目的 探讨Ivor-Lewis经胸颈部机械吻合术治疗中段食管癌的疗效.方法 前瞻性研究2005年3月至2013年3月两家医院收治的303例中段食管癌患者(江苏省如皋市博爱医院107例、江苏省如皋市人民医院196例)的临床资料,按患者入院先后顺序编号分为Ivor-Lewis组(151例),施行Ivor-Lewis径路经胸颈部机械吻合术；Sweet组(152例),施行Sweet径路经胸颈部机械吻合术.比较两组患者术中情况、围手术期并发症、淋巴结清扫和术后随访等情况.采用门诊复查方式随访,随访时间截至2012年12日.计量资料采用成组t检验,计数资料采用x2检验或Fisher确切概率法,等级资料采用Wilcoxon成组秩和检验.采用Kaplan-Meier法绘制生存曲线,COX比例风险模型分析术后死亡风险.结果 Ivor-Lewis组的手术时间和手术切除率分别为(239±21) min和98.68％(149/151),Sweet组分别为(188±30) min和92.76％(141/152),两组比较,差异有统计学意义(t=11.32,x2=6.45,P＜0.05).Ivor-Lewis组和Sweet组的食管上切缘阳性率分别为0.67％(1/149)和0.71％(1/141),术后并发症发生率分别为10.07％ (15/149)和11.35％(16/141),手术死亡率分别为0和0.71％(1/141),两组比较,差异均无统计学意义(P＞0.05).Ivor-Lewis组清扫的颈胸交界部、腹上区淋巴结数目以及颈胸交界部阳性淋巴结数目分别为(3.6±1.1)枚、(3.5±1.1)枚和(0.7±1.1)枚,Sweet组分别为(2.3±0.8)枚、(2.4±0.8)枚和(0.3±0.6)枚,两组比较,差异均有统计学意义(Z=9.96,9.02,3.26,P＜0.05).290例手术切除治疗的食管癌患者中273例获得术后随访,随访率为94.14％ (273/290),中位随访时间为28.0个月.Ivor-Lewis组患者术后第1、2、3年肿瘤复发、转移率分别为8.21％(11/134)、19.64％ (22/112)、29.35％(27/92),Sweet组分别为19.05％ (24/126)、35.24％ (37/105)、44.19％ (38/86),两组比较,差异有统计学意义(x2=6.55,7.33,5.03,P＜O.05).其中两组患者术后1、2、3年区域淋巴结复发率比较,差异有统计学意义(x2=7.03,9.68,6.87,P＜0.05).Ivor-Lewis组患者术后1、2、3年累积生存率分别为90.30％ (121/134)、80.36％ (90/112)、71.74％ (66/92),Sweet组分别为80.95％ (102/126)、59.05％ (62/105)、51.16％ (44/86),两组比较,差异均有统计学意义(x2=4.65,11.73,7.97,P＜0.05).结论 Ivor-Lewis经胸颈部机械吻合术治疗中段食管癌,手术切除率高、安全性好,术后患者生存获益明显.该术式可以作为治疗颈部无肿大可疑转移淋巴结的中段食管癌的优选手术方法.
目的 探討Ivor-Lewis經胸頸部機械吻閤術治療中段食管癌的療效.方法 前瞻性研究2005年3月至2013年3月兩傢醫院收治的303例中段食管癌患者(江囌省如皋市博愛醫院107例、江囌省如皋市人民醫院196例)的臨床資料,按患者入院先後順序編號分為Ivor-Lewis組(151例),施行Ivor-Lewis徑路經胸頸部機械吻閤術；Sweet組(152例),施行Sweet徑路經胸頸部機械吻閤術.比較兩組患者術中情況、圍手術期併髮癥、淋巴結清掃和術後隨訪等情況.採用門診複查方式隨訪,隨訪時間截至2012年12日.計量資料採用成組t檢驗,計數資料採用x2檢驗或Fisher確切概率法,等級資料採用Wilcoxon成組秩和檢驗.採用Kaplan-Meier法繪製生存麯線,COX比例風險模型分析術後死亡風險.結果 Ivor-Lewis組的手術時間和手術切除率分彆為(239±21) min和98.68％(149/151),Sweet組分彆為(188±30) min和92.76％(141/152),兩組比較,差異有統計學意義(t=11.32,x2=6.45,P＜0.05).Ivor-Lewis組和Sweet組的食管上切緣暘性率分彆為0.67％(1/149)和0.71％(1/141),術後併髮癥髮生率分彆為10.07％ (15/149)和11.35％(16/141),手術死亡率分彆為0和0.71％(1/141),兩組比較,差異均無統計學意義(P＞0.05).Ivor-Lewis組清掃的頸胸交界部、腹上區淋巴結數目以及頸胸交界部暘性淋巴結數目分彆為(3.6±1.1)枚、(3.5±1.1)枚和(0.7±1.1)枚,Sweet組分彆為(2.3±0.8)枚、(2.4±0.8)枚和(0.3±0.6)枚,兩組比較,差異均有統計學意義(Z=9.96,9.02,3.26,P＜0.05).290例手術切除治療的食管癌患者中273例穫得術後隨訪,隨訪率為94.14％ (273/290),中位隨訪時間為28.0箇月.Ivor-Lewis組患者術後第1、2、3年腫瘤複髮、轉移率分彆為8.21％(11/134)、19.64％ (22/112)、29.35％(27/92),Sweet組分彆為19.05％ (24/126)、35.24％ (37/105)、44.19％ (38/86),兩組比較,差異有統計學意義(x2=6.55,7.33,5.03,P＜O.05).其中兩組患者術後1、2、3年區域淋巴結複髮率比較,差異有統計學意義(x2=7.03,9.68,6.87,P＜0.05).Ivor-Lewis組患者術後1、2、3年纍積生存率分彆為90.30％ (121/134)、80.36％ (90/112)、71.74％ (66/92),Sweet組分彆為80.95％ (102/126)、59.05％ (62/105)、51.16％ (44/86),兩組比較,差異均有統計學意義(x2=4.65,11.73,7.97,P＜0.05).結論 Ivor-Lewis經胸頸部機械吻閤術治療中段食管癌,手術切除率高、安全性好,術後患者生存穫益明顯.該術式可以作為治療頸部無腫大可疑轉移淋巴結的中段食管癌的優選手術方法.
목적 탐토Ivor-Lewis경흉경부궤계문합술치료중단식관암적료효.방법 전첨성연구2005년3월지2013년3월량가의원수치적303례중단식관암환자(강소성여고시박애의원107례、강소성여고시인민의원196례)적림상자료,안환자입원선후순서편호분위Ivor-Lewis조(151례),시행Ivor-Lewis경로경흉경부궤계문합술；Sweet조(152례),시행Sweet경로경흉경부궤계문합술.비교량조환자술중정황、위수술기병발증、림파결청소화술후수방등정황.채용문진복사방식수방,수방시간절지2012년12일.계량자료채용성조t검험,계수자료채용x2검험혹Fisher학절개솔법,등급자료채용Wilcoxon성조질화검험.채용Kaplan-Meier법회제생존곡선,COX비례풍험모형분석술후사망풍험.결과 Ivor-Lewis조적수술시간화수술절제솔분별위(239±21) min화98.68％(149/151),Sweet조분별위(188±30) min화92.76％(141/152),량조비교,차이유통계학의의(t=11.32,x2=6.45,P＜0.05).Ivor-Lewis조화Sweet조적식관상절연양성솔분별위0.67％(1/149)화0.71％(1/141),술후병발증발생솔분별위10.07％ (15/149)화11.35％(16/141),수술사망솔분별위0화0.71％(1/141),량조비교,차이균무통계학의의(P＞0.05).Ivor-Lewis조청소적경흉교계부、복상구림파결수목이급경흉교계부양성림파결수목분별위(3.6±1.1)매、(3.5±1.1)매화(0.7±1.1)매,Sweet조분별위(2.3±0.8)매、(2.4±0.8)매화(0.3±0.6)매,량조비교,차이균유통계학의의(Z=9.96,9.02,3.26,P＜0.05).290례수술절제치료적식관암환자중273례획득술후수방,수방솔위94.14％ (273/290),중위수방시간위28.0개월.Ivor-Lewis조환자술후제1、2、3년종류복발、전이솔분별위8.21％(11/134)、19.64％ (22/112)、29.35％(27/92),Sweet조분별위19.05％ (24/126)、35.24％ (37/105)、44.19％ (38/86),량조비교,차이유통계학의의(x2=6.55,7.33,5.03,P＜O.05).기중량조환자술후1、2、3년구역림파결복발솔비교,차이유통계학의의(x2=7.03,9.68,6.87,P＜0.05).Ivor-Lewis조환자술후1、2、3년루적생존솔분별위90.30％ (121/134)、80.36％ (90/112)、71.74％ (66/92),Sweet조분별위80.95％ (102/126)、59.05％ (62/105)、51.16％ (44/86),량조비교,차이균유통계학의의(x2=4.65,11.73,7.97,P＜0.05).결론 Ivor-Lewis경흉경부궤계문합술치료중단식관암,수술절제솔고、안전성호,술후환자생존획익명현.해술식가이작위치료경부무종대가의전이림파결적중단식관암적우선수술방법.
Objective To investigate the efficacy of the Ivor-Lewis cervical stapled esophagogastrostomy via thorax in the treatment of middle esophageal carcinoma.Methods The clinical data of 303 patients with middle esophageal carcinoma who were admitted to the Rugao Boai Hospital (107 patients) and the Rugao People's Hospital (196 patients) from March 2005 to March 2013 were prospectively analyzed.All the patients received Ivor-Lewis stapled cervical esophagogastrectomy (Ivor-Lewis group,151 patients) or Sweet stapled cervical esophagogastrostomy (Sweet group,152 patients) according to the admission order.The intraoperative condition,perioperative complications,lymph node dissection and postoperative follow-up of the 2 groups were analyzed.All the patients were followed up via out-patient examination till December 2012.The measurement data,enumeration data and the ranked data were analyzed using the independent samples t-test,chi-square test or Fisher exact probability and Wilcoxon rank sum test,respectively.The survival curve was drawn by the Kaplan-Meier method,and the postoperative mortality rate was analyzed using the Cox proportional hazard model.Results The operation time of the Ivor-Lewis group was (239 ± 21)minutes,which was significantly longer than (188 ± 30)minutes of the Sweet group (t =11.32,P ＜ 0.05).The surgical resection rate of the Ivor-Lewis group was 98.68％ (149/151),which was significantly higher than 92.76％ (141/152) of the Sweet group (x2 =6.45,P ＜ 0.05).The positive rate of the upper resection margin of the esophagus,postoperative morbidity rate and operative were 0.67％(1/149),10.07％ (15/149) and 0 in the Ivor-Lewis group,and 0.71％ (1/141),11.35％ (16/141) and 0.71％(1/141) in the Sweet group,with no significant difference between the 2 groups (P ＞ 0.05).The number of lymph nodes dissected from the cervical-thoracic junction and the upper abdomen were 3.6 ± 1.1 and 3.5 ± 1.1 in the Ivor-Lewis group,which were significantly greater than 2.3 ± 0.8 and 2.4 ± 0.8 in the Sweet group (Z =9.96,9.02,P ＜ 0.05).The number of positive lymph nodes dissected from the cervical-thoracic junction was 0.7 ± 1.1 in the Ivor-Lewis group,which was greater than 0.3 ± 0.6 of the Sweet group,with significant difference between the 2 groups (Z =3.26,P ＜ 0.05).Of the 290 patients who received surgical treatment,273 were followed up with the follow-up rate of 94.14％ (273/290),and the median time for follow-up was 28.0 months.The 1-,2-,3-year tumor recurrence rates were 8.21％ (11/134),19.64％ (22/112) and 29.35％ (27/92) of the Ivor-Lewis group,which was significantly lower than 19.05％ (24/126),35.24％ (37/105) and 44.19％(38/86) of the Sweet group (x2=6.55,7.33,5.03,P ＜ 0.05).There were significant differences in the 1-,2-,3-year locoregional recurrence rate of the lymph nodes between the 2 groups (x2 =7.03,9.68,6.87,P ＜0.05).The 1-,2-,3-year accumulative survival rates of the Ivor-Lewis group were 90.30％ (121/134),80.36％(90/112) and 71.74％ (66/92),which were significantly higher than 80.95％ (102/126),59.05％ (62/105)and 51.16％ (44/86) of the Sweet group (x2=4.65,1 1.73,7.97,P ＜ 0.05).Conclusion Ivor-Lewis stapled cervical esophagogastrostomy via thorax has advantages of high resection rate,better safety and better quality of life of patients,and it could be an optimized design of the treatment for patients with middle esophageal cancer without intumescent lymph node of neck.
