中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2011年
9期
699-701
,共3页
刘向明%于振涛%赵锡江%张熙曾
劉嚮明%于振濤%趙錫江%張熙曾
류향명%우진도%조석강%장희증
食管肿瘤%老年人%外科手术%术后并发症
食管腫瘤%老年人%外科手術%術後併髮癥
식관종류%노년인%외과수술%술후병발증
Esophageal neoplasms%Elderly%Surgical procedures%postoperative complications
目的探讨Ivor-Lewis手术治疗老年中下段食管癌患者的安全性。方法前瞻性入组2009年6月至2010年6月天津医科大学肿瘤医院老年（60岁以上）中下段食管癌患者232例，按随机数字表法分为Ivor-Lewis手术组（116例，取右胸后外侧及上腹正中切口）和Sweet手术组（116例，取左胸后外侧切口）,比较两组术中及术后情况。结果Ivor-Lewis手术组与Sweet手术组根治性切除率分别为95.7％(111/116)和92.2％ (107/116) (P＞0.05)；开胸手术时间分别为(47.2±5.2) min和(105.4±9.3) min（P=0.000）。术后呼吸衰竭发生率分别为1.7％(2/116)和6.9％(8/116)(P=0.049)；室上性心律失常发生率分别为3.4％(4/116)和10.3％(12/116)(P=0.035)；总并发症发生率分别为22.4％(26/116)和34.5％(40/116)(P=0.004)；围手术死亡率分别为1.7％(2/116)和3.4％(4/116) (P＞0.05)。两组术后下床活动时间分别为(4.0±2.0)d和(4.8±3.7)d(P=0.046)；术后住院时间分别为(11.5±4.7)d和(13.7±7.8) d(P=0.008)。结论Ivor-Lewis手术具有不损伤膈肌、胸腔内手术时间短、对心肺功能影响小、术后并发症少、恢复快的优势，可考虑作为老年中下段食管癌的首选手术方式。
目的探討Ivor-Lewis手術治療老年中下段食管癌患者的安全性。方法前瞻性入組2009年6月至2010年6月天津醫科大學腫瘤醫院老年（60歲以上）中下段食管癌患者232例，按隨機數字錶法分為Ivor-Lewis手術組（116例，取右胸後外側及上腹正中切口）和Sweet手術組（116例，取左胸後外側切口）,比較兩組術中及術後情況。結果Ivor-Lewis手術組與Sweet手術組根治性切除率分彆為95.7％(111/116)和92.2％ (107/116) (P＞0.05)；開胸手術時間分彆為(47.2±5.2) min和(105.4±9.3) min（P=0.000）。術後呼吸衰竭髮生率分彆為1.7％(2/116)和6.9％(8/116)(P=0.049)；室上性心律失常髮生率分彆為3.4％(4/116)和10.3％(12/116)(P=0.035)；總併髮癥髮生率分彆為22.4％(26/116)和34.5％(40/116)(P=0.004)；圍手術死亡率分彆為1.7％(2/116)和3.4％(4/116) (P＞0.05)。兩組術後下床活動時間分彆為(4.0±2.0)d和(4.8±3.7)d(P=0.046)；術後住院時間分彆為(11.5±4.7)d和(13.7±7.8) d(P=0.008)。結論Ivor-Lewis手術具有不損傷膈肌、胸腔內手術時間短、對心肺功能影響小、術後併髮癥少、恢複快的優勢，可攷慮作為老年中下段食管癌的首選手術方式。
목적탐토Ivor-Lewis수술치료노년중하단식관암환자적안전성。방법전첨성입조2009년6월지2010년6월천진의과대학종류의원노년（60세이상）중하단식관암환자232례，안수궤수자표법분위Ivor-Lewis수술조（116례，취우흉후외측급상복정중절구）화Sweet수술조（116례，취좌흉후외측절구）,비교량조술중급술후정황。결과Ivor-Lewis수술조여Sweet수술조근치성절제솔분별위95.7％(111/116)화92.2％ (107/116) (P＞0.05)；개흉수술시간분별위(47.2±5.2) min화(105.4±9.3) min（P=0.000）。술후호흡쇠갈발생솔분별위1.7％(2/116)화6.9％(8/116)(P=0.049)；실상성심률실상발생솔분별위3.4％(4/116)화10.3％(12/116)(P=0.035)；총병발증발생솔분별위22.4％(26/116)화34.5％(40/116)(P=0.004)；위수술사망솔분별위1.7％(2/116)화3.4％(4/116) (P＞0.05)。량조술후하상활동시간분별위(4.0±2.0)d화(4.8±3.7)d(P=0.046)；술후주원시간분별위(11.5±4.7)d화(13.7±7.8) d(P=0.008)。결론Ivor-Lewis수술구유불손상격기、흉강내수술시간단、대심폐공능영향소、술후병발증소、회복쾌적우세，가고필작위노년중하단식관암적수선수술방식。
Objective To evaluate the safety of Ivor-Lewis procedure for middle and lower esophageal carcinoma in the elderly. Methods From June 2009 to June 2010, 232 cases aged over 60 years were diagnosed as esophageal carcinoma. These cases were randomly divided into two groups using table of random digits. One group underwent abdominal and right chest approaches for middle and lower esophageal carcinoma (Ivor-Lewis procedure, n=116). The other group underwent posterolateral left thoracal incisions (Sweet procedure,n=116). Intraoperative and postoperative parameters were compared. Results The radical resection rates in Ivor-Lewis and Sweet procedure were 95.7％ and 92.2％ respectively (P＞0.05). The time required for opening the thorax was (47.2±5.2) min and (105.4±9.3) min(P=0.000), respectively. The respiratory failure rates were 1.7％ and 6.9％(P=0.049).The incidences of supraventricular tachyarrhythmia were 3.4％ and 10.3％, respectively. The overall complication rates were 22.4％ and 34.5％(P=0.004). The perioperative mortalities were 1.7％ and 3.4％(P＞0.05). The postoperative ambulation time was (4.0±2.0) d and (4.8±3.7) d(P=0.046). The postoperative time in hospital was (11.5±4.7) d and (13.7±7.8) d (P=0.008). Conclusions Ivor-Lewis procedure is associated with little damage to diaphragm, shorter intrathoracic operative time, minimal influence on cardiopulmonary function, less postoperative complications, and quicker recovery. This procedure should be considered as the first choice for middle and lower esophageal carcinoma in the elderly.
