中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
17期
35-38
,共4页
食管肿瘤%食管切除术%胸腔镜%腹腔镜
食管腫瘤%食管切除術%胸腔鏡%腹腔鏡
식관종류%식관절제술%흉강경%복강경
Esophageal neoplasms%Esophagectomy%Thoracoscopes%Laparoscopes
目的 比较食管胸中下段癌应用微创McKeown手术与常规左侧开胸食管切除颈部吻合术的手术效果.方法 回顾性分析2009年1月至2013年10月收治的148例食管胸中下段癌患者的临床资料,其中78例行微创McKeown手术治疗(观察组),另70例行左胸-左颈切口手术治疗(对照组),观察比较两组围手术期情况、术后并发症及淋巴结转移情况.结果 两组均顺利完成手术切除.观察组无死亡病例,对照组1例患者死于急性心肌梗死.观察组术中出血量少于对照组[(89.2±40.7) ml比(361.6±81.5) ml],淋巴结清扫数目及胸部淋巴结数多于对照组[(22.8±5.6)枚比(15.7±3.4)枚、(14.7±4.6)枚比(9.1±3.6)枚],术后住院时间少于对照组[(11.6±3.5)d比(14.0±6.6)d],差异均有统计学意义(P＜0.05).观察组肺炎、肺不张、需要处理的胸腔积液发生率显著低于对照组[5.1％(4/78)比12.9％(9/70)、3.8％(3/78)比11.4％(8/70)、2.6％(2/78)比10.0％(7/70)],胃排空障碍发生率高于对照组[9.0％(7/78)比1.4％(1/70)],差异均有统计学意义(P＜0.05).观察组右侧喉返神经旁、左侧喉返神经旁及上纵隔淋巴结转移率明显高于对照组,差异有统计学意义(P＜0.05).结论 微创McKeown手术治疗食管胸中下段癌在技术上是安全可行的,且在减少术中出血量、缩短住院时间、降低术后呼吸系统并发症上具有优势,但术后胃排空障碍发生率较高.以右胸路径为基础的微创食管切除术更符合肿瘤学根治与微创原则的食管癌主流手术方向.
目的 比較食管胸中下段癌應用微創McKeown手術與常規左側開胸食管切除頸部吻閤術的手術效果.方法 迴顧性分析2009年1月至2013年10月收治的148例食管胸中下段癌患者的臨床資料,其中78例行微創McKeown手術治療(觀察組),另70例行左胸-左頸切口手術治療(對照組),觀察比較兩組圍手術期情況、術後併髮癥及淋巴結轉移情況.結果 兩組均順利完成手術切除.觀察組無死亡病例,對照組1例患者死于急性心肌梗死.觀察組術中齣血量少于對照組[(89.2±40.7) ml比(361.6±81.5) ml],淋巴結清掃數目及胸部淋巴結數多于對照組[(22.8±5.6)枚比(15.7±3.4)枚、(14.7±4.6)枚比(9.1±3.6)枚],術後住院時間少于對照組[(11.6±3.5)d比(14.0±6.6)d],差異均有統計學意義(P＜0.05).觀察組肺炎、肺不張、需要處理的胸腔積液髮生率顯著低于對照組[5.1％(4/78)比12.9％(9/70)、3.8％(3/78)比11.4％(8/70)、2.6％(2/78)比10.0％(7/70)],胃排空障礙髮生率高于對照組[9.0％(7/78)比1.4％(1/70)],差異均有統計學意義(P＜0.05).觀察組右側喉返神經徬、左側喉返神經徬及上縱隔淋巴結轉移率明顯高于對照組,差異有統計學意義(P＜0.05).結論 微創McKeown手術治療食管胸中下段癌在技術上是安全可行的,且在減少術中齣血量、縮短住院時間、降低術後呼吸繫統併髮癥上具有優勢,但術後胃排空障礙髮生率較高.以右胸路徑為基礎的微創食管切除術更符閤腫瘤學根治與微創原則的食管癌主流手術方嚮.
목적 비교식관흉중하단암응용미창McKeown수술여상규좌측개흉식관절제경부문합술적수술효과.방법 회고성분석2009년1월지2013년10월수치적148례식관흉중하단암환자적림상자료,기중78례행미창McKeown수술치료(관찰조),령70례행좌흉-좌경절구수술치료(대조조),관찰비교량조위수술기정황、술후병발증급림파결전이정황.결과 량조균순리완성수술절제.관찰조무사망병례,대조조1례환자사우급성심기경사.관찰조술중출혈량소우대조조[(89.2±40.7) ml비(361.6±81.5) ml],림파결청소수목급흉부림파결수다우대조조[(22.8±5.6)매비(15.7±3.4)매、(14.7±4.6)매비(9.1±3.6)매],술후주원시간소우대조조[(11.6±3.5)d비(14.0±6.6)d],차이균유통계학의의(P＜0.05).관찰조폐염、폐불장、수요처리적흉강적액발생솔현저저우대조조[5.1％(4/78)비12.9％(9/70)、3.8％(3/78)비11.4％(8/70)、2.6％(2/78)비10.0％(7/70)],위배공장애발생솔고우대조조[9.0％(7/78)비1.4％(1/70)],차이균유통계학의의(P＜0.05).관찰조우측후반신경방、좌측후반신경방급상종격림파결전이솔명현고우대조조,차이유통계학의의(P＜0.05).결론 미창McKeown수술치료식관흉중하단암재기술상시안전가행적,차재감소술중출혈량、축단주원시간、강저술후호흡계통병발증상구유우세,단술후위배공장애발생솔교고.이우흉로경위기출적미창식관절제술경부합종류학근치여미창원칙적식관암주류수술방향.
Objective To compare the outcome between McKeown minimally invasive approach and left chest-neck incision approach esophagectomy in mid-to-distal esophageal cancer.Methods The clinical data of 148 patients with mid-to-distal esophageal cancer from January 2009 to October 2013 were analyzed retrospectively.Seventy-eight patients (observation group) were performed with McKeown minimally invasive approach esophagectomy and 70 patients (control group) were performed with left chest-neck incision approach esophagectomy.The peroperative period status,postoperative complications and lymph nodes transfer between two groups were compared.Results All the operations were performed successfully.One patient in control group was dead because of acute myocardial infarction.The blood loss in observation group was significantly lower than that in control group[(89.2 ± 40.7) ml vs.(361.6 ± 81.5) ml] (P ＜ 0.05),the number of lymph nodes harvested and lymph node of thorax were significantly higher than those in control group[(22.8 ± 5.6) lymph nodes vs.(15.7 ± 3.4) lymph nodes,(14.7 ± 4.6) lymph nodes vs.(9.1 ± 3.6)lymph nodes] (P ＜ 0.05),the hospital stay was significantly shorter than that in control group [(11.6 ± 3.5)d vs.(14.0 ±6.6) d] (P ＜0.05).There were significant differences between two groups with regard to pneumonia,atelectasis,pleural effusion and delayed gastric emptying [5.1％ (4/78) vs.12.9％ (9/70),3.8％ (3/78) vs.11.4％(8/70),2.6％(2/78) vs.10.0％(7/70),9.0％(7/78) vs.1.4％(1/70)] (P ＜0.05).The transfer rate at the side of right recurrent laryngeal,left recurrent laryngeal and upper mediastinal lymph node in observation group were significantly higher than those in control group(P ＜ 0.05).Conclusion McKeown minimally invasive approach esophagectomy is feasible and safe which has lower blood loss,lower respiratory complication,shorter hospital stay and more number of lymph nodes harvested.
