单孔胸腔镜下Ivor-Lewis食管癌根治术的临床应用

Clinical application of Ivor-Lewis procedure under uniportal video-assisted thoracoscopy for esophageal cancer

目的探讨单孔胸腔镜下Ivor-Lewis术在中下段食管癌和Siewert Ⅰ型食管胃结合部癌手术中的安全性和可行性。方法回顾性分析空军军医大学唐都医院胸腔外科2020年10月至2021年6月行胸腔镜下食管癌根治手术患者的临床资料。结果 26例患者行单孔胸腔镜下食管癌Ivor-Lewis手术(单孔组), 45例接受胸部4孔胸腔镜McKeown手术(4孔组), 两组患者平均手术时间[(265 ± 110)min对(235±94)min]、平均术中出血量[(80±57)ml对(105±60)ml]、平均清理淋巴结数量[(19.3±2.9)枚对(18.6±2.7)枚]、平均住院时间[(7.5±3.5)天对(8.3±2.7)天]、围手术期并发症发生率等差异均无统计学意义。单孔组患者术后第1、3、7天和术后1个月的术后疼痛VAS评分均低于4孔组, 差异有统计学意义(P<0.05)。结论单孔胸腔镜下Ivor-Lewis手术具有术后疼痛轻的优势, 对于中下段食管癌和Siewert Ⅰ型的食管胃结合部癌是一种安全可行的手术方式。

Objective To investigate the safety and feasibility of Ivor-Lewis procedure under uniportal video-assisted thoracoscopy(VATS)for esophageal cancer and Siewert type I esophago-gastric junction carcinoma.Methods The patients with middle-lower segment esophageal cancer or Siewert type I esophago-gastric junction carcinoma received minimally invasive esophagectomy between October 2020 and June 2021,and the clinical data was collected and analyzed.Results 26 patients received Ivor-Lewis procedure underwent uniportal VATS,while 45 patients underwent McKeown surgery under multiport VATS.The average operation time of patients in the two groups were(265±110)min and(235±94)min,and the average intraoperative blood loss were(80±57)ml and(105±60)ml.The mean number of lymph nodes removed in the surgery were(19.3±2.9)and 18.6±2.7 respectively in two groups,and the mean length of hospital stay was(7.5±3.5)days and(8.3±2.7)days.The incidence of perioperative complications were not significantly different in two groups.The VAS score of patients received Ivor-Lewis procedure underwent uniportal VATS was lower than that of patients received McKeown surgery in ostoperative day 1,day 3,day 7 and 1 month.The difference was statistically significant in two groups(P<0.05).Conclusion The Ivor-Lewis procedure under uniportal VATS for esophageal cancer and Siewert type I esophago-gastric junction carcinoma has the advantage of less postoperative pain,and the procedure is feasible in clinical practice.