胸腹腔镜下胸内吻合术与颈部吻合术治疗胸中下段食管癌的近期疗效分析

doi:10.3969/j.issn.1005-6483.2020.07.012

摘要/Abstract

摘要： 目的探讨胸腹腔镜下胸内吻合术（Ivor-Lewis）与颈部吻合术（McKeown）治疗胸中下段食管癌的近期疗效。
方法 2016年2月～2018年4月本院收治的胸中下段食管癌病人110例，按照手术方式分为两组，Ivor-Lewis组52例，行胸腹腔镜Ivor-Lewis术治疗。McKeown组58例，行胸腹腔镜McKeown术治疗，比较两组病人围术期手术相关指标及并发症发生情况，术前和术后10天评估两组病人肺功能；以食管癌病人补充量表（QLQ-OES18）评价两组病人术前、术后4周的生活质量。
结果两组病人手术时间、住院时间等围术期指标比较差异无统计学意义（P＞0.05），术后6个月淋巴结转移和肿瘤复发情况比较差异无统计意义（P＞0.05）；术后10天两组病人FEV1/FVC、FEV1预计值、PaO₂、SaO₂显著低于术前（P＜0.05）；术后4周Ivor-Lewis组病人进食困难、咳嗽、言语评分低于McKeown组（P＜0.05）；两组病人术后4周进食困难低于术前（P＜0.05），反流、咳嗽、言语评分高于术前（P＜0.05）。
结论胸腹腔镜Ivor-Lewis与McKeown术治疗胸中下段食管癌对肿瘤清除效果相近，但Ivor-Lewis术病人并发症发生率更低，肺功能恢复更好，生活质量更高，近期疗效更有优势。

关键词: 胸腔镜, 腹腔镜, 胸内吻合, 颈部吻合, 食管癌

Abstract: Objective To explore short-term curative effect of thoracoscopic-laparoscopic intrathoracic anastomosis（Ivor-Lewis）and neck anastomosis（McKeown）on thoracic middle-lower segment esophageal cancer.
Methods A total of 110 patients with thoracic middle-lower segment esophageal cancer who were admitted to the hospital from February 2016 to April 2018 were enrolled.According to different surgical methods，they were divided into two groups.Fifty-two patients in Ivor-Lewis group were treated with thoracoscopic-laparoscopic Ivor-Lewis，while fifty-eight patients in McKeown group were treated with thoracoscopic-laparoscopic McKeown.The perioperative surgical related indexes and complications were compared between the two groups.The lung function in both groups was evaluated before surgery and after 10d of surgery.Quality of Life Questionnaire-Oesophagus 18（QLQ -OES18）was applied to assess quality of life in both groups before surgery and after 4 weeks of surgery.
Results There were no significant differences in perioperative indexes such as operation time and hospitalization time between the two groups（P＞0.05）.After 6 months of surgery，there were no significant differences in lymph node metastasis and tumor recurrence between the two groups（P＞0.05）.After 10d after surgery，FEV1/FVC，FEV1 predicted value，PaO₂ and SaO₂ in both groups were significantly higher than those before surgery（P＜0.05）.After 4 weeks of surgery，scores of difficulty eating，coughing and speech in Ivor-Lewis group significantly lower than those in McKeown group（P＜0.05）.After 4 months of surgery，difficulty eating scores in both groups were significantly lower than those before surgery（P＜0.05），while scores of reflux，cough and speech were significantly higher than those before surgery（P＜0.05）.
Conclusion The tumor clearance effects of thoracoscopic-laparoscopic Ivor-Lewis and McKeown are similar in treatment of thoracic middle-lower segment esophageal cancer.However，incidence of complications is lower in patients treated with the former，lung function recovery is better，and quality of life is higher，whose short-term curative effect is more advantageous.

Key words: Thoracoscope, Laparoscope, Intrathoracic anastomosis, Neck anastomosis, Esophageal cancer

李剑童希文汪坤廖进勇. 胸腹腔镜下胸内吻合术与颈部吻合术治疗胸中下段食管癌的近期疗效分析[J]. 临床外科杂志, 2020, 28(7): 639-642.

LI Jian, TONG Xiwen, WANG Kun, et al.. Short-term curative effect of thoracoscopic-laparoscopic Ivor-Lewis and McKeown on thoracic middle-lower segment esophageal cancer and their influences on postoperative complications and quality of life[J]. JOURNAL OF CLINICAL SURGERY, 2020, 28(7): 639-642.

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