【摘要】 目的探讨胸腹腔镜Ivor-Lewis术在食管中下段癌手术治疗中的临床应用。方法回顾分析2014年3月—2016年5月行Ivor-Lewis术治疗胸中下段食管癌的148例患者的临床资料。按手术方式分为胸腹腔镜Ivor-Lewis组(腔镜组,80例)或开放Ivor-Lewis组(开放组,68例)。两组患者术前一般资料比较,差异无统计学意义(P>0.05)。比较两组患者围手术期情况及2年随访结果。结果与开放组相比,腔镜组淋巴结清扫枚数多、出血量少,术后住院时间缩短,总并发症减少,其中以肺部并发症减少为主;腔镜组总手术时间长,住院费用增加(P <0.05),其中主要为胸部手术时间长。随访2年,两组患者预后(吻合口狭窄、膈疝、局部复发/转移、死亡等)比较,差异无统计学意义(P>0.05)。结论胸腹腔镜Ivor-Lewis术在肿瘤根治性、术中出血控制、术后恢复等方面具有优势,近期并发症少,且远期效果可靠,值得临床推广。更多还原

【Abstract】 Objective To compare the perioperative and follow-up outcomes following thoraco-laparoscopic versus open Ivor-Lewis esophagectomy for middle to distal esophageal cancer, and to explore the application of thoraco-laparoscopic Ivor-Lewis esophagectomy. Methods The clinical data of 148 patients with middle-todistal esophageal cancer, who were treated with thoraco-laparoscopic(minimally-invasive surgery, MIE group, 80 patients) or open(open surgery, OE group, 68 patients) Ivor-Lewis esophagectomy with two-field lymphadenectomy from March 2014 to May 2016, were retrospectively analyzed. There was no significant difference in gender, age, smoking history, tumor location, tumor size, pathological type or staging between the two groups(P > 0.05). Perioperative outcomes and 2-year follow-up outcomes were compared. Results Compared with the OE group, the MIE group had more lymph nodes dissected, less blood loss, shorter postoperative hospital stay and fewer total complications especially pulmonary complications(P < 0.05). However, the total operation time, especially the time for the thoracoscopic surgery in the MIE group was significantly longer than that in the OE group(P < 0.05). Meanwhile, the hospitalization cost of the MIE group was significantly increased(P < 0.05). Upon 2-year follow-up, there was no significant difference in the incidence of anastomotic stenosis, diaphragmatic hernia, local recurrence, metastasis or survival rate between the two groups(P > 0.05). Conclusions Although thoraco-laparoscopic IvorLewis esophagectomy has a longer operation time and higher hospitalization costs, it is superior to open IvorLewis esophagectomy in terms of control of intraoperative bleeding, postoperative complications and postoperative recovery. The long-term effect of thoraco-laparoscopic Ivor-Lewis esophagectomy is not inferior to open Ivor-Lewis surgery, therefore, it is worthy of clinical promotion.更多还原