胸腹腔镜联合Ivor Lewis术与McKeown术治疗胸中下段食管癌近期疗效的比较
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摘要
目的比较胸腹腔镜联合Ivor Lewis术与McKeown术治疗胸中下段食管癌的临床近期疗效。方法采用随机分组的方法,将120例胸中下段食管癌的患者均分为2组,分别行Ivor Lewis术与McKeown术,比较两组患者的手术指标、治疗后两组患者的淋巴结清扫及转移情况、两组患者的术后并发症和术后6个月复发情况、两组患者治疗前后的生活质量。结果两组患者接受不同的治疗后,其淋巴结清扫及转移情况的差异有统计学意义(χ~2=76. 13,P=0. 00)、术后并发症和术后6个月复发情况差异有统计学意义(χ~2=55. 24,P=0. 00)、生活质量差异显著(χ~2=79. 63,P=0. 00);造成两组患者间淋巴结清扫及转移情况差异、术后并发症和术后6个月复发情况差异和生活质量差异显著的主要原因在于:Ivor Lewis组和McKeown组的疗效差异。结论 Ivor Lewis术与McKeown术对于治疗胸中下段食管癌均有一定疗效,McKeown术的治疗效果相对更好,并发症发生率更低。
Objective To evaluate the short-term clinical efficacy of thoracic-laparoscopic combined with Ivor Lewis and McKeown in the treatment of lower thoracic esophageal cancer and to provide clinical data for the treatment of lower thoracic esophageal cancer. Methods A total of 120 patients with lower thoracic esophageal cancer were randomly divided into two groups.The patients were treated with Ivor Lewis and McKeown respectively. The operation indexes of the two groups were compared. The lymph node dissection and Metastasis,postoperative complications in both groups and relapse 6 months after operation,the quality of life of the two groups before and after treatment were statistically different. Results The difference of lymph node dissection and metastasis between the two groups was statistically significant( P < 0. 05),postoperative complications and recurrence after 6 months were statistically significant( P < 0. 05). There were significant differences in quality of life between the two groups( P <0. 05); differences in lymph node dissection and metastasis between the two groups were observed,postoperative complications and recurrence after 6 months The main reason for the significant difference in quality is the difference in efficacy between the McKeown and Ivor Lewis groups. Conclusion Lvor Lewis surgery and McKeown surgery have certain curative effect on the treatment of middle and lower thoracic esophageal cancer. The treatment effect of McKeown surgery is relatively better and the incidence of complications is relatively lower.
Objective To evaluate the short-term clinical efficacy of thoracic-laparoscopic combined with Ivor Lewis and McKeown in the treatment of lower thoracic esophageal cancer and to provide clinical data for the treatment of lower thoracic esophageal cancer. Methods A total of 120 patients with lower thoracic esophageal cancer were randomly divided into two groups.The patients were treated with Ivor Lewis and McKeown respectively. The operation indexes of the two groups were compared. The lymph node dissection and Metastasis,postoperative complications in both groups and relapse 6 months after operation,the quality of life of the two groups before and after treatment were statistically different. Results The difference of lymph node dissection and metastasis between the two groups was statistically significant( P < 0. 05),postoperative complications and recurrence after 6 months were statistically significant( P < 0. 05). There were significant differences in quality of life between the two groups( P <0. 05); differences in lymph node dissection and metastasis between the two groups were observed,postoperative complications and recurrence after 6 months The main reason for the significant difference in quality is the difference in efficacy between the McKeown and Ivor Lewis groups. Conclusion Lvor Lewis surgery and McKeown surgery have certain curative effect on the treatment of middle and lower thoracic esophageal cancer. The treatment effect of McKeown surgery is relatively better and the incidence of complications is relatively lower.
引文
[1]许建宁,刘国锋.胸腹腔镜Ivor-Lewis术与Mc Keown术在胸中下段食管癌中的应用效果比较[J].中国临床研究,2017,30(9):1219-1221.
[2]Lindner K,Palmes D,Grübener A,et al.Esophageal Cancer Specific Risk Score Is Associated with Postoperative Complications Following Open Ivor-Lewis Esophagectomy for Adenocarcinoma[J].Dig Surg,2016,33(1):58-65.
[3]钱世国,戴佳鸿,张源源.Ivor-lewis食管癌根治术治疗食管癌的效果观察[J].现代诊断与治疗,2017,28(12):2319-2320.
[4]许峰,于在诚.微创食管癌术后吻合口瘘危险因素的分析[J].安徽医药,2017,21(6):1015-1019.
[5]伍成德,卢伟,林巍,等.改良Ivor-Lewis与颈胸腹三切口治疗食管癌的临床对比观察[J].现代消化及介入诊疗,2017,22(3):368-370.
[6]杨智.微创Mc Keown术治疗胸中下段食管癌并发症及其影响因素分析[J].山西医药杂志,2017,46(11):1342-1345.
[7]高飞,齐宇,张春敭,等.单腔和双腔气管插管在胸段食管癌微创Mc Keown术中的应用比较[J].河南医学研究,2017,26(7):1165-1168.
[8]李宗荣,李柏钧,卢昌超,等.单操作孔胸腔镜联合腹腔镜在Mc Keown食管癌根治术中的应用评估[J].第三军医大学学报,2017,39(18):1854-1858.
[9]Xiao P,Zhuang X,Shen Y,et al.Reverse-Puncture Anastomotic Technique for Minimally Invasive Ivor-Lewis Esophagectomy[J].Ann Thorac Surg,2015,100(6):2372-2375.
[10]彭雄,陈云,Abdillah Nassor Juma,等.微创Mc Keown食管癌根治术与Ivor-Lewis手术治疗食管癌的近期疗效对比[J].中南大学学报(医学版),2017,42(5):546-552.
[11]戎保林,梅新宇,吴显宁.腹腔镜下空肠造瘘在微创食管癌Ivor-Lewis手术中的应用[J].中国临床保健杂志,2017,20(2):170-172.
[12]薛亚斌.微创Mc Keown食管癌切除术中喉返神经旁淋巴结清扫的可行性与安全性研究[D].新疆医科大学,2017.
[13]孙勇攀,梅宏,许川,等.胸腹腔镜联合Ivor-Lewis手术治疗食管胸中下段癌可行性、安全性及近期疗效观察[J].海南医学,2017,28(4):575-577.
[14]刘雷,艾波,廖永德,等.大网膜包埋吻合口在全胸腔镜下食管胃胸内吻合治疗食管癌中的应用[J].中国微创外科杂志,2017,17(2):104-107.
[15]李庆庆,王征,罗全,等.腹部无小切口腹腔镜联合右胸小切口Ivor-Lewis食管癌根治术30例近期疗效[J].现代肿瘤医学,2017,25(3):381-385.
[16]Hosoda K,Yamashita K,Katada N,et al.Overview of multimodal therapy for adenocarcinoma of the esophagogastric junction[J].Gen Thorac Cardiovasc Surg,2015,63(10):549-556.
[17]翟春波.微创食管癌切除Ivor-Lewis术与Mc Keown术的近期疗效比较及短期生活质量评价[D].山东大学,2016.
[18]熊剑文,喻东亮,魏益平,等.常规吻合器行微创Ivor Lewis中下段食管癌根治术的临床研究[J].江西医药,2016,51(10):999-1001.
[19]薛亚斌,吕红博,杜同心,等.微创Mc Keown食管癌切除术行喉返神经旁淋巴结清扫的临床效果探讨[J].天津医药,2016,44(10):1276-1279.
[20]王波,曾涛,任王胜,等.胸腔镜Mc Keown食管癌根治术与传统开胸食管癌根治术效果比较[J].四川医学,2016,37(8):891-893.
[21]高炳玉,吴毓优,刘玉,等.完全胸腹腔镜联合Mc Keown根治术治疗食管癌的近期疗效观察[J].海南医学,2016,27(15):2463-2465.
[2]Lindner K,Palmes D,Grübener A,et al.Esophageal Cancer Specific Risk Score Is Associated with Postoperative Complications Following Open Ivor-Lewis Esophagectomy for Adenocarcinoma[J].Dig Surg,2016,33(1):58-65.
[3]钱世国,戴佳鸿,张源源.Ivor-lewis食管癌根治术治疗食管癌的效果观察[J].现代诊断与治疗,2017,28(12):2319-2320.
[4]许峰,于在诚.微创食管癌术后吻合口瘘危险因素的分析[J].安徽医药,2017,21(6):1015-1019.
[5]伍成德,卢伟,林巍,等.改良Ivor-Lewis与颈胸腹三切口治疗食管癌的临床对比观察[J].现代消化及介入诊疗,2017,22(3):368-370.
[6]杨智.微创Mc Keown术治疗胸中下段食管癌并发症及其影响因素分析[J].山西医药杂志,2017,46(11):1342-1345.
[7]高飞,齐宇,张春敭,等.单腔和双腔气管插管在胸段食管癌微创Mc Keown术中的应用比较[J].河南医学研究,2017,26(7):1165-1168.
[8]李宗荣,李柏钧,卢昌超,等.单操作孔胸腔镜联合腹腔镜在Mc Keown食管癌根治术中的应用评估[J].第三军医大学学报,2017,39(18):1854-1858.
[9]Xiao P,Zhuang X,Shen Y,et al.Reverse-Puncture Anastomotic Technique for Minimally Invasive Ivor-Lewis Esophagectomy[J].Ann Thorac Surg,2015,100(6):2372-2375.
[10]彭雄,陈云,Abdillah Nassor Juma,等.微创Mc Keown食管癌根治术与Ivor-Lewis手术治疗食管癌的近期疗效对比[J].中南大学学报(医学版),2017,42(5):546-552.
[11]戎保林,梅新宇,吴显宁.腹腔镜下空肠造瘘在微创食管癌Ivor-Lewis手术中的应用[J].中国临床保健杂志,2017,20(2):170-172.
[12]薛亚斌.微创Mc Keown食管癌切除术中喉返神经旁淋巴结清扫的可行性与安全性研究[D].新疆医科大学,2017.
[13]孙勇攀,梅宏,许川,等.胸腹腔镜联合Ivor-Lewis手术治疗食管胸中下段癌可行性、安全性及近期疗效观察[J].海南医学,2017,28(4):575-577.
[14]刘雷,艾波,廖永德,等.大网膜包埋吻合口在全胸腔镜下食管胃胸内吻合治疗食管癌中的应用[J].中国微创外科杂志,2017,17(2):104-107.
[15]李庆庆,王征,罗全,等.腹部无小切口腹腔镜联合右胸小切口Ivor-Lewis食管癌根治术30例近期疗效[J].现代肿瘤医学,2017,25(3):381-385.
[16]Hosoda K,Yamashita K,Katada N,et al.Overview of multimodal therapy for adenocarcinoma of the esophagogastric junction[J].Gen Thorac Cardiovasc Surg,2015,63(10):549-556.
[17]翟春波.微创食管癌切除Ivor-Lewis术与Mc Keown术的近期疗效比较及短期生活质量评价[D].山东大学,2016.
[18]熊剑文,喻东亮,魏益平,等.常规吻合器行微创Ivor Lewis中下段食管癌根治术的临床研究[J].江西医药,2016,51(10):999-1001.
[19]薛亚斌,吕红博,杜同心,等.微创Mc Keown食管癌切除术行喉返神经旁淋巴结清扫的临床效果探讨[J].天津医药,2016,44(10):1276-1279.
[20]王波,曾涛,任王胜,等.胸腔镜Mc Keown食管癌根治术与传统开胸食管癌根治术效果比较[J].四川医学,2016,37(8):891-893.
[21]高炳玉,吴毓优,刘玉,等.完全胸腹腔镜联合Mc Keown根治术治疗食管癌的近期疗效观察[J].海南医学,2016,27(15):2463-2465.