胸骨后重建路径联合术后辅助放疗在微创Mckeown食管癌切除术近期并发症与安全性分析

Short Term Complications and Safety Analysis of Retrosternal Reconstruction Pathway Combined with Postoperative Adjuvant Radiotherapy in Minimally Invasive Mckeown Esophagectomy

【目的】分析管状胃经胸骨后路径和后纵隔路径联合术后辅助放疗对微创Mckeown食管癌切除术患者的近期并发症与安全性的影响。【方法】回顾性分析2020年1月至2021年6月期间在中国科学技术大学附属第一医院胸外科行微创Mckeown食管癌切除术89例,部分患者接受术后辅助放疗,根据管状胃上提途径分为胸骨后路径及后纵隔路径两组,其中胸骨后路径组39例,后纵隔路径组50例,比较两组患者临床特征及围手术期并发症情况。【结果】两组患者临床特征差异无统计学意义(P>0.05);两组患者在手术时间,术中出血,术后引流情况,术后住院时间等方面差异无统计学意义(P>0.05)。胸骨后路径组吻合口瘘及吻合口狭窄发生率高于后纵隔路径组,但是差异无统计学意义(P>0.05)。另外,后纵隔路径组较胸骨后路径组肺部感染发生率更高,同样差异无统计学意义(P>0.05)。后纵隔路径组较胸骨后路径组胃食管反流发生率更高,差异有统计学意义(P<0.05)。术后共30例患者接受辅助放疗(其中胸骨后路径组10例,后纵隔路径组20例),胸骨后路径组患者出现放射性胃炎发生率低于后纵隔路径患者(胸骨后路径组:1例患者出现急性放射性食管(胃)炎,为1级;后纵隔路径组:6例患者出现急性放射性食管(胃)炎,其中1、2级分别为2例、4例)。【结论】微创Mckeown食管癌切除术管状胃经胸骨后路径与经后纵隔路径的近期疗效及安全性一致,但经胸骨后路径术后胃食管反流发生率更低。

【Objective】To compare and analyze the effect of tubular gastric transsternal route and posterior mediasti⁃nal route combined with postoperative adjuvant radiotherapy on the short-term complications and safety of minimally inva⁃sive Mckeown esophageal carcinoma resection.【Methods】Retrospective analysis of 89 patients who underwent minimally invasive Mckeown esophagectomy in the Department of thoracic surgery of the First Affiliated Hospital of China University of science and technology from January 2020 to June 2021.Some patients received postoperative adjuvant radiotherapy.Ac⁃cording to the tubular gastric lifting pathway,they were divided into two groups:retrosternal route group and posterior me⁃diastinal route group,including 39 cases in the retrosternal route group and 50 cases in the posterior mediastinal route group.The clinical characteristics and perioperative complications of the two groups were compared.【Results】There was no significant difference in clinical characteristics between the two groups(P>0.05);there was no significant difference in operation time,intraoperative bleeding,postoperative drainage and postoperative hospital stay between the two groups(P>0.05).In addition,the incidence of pulmonary infection in the posterior mediastinal pathway group was higher than that in the retrosternal pathway group,and the difference was not statistically significant(P>0.05).The incidence of gastroesoph⁃ageal reflux in the posterior mediastinal route group was higher than that in the retrosternal route group,and the difference was statistically significant(P<0.05).A total of 30 patients received adjuvant radiotherapy(10 cases in the retrosternal route group and 20 cases in the posterior mediastinal route group).The incidence of radioactive gastritis in the retrosternal route group was lower than that in the posterior mediastinal route group(1 case had acute radioactive esophagitis,grade 1;In the posterior mediastinal route group,6 patients developed acute radiation esophagitis(gastritis),there were 2 cases in grade 1 and 4 cases in grade 2)【.Conclusion】The short-term efficacy and safety of tubular gastric retrosternal route and posterior mediastinal route in minimally invasive Mckeown esophagectomy are consistent,but the incidence of gastroesoph⁃ageal reflux after retrosternal route is lower.