| 李尘宸,吴汉然,邓杰,吴显宁,解明然,徐美青.微创Ivor-Lewis食管切除术与开放Ivor-Lewis食管切除术治疗胸中下段食管癌的疗效对比[J].中国临床保健杂志,2017,20(6):689-692. |
| 微创Ivor-Lewis食管切除术与开放Ivor-Lewis食管切除术治疗胸中下段食管癌的疗效对比 |
| Efficacy comparision of minimally ninvasive and open Ivor-Lewis esophagectomy for thoracic middle-lower esophageal carcinoma |
| 投稿时间：2017-06-06 |
| DOI：10.3969/J.issn.1672-6790.2017.06.018 |
| 中文关键词: 食管肿瘤 食管切除术 外科手术,微创性 预后 |
| 英文关键词: Esophageal neoplasms Esophagectomy Surgical procedures,minimally invasive Prognosis 〖FL |
| 基金项目:安徽省科技攻关项目(1501041143) |
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| 中文摘要: |
| 目的 对比胸中下段食管癌患者行微创和开放Ivor-Lewis食管切除术治疗的可行性、安全性和近中期治疗效果。方法 回顾分析接受微创Ivor-Lewis及开放Ivor-Lewis食管切除术的294例患者临床及随访资料,其中微创组180例,开放组114例。结果 微创组与开放组比较,术后吻合口瘘[10例(3.3%)比16例(4.4%),P=0.013]、喉返神经损伤[6例(3.3%)比13例(11.4%),P=0.006]及吻合口狭窄[(5例(2.8%)比11例(9.6%),P=0.011)]的发生率均较低。294例患者中,随访271例(92.2%),中位随访时间为34个月。全组患者的中位生存时间及1、2、3年生存率分别为44.5个月、95.9%、80.2%和61.9%。其中微创组患者的中位生存时间及1、2、3年生存率分别为45个月、96.1%、81.8%、62.5%。开放组患者的中位生存时间为41个月,1、2、3年生存率分别为95.6%、77.8%、61.2%。MIILE组患者生存率和OILE组患者总生存率差异无统计学意义(P=0.976)。在随访过程中发现,294例患者局部复发或远处转移150(51.0%)例,其中死亡102例。微创组180例患者中局部复发或远处转移79(43.8%)例,其中死亡59例。开放组114例患者中局部复发或远处转移52(45.6%)例,其中死亡43例。两组患者比较,差异无统计学意义(P=0.539)。T分期、有无淋巴结转移、肿瘤分化程度为食管癌患者的独立预后因素(均P<0.05),预后与患者的年龄、性别、手术方式、肿瘤位置无明显相关(P>0.05)。结论 微创Ivor-Lewis食管切除术与开放Ivor-Lewis食管切除术治疗胸中下段食管癌中期总生存率效果相似,但微创Ivor-Lewis食管切除术在吻合口瘘、喉返神经损伤及吻合口狭窄方面优于开放术式。 |
| 英文摘要: |
| Objective To compare the feasibility,safety and middle-term outcomes of minimally invasive Ivor-Lewis esophagectomy and and open Ivor-Lewis esophagectomy.Methods A total of 294 esophageal cancer were collected,including 180 patients of minimally invasive Ivor-Lewis esophagectomy and 114 open Ivor-Lewis esophagectomy.Results The incidence rate of anastomotic leakage[10 patients(3.3%) VS.16 patients(4.4%),P=0.013],recurrent laryngeal nerve injury[6 patients(3.3%) VS.13 patients(11.4%),P=0.006],and anastomotic stricture[(5 patients(2.8%) VS.11 patients(9.6%),P=0.011)] in MIILE group was lower than those in OILE group.Among all the 294 patients,271 cases were followed up and the follow-up rate was 92.2%.The median follow-up time was 34 months and median survival time was 44.5 months.The overall survival rate of 1,2 and 3 years was 95.9%,80.2% and 61.9% respectively.In MIILE group,the median survival time of MIILE was 45 months,the overall survival rate of 1,2 and 3 years was 96.1%,81.8% and 62.5% respectively.In OIILE group,the median survival time was 41 months,the overall survival rate of 1,2 and 3 years was 95.6%,77.8% and 61.2% respectively.There was no significant difference in overall survival rate of MILLE and OILE.One hundred and fifty(51.0%) patients had local recurrence and 102 patients were dead during the follow-up period.At the same time,the patients of local recurrence with MIILE were 79(43.8%)and 59 patients died.The patients of local recurrence in OILE was 52(45.6%)and 43 patients were dead.T stage,metastasis of lymph node,and tumor differentiation are independent prognostic factors for the overallsurvival (P＜0.05) and has no significant connection with age,sex,modus operandi and location of the tumor(P＞0.05).Conclusions There is no significant difference of middle-term overall survival rate between minimally invasive and open Ivor-Lewis esophagectomy.The anastomotic leakage,injury of recurrent laryngeal nerve,and anastomotic stenosis of minimally invasive Ivor-Lewis surgery are low. |
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