中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2015年
7期
508-512
,共5页
解明然%柳常青%孙效辉%郭明发%吴汉然%徐美青
解明然%柳常青%孫效輝%郭明髮%吳漢然%徐美青
해명연%류상청%손효휘%곽명발%오한연%서미청
食管肿瘤%胸腔镜检查%腹腔镜检查%食管切除术
食管腫瘤%胸腔鏡檢查%腹腔鏡檢查%食管切除術
식관종류%흉강경검사%복강경검사%식관절제술
Esophageal neoplasms%Thoracoscopy%Laparoscopy%Esophagectomy
目的 探讨完全胸腔镜联合腹腔镜施行微创Ivor Lewis食管癌切除术治疗局部进展期食管癌的可行性、安全性和近期疗效.方法 回顾性分析2011年10月至2013年10月于安徽医科大学附属省立医院胸外科接受Ivor Lewis食管癌切除术的309例局部进展期食管癌患者的临床资料.其中112例接受微创手术,197例接受开放手术.t检验和x2检验比较两组患者临床病理特征、术中情况和术后并发症发生率.结果 两组患者在性别、年龄、术前合并症、术前美国麻醉师协会分级、肿瘤位置和术前临床分期方面差异无统计学意义,临床资料具有可比性.两组患者术后临床病理特征、手术时间和淋巴结清扫个数差异无统计学意义(P＞0.05).微创组术中失血量低于开放组[(186 ±45)ml比(198±47)ml,t=2.086,P=0.039],胸腔引流时间低于开放组[(9±5)d比(11±6)d,t =2.760,P=0.005],术后住院时间低于开放组[(12±6)d比(14±7)d,t=2.932,P=0.005].两组患者术后在院病死率、总并发症发生率和肺部感染发生率差异无统计学意义(P＞0.05).微创组切口感染率低于开放组,差异有统计学意义(0比4.6％,x2=3.779,P=0.029).结论 完全胸腔镜联合腹腔镜施行微创Ivor Lewis食管癌切除术治疗局部进展期食管癌安全可行,可获得满意的近期疗效.
目的 探討完全胸腔鏡聯閤腹腔鏡施行微創Ivor Lewis食管癌切除術治療跼部進展期食管癌的可行性、安全性和近期療效.方法 迴顧性分析2011年10月至2013年10月于安徽醫科大學附屬省立醫院胸外科接受Ivor Lewis食管癌切除術的309例跼部進展期食管癌患者的臨床資料.其中112例接受微創手術,197例接受開放手術.t檢驗和x2檢驗比較兩組患者臨床病理特徵、術中情況和術後併髮癥髮生率.結果 兩組患者在性彆、年齡、術前閤併癥、術前美國痳醉師協會分級、腫瘤位置和術前臨床分期方麵差異無統計學意義,臨床資料具有可比性.兩組患者術後臨床病理特徵、手術時間和淋巴結清掃箇數差異無統計學意義(P＞0.05).微創組術中失血量低于開放組[(186 ±45)ml比(198±47)ml,t=2.086,P=0.039],胸腔引流時間低于開放組[(9±5)d比(11±6)d,t =2.760,P=0.005],術後住院時間低于開放組[(12±6)d比(14±7)d,t=2.932,P=0.005].兩組患者術後在院病死率、總併髮癥髮生率和肺部感染髮生率差異無統計學意義(P＞0.05).微創組切口感染率低于開放組,差異有統計學意義(0比4.6％,x2=3.779,P=0.029).結論 完全胸腔鏡聯閤腹腔鏡施行微創Ivor Lewis食管癌切除術治療跼部進展期食管癌安全可行,可穫得滿意的近期療效.
목적 탐토완전흉강경연합복강경시행미창Ivor Lewis식관암절제술치료국부진전기식관암적가행성、안전성화근기료효.방법 회고성분석2011년10월지2013년10월우안휘의과대학부속성립의원흉외과접수Ivor Lewis식관암절제술적309례국부진전기식관암환자적림상자료.기중112례접수미창수술,197례접수개방수술.t검험화x2검험비교량조환자림상병리특정、술중정황화술후병발증발생솔.결과 량조환자재성별、년령、술전합병증、술전미국마취사협회분급、종류위치화술전림상분기방면차이무통계학의의,림상자료구유가비성.량조환자술후림상병리특정、수술시간화림파결청소개수차이무통계학의의(P＞0.05).미창조술중실혈량저우개방조[(186 ±45)ml비(198±47)ml,t=2.086,P=0.039],흉강인류시간저우개방조[(9±5)d비(11±6)d,t =2.760,P=0.005],술후주원시간저우개방조[(12±6)d비(14±7)d,t=2.932,P=0.005].량조환자술후재원병사솔、총병발증발생솔화폐부감염발생솔차이무통계학의의(P＞0.05).미창조절구감염솔저우개방조,차이유통계학의의(0비4.6％,x2=3.779,P=0.029).결론 완전흉강경연합복강경시행미창Ivor Lewis식관암절제술치료국부진전기식관암안전가행,가획득만의적근기료효.
Objective To describe the technique for minimally invasive Ivor Lewis esophagectomy (MIILE) and to evaluate the feasibility,safety and the short-term clinical outcomes of this approach.Methods The clinical data of 309 patients with locally advanced esophageal cancer who received Ivor Lewis esophagectomy between October 2011 and October 2013 was analyzed retrospectively.Of those 309 patients,112 underwent MIILE and 197 underwent open Ivor Lewis esophagectomy (OILE).The clinicopathologic factors,operational factors and postoperative complications of the two groups were compared by t test and x2 test.Results The two groups were similar in terms of gender,age,American Society of Anesthesiologists grade,tumor location,preoperative staging and incidence of comorbidities (P ＞ 0.05).The MIILE approach was associated with a significant decrease in surgical blood loss ((186 ± 45) ml vs.(198 ± 47) ml,t =2.086,P =0.039),chest tube duration ((9 ± 5) days vs.(11 ± 6) days,t =2.760,P =0.005) and postoperative stay ((12 ± 6) days vs.(14 ± 7) days,t =2.932,P =0.005) relative to the OILE approach.There was no significant difference between the two groups in the number of total lymph nodes dissected or the stations of the total lymph nodes dissected (P ＞ 0.05).The postoperative in-hospital mortality and total morbidity did not differ between the two groups (P ＞ 0.05).The MIILE approach was associated with significantly fewer wound infections than the OILE approach (0 vs.4.6％,P =0.029).Conclusion Our MIILE technique for locally advanced esophageal cancer can be safely and effectively performed for intrathoracic anastomosis during esophageal surgeries with favorable early outcomes.
