Ivor Lewis食管次全切除术和二野淋巴结清扫术及其对预后的影响

Ivor Lewis subtotal esophagectomy with two-field lymphadenectomy and prognosis

目的 :评价食管癌IvorLewis食管次全切除术和胸腹二野淋巴结清扫术的手术方法及其对预后的影响。方法 :从 1997年 3月～ 2 0 0 1年 3月对 35 6例食管胸中下段癌患者经上腹正中切口和右胸后外侧切口行IvorLewis食管次全切除术和胸腹二野淋巴结清扫术 ,食管胃颈部或胸顶器械吻合术。结果 :35 6例患者无围手术期死亡 ,术后并发症低 :吻合口瘘 3例 (0 8% ) ,应激性胃溃疡穿孔 2例 (0 6 % ) ,乳糜胸 2例 (0 6 % ) ,声嘶 5例 (1 4 % ) ,4例 3月后恢复。其余患者术后吞钡复查显示吻合口和幽门通畅。完全随访 346例 (97 2 % ) ,中位生存时间 2 6年 (6 1天 - 5年 ) ,五年生存率 :Ⅰ期 94 2 %、Ⅱa期 81 5 %、Ⅱb期 78 3%、Ⅲ期 36 %、Ⅳ期 0 % ;总体 3年生存率74 5 % ,总体五年生存率 5 5 4 9%。结论 :食管癌IvorLewis食管次全切除术和二野淋巴结清扫术是一种安全的手术 ,术后并发症低 ,远期生存率较高 ,具有一定的推广价值。

Purpose:Evaluate the operation methods and prognosis following Ivor Lewis subtotal esophagectomy with two-field lymphadenectomy for carcinoma of the middle and lower third of the oesophagus. Methods:From March 1997 to March 2001, A total of 356 consecutive patients underwent Ivor Lewis esophagogastrectomy with two-field radical lymphadenectomy for carcinoma of the middle and lower third of the oesophagus ,The patients received cupula of pleura or cervical esophagogastroanastomosis with mechanical methods through two incisions (right posterolateral thoracotomy and upper abdominal).Results:The post-operative mortality was 0. anastomotic leakages occurred in 3 patients(0.8%). Gastric leaks for stress gastric ulcer occurred in 2 patients (0.6%). Chylothorax occurred in 2 patients(0.6%). Hoarseness occurred in 5 patients(1.4%),4 cases recuperated after 3 months. Barium swallowed postsurgery through anastomosis and pylorus went through smoothly.Full follow-up was 97.2%. Median survival for operative survivors was 2.6 years (range,61 days to 5 years). The overall 3-year survival rate was 74.5% .The overall 5-year survival rate was 55.49%,it was 94.2% for those in stage Ⅰ,81.5% for those in stage Ⅱa,78.3% for patients in stage Ⅱb,36% for those in stage Ⅲ and 0% for patients in stage Ⅳ. Conclusions:Ivor Lewis esophagogastrectomy with two-field radical lymphadenectomy for carcinoma of the middle and lower third of the oesophagus is a safe operation. There is the low post-operative morbidity. Long-term survival have been improved.