【摘要】 目的:总结74例微创Mc Keown食管癌根治术(minimally invasive Mc Keown esophagectomy,MIE-Mc Keown)经验及体会,并与经典Ivor-Lewis食管癌手术(Ivor-Lewis esophagectomy,ILE)比较,探讨二者手术的近期疗效。方法:回顾性分析2014年11月至2016年7月期间在中南大学湘雅医院胸外科接受MIE-Mc Keown的74例患者的临床资料,选择同期接受ILE的食管癌患者85例作为对照,比较二者近期疗效。结果:与ILE组相比,MIE-Mc Keown组患者术中出血量更少,术后肺部感染发生率更低,手术切除食管长度更长,淋巴结清除组数及个数更多,但手术时间和术后住院时间更长,术后吻合口瘘和吻合口狭窄发生率更高,差异均有统计学意义(P<0.05)。两组整体淋巴结转移率52.8%,MIE-Mc Keown组的颈部淋巴结转移率9.5%。两组共发现食管多中心病灶16例,次瘤位于主瘤上方者7例,次瘤远侧缘距主瘤中心的距离(D)为20~85(50.7±23.0)mm,次瘤位于主瘤下方者9例,D值为30~90(57.8±20.5)mm。结论:MIEMc Keown病灶切除更彻底,淋巴结清除度较高,安全、创伤小、短期效果好,是治疗食管癌的适合术式,但吻合口瘘及吻合口狭窄发生率较高,需进一步优化。更多还原

【Abstract】 Objective: To summarize the outcomes of 74 patients with minimally invasive McKeown esophagectomy(MIE-McKeown), and to discuss the short-term outcomes by comparing with IvorLewis esophagectomy(ILE) procedure. Methods: A total of 74 patients with esophageal carcinoma underwent MIE-McKeown in Xiangya Hospital from November 2014 to July 2016 were retrospectively reviewed, and 85 patients underwent ILE procedure were selected as a control group. Perioperative and short-term outcomes were analyzed. Results: Compared with the ILE group, patients underwent MIE-McKeown had less blood loss, less pulmonary infection, longer resection length and more harvested lymph nodes(P<0.05), but they had more anastomotic leakage and stricture rate, longer operation time and hospital stay as well(P<0.05). The total rate of lymph node metastatic in all patients was 52.8%, and the rate of cervical lymph node metastases was 9.5% in the MIE-McKeown group. Multiple carcinomas were found in 16 cases, and 7 were proximally located. The distance from the distal margin of the second lesion to the center of the main lesion was 20-85(50.7±23.0) mm, while the distance in 9 second carcinomas distally located was 30-90(57.8±20.5) mm. Conclusion: Compared with Ivor-Lewis esophagectomy procedure, MIE-McKeown procedure has a more complete lesion dissection and more harvested lymph nodes with smaller incisions, better short-term outcomes and more safety. It is an appropriate procedure for esophagectomy. However, it should be optimized for its high rate of anastomotic leakage and stricture.更多还原