摘要目的 探讨胸腹腔镜联合Ivor-Lewis食管癌根治术的可行性、安全性及近期临床效果。方法 回顾性分析2011年10月—2013年6月安徽医科大学附属省立医院胸外科行胸腹腔镜联合Ivor-Lewis食管癌根治术146例(腔镜组)以及开放右胸上腹两切口食管癌根治术168例(开放组)患者的临床资料。比较两组手术时间、术中出血量、淋巴结清扫数目、术后住院时间及术后并发症的发生情况。结果 与开放组相比,腔镜组的出血量少[(181.8±60.7)mL vs (205.7±105.9)mL, t=-2.396],术后住院时间短[(11.5±5.5) d vs (13.0±7.4)d, t=-2.023],术后呼吸系统并发症发生率较低[8.2%(12/146) vs 22.0%(37/168), χ2=11.303],差异均有统计学意义(P值均<0.05);而手术时间、淋巴结清扫数目、循环和消化系统并发症发生率、二次手术率、近期总复发率及总生存率的差异均无统计学意义(P值均>0.05)。结论 胸腹腔镜联合Ivor-Lewis食管癌根治术在技术上是安全可行的,且具有术中出血量少、术后肺部感染发生率低和住院时间短等优势;但其远期疗效需进一步随访观察。
Abstract：Objective Toexplore the feasibility, security and the short-term clinical effect of thoracolaproscopic Ivor-Lewis esophagectomy.Methods The clinical data of 146 patients who underwent thoracolaproscopic Ivor-Lewis esophagectomy from October 2011 to July 2013 were retrospectively analyzed, while 168 patients underwent conventional two incision esophagectomy were served as controls. The operation time, blood loss, number of lymph node harvested, postoperative hospital stay and postoperative complications were compared.Results Compared with the open group, less intraoperative blood loss [(181.8±60.7)mL vs (205.7±105.9)mL, t=-2.396], shorter postoperative hospital stay [(11.5±5.5)d vs (13.0±7.4)d, t=-2.023] and lower incidence of postoperative respiratory complications [8.2%(12/146) vs 22.0%(37/168), χ2=11.303] were observed in thoracolaproscopic Ivor-Lewis esophagectomy group(all P values<0.05). No significant differences were observed in the operation time, number of lymph node harvested, the complications of the circulatory and respiratory systems, the total rate of relapse and overall survival between the two groups (all P values>0.05).Conclusions Thoracolaproscopic Ivor-Lewis esophagectomy is safe and feasible, with the advantages in less blood loss, shorter hospital stay and lower incidence of respiratory complications. But its long-term effect needs further observation.
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2015, Vol. 20 
