Rank test,P=0.213).Conclusion The modified Ivor-Lewis operation can obtain a more ideal effect in the treatment of middle and lower esophageal cancer,with fewer postoperative complications and shorter hospital stay,which is worthy of priority.