胸腹腔镜联合Ivor-Lewis手术治疗 食管胸中下段癌可行性、安全性及近期疗效观察

目的 研究胸腹腔镜下行Ivor-Lewis术式治疗胸中下段食管癌的临床疗效,探讨其可行性和安全性.方法 回顾性分析2014年5月至2015年5月贵州省人民医院收治的92例胸中下段食管癌患者的临床资料,根据治疗方法分为两组.Ivor-Lewis组50例于胸腹腔镜下经胸、腹两切口行食管癌根治术并胃代食管右胸内吻合术,同期McKeown组42例于胸腹腔镜下经胸、腹、颈三切口行食管癌根治术并胃代食管颈部吻合术.比较两组患者的手术相关指标、围手术期并发症,术后随访12个月,记录复发转移情况及生存率.结果 Ivor-Lewis组患者的手术时间为(292.5±36.7)min,短于McKeown组的(326.4±55.1)min,差异具有统计学意义(P<0.05);Ivor-Lewis组患者的住院费用为(85172.3±20338.4)元,高于McKeown组的(70838.1±21153.0)元,差异具有统计学意义(P<0.05);Ivor-Lewis组患者的总并发症发生率为28.0%,低于McKeown组的47.6%,差异具有统计学意义(P<0.05).随访12个月,Ivor-Lewis组3例出现转移,5例死亡,一年生存率为90.0%;McKeown组2例出现转移,3例死亡,一年生存率为92.9%,两组患者的转移率和一年生存率比较差异均无统计学意义(P>0.05).结论 Ivor-Lewis术式治疗胸中下段食管癌淋巴癌清扫彻底、分期明确,手术时间和术后并发症率均优于McKeown术,但手术费用相对略高,总体上具有良好的安全性和可行性.

Feasibility,safety and short-term efficacy of thoracoscopy and laparoscopy combined with Ivor-Lewis surgery for middle and lower esophageal carcinoma

Objective To study the feasibility, safety and short-term efficacy of thoracoscopy and laparoscopy combined with Ivor-Lewis surgery for middle and lower esophageal carcinoma. Methods The clinical data of 92 pa-tients with esophageal cancer, who admitted to the People's Hospital of Guizhou Province from May 2014 to May 2015, were retrospectively analyzed. These cases were divided into the two groups according to the treatment method. The Ivor-Lewis group (n=50) was treated with laparoscopic and thoracoscopic esophagectomy for esophageal carcinoma via the chest and abdominal incision and gastro-esophageal anastomosis in the right thoracic cavity;the McKeown group (n=42) was treated with laparoscopic and thoracoscopic esophagectomy for esophageal carcinoma via the chest, abdominal, neck incision and gastro-esophageal anastomosis in neck. The related parameters of the treatment and perioperative com-plications were compared between the two groups. The patients were followed up for 12 months, and the recurrence and metastasis and survival rate were recorded. Results The operation time of the Ivor-Lewis group was (292.5±36.7) min, which was significantly shorter than (326.4±55.1) min of the McKeown group (P<0.05). The hospitalization expenses of the Ivor-Lewis group was (85172.3±20338.4) yuan, which was higher than (70838.1±21153.0) yuan of the McKeown group (P<0.05). The total complications rate of the Ivor-Lewis group was 28.0%, which was significantly less than 47.6% of the McKeown group (P<0.05). After 12 months of follow-up, there were 3 metastases and 5 deaths in the Ivor-Lewis group with a one-year survival rate of 90.0%;there were 2 metastases and 3 deaths in the McKeown group with a one-year survival rate of 92.9%a year. There was no statistically significant difference between the two groups in the rate of metastasis and the one-year survival rate (P>0.05). Conclusion Ivor-Lewis surgery has the advantages of a thorough clearance rate and clear staging, which also is superior to McKeown method in the operation time and postoperative complications rate. The cost of Ivor-Lewis surgery is relatively high, but in general it has good safety and feasibility.