胸部小切口Ivor-Lewis术在食管癌治疗中的应用研究
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摘要
目的探讨胸部小切口在Ivor-Lewis食管癌根治术中的应用及价值。方法回顾性分析合肥市滨湖医院胸心外科2014年1月至2016年12月收治的46例胸中下段食管癌手术病人的临床资料,分为观察组(右胸小切口和上腹正中切口)和对照组(右胸后外侧切口和上腹正中切口)各23例。对两组的胸部切口长度、胸部操作时间、淋巴结清扫数目、术中出血量、上肢功能恢复时间、镇痛药物使用时间、术后并发症等进行比较。结果观察组和对照组在切口长度[(12.1±3.5) cm比(25.2±4.4) cm]、上肢功能恢复时间[(8.4±1.4) d比(13.6±2.7) d]、镇痛药物使用时间[(42.3±6.6) h比(64.4±7.2) h]等方面比较,均差异有统计学意义(t=11.138、8.279、12.770,均P=0.000);胸部操作时间,淋巴结清扫数目,术中出血量,术后并发症,差异无统计学意义(P>0.05)。结论胸部小切口Ivor-Lewis术式缩小了胸部切口,胸部操作时间并无延长,能够充分清扫淋巴结,改善病人术后情况,不增加术后并发症,是安全可行的手术方式。
Objective To explore the application and value of mini-thoracotomy Ivor-Lewis in radical operation of esophageal carcinoma.Methods The clinical data of 46 patients with thoracic middle-lower segment esophageal carcinoma treated in Hefei Binhu Hospital from January 2014 to December 2016 were reviewed retrospectively.The patients were assigned into observation group(right mini-thoracotomy incision and upper abdominal median incision) and control group(right posterolateral thoracotomy incision and upper abdominal median incision),with 23 cases in each group.The length of thoracic incision,intrathoracic operation time,increment of dissected lymph nodes number,intraoperative blood loss,functional restoration of upper limb,time for analgesics use and postoperative complications were compared between the two groups.Results There were significant differences between the two groups in the length of incision [(12.1±3.5) cm vs.(25.2±4.4) cm],the functional restoration of upper limb [(8.4±1.4) d vs.(13.6±2.7) d],and time for analgesics use [(42.3±6.6) h vs.(64.4±7.2) h](t=11.138,8.279,12.770,all P=0.000); intrathoracic operation time,increment of dissected lymph nodes number,intraoperative blood loss and postoperative complications between both groups had no significant differences(P>0.05).Conclusions Mini-thoracotomy Ivor-Lewis esophagectomy can reduce the length of thoracic incision without prolonged intrathoracic operation time,which may adequately dissect lymph nodes,improve the postoperative condition of the patients without increasing postoperative complications.It is a safe and feasible operation procedure.
Objective To explore the application and value of mini-thoracotomy Ivor-Lewis in radical operation of esophageal carcinoma.Methods The clinical data of 46 patients with thoracic middle-lower segment esophageal carcinoma treated in Hefei Binhu Hospital from January 2014 to December 2016 were reviewed retrospectively.The patients were assigned into observation group(right mini-thoracotomy incision and upper abdominal median incision) and control group(right posterolateral thoracotomy incision and upper abdominal median incision),with 23 cases in each group.The length of thoracic incision,intrathoracic operation time,increment of dissected lymph nodes number,intraoperative blood loss,functional restoration of upper limb,time for analgesics use and postoperative complications were compared between the two groups.Results There were significant differences between the two groups in the length of incision [(12.1±3.5) cm vs.(25.2±4.4) cm],the functional restoration of upper limb [(8.4±1.4) d vs.(13.6±2.7) d],and time for analgesics use [(42.3±6.6) h vs.(64.4±7.2) h](t=11.138,8.279,12.770,all P=0.000); intrathoracic operation time,increment of dissected lymph nodes number,intraoperative blood loss and postoperative complications between both groups had no significant differences(P>0.05).Conclusions Mini-thoracotomy Ivor-Lewis esophagectomy can reduce the length of thoracic incision without prolonged intrathoracic operation time,which may adequately dissect lymph nodes,improve the postoperative condition of the patients without increasing postoperative complications.It is a safe and feasible operation procedure.
引文
[1] 邹小农,陈万青,张思维,等.中国部分市县1998～2002年食管癌发病与死亡[J].中国肿瘤,2007,16(3):142-146.
[2] 陈克能.食管癌手术入路的百年演变及临床意义[J].中华胃肠外科杂志,2012,15(9):886-888.
[3] HUANG LL,ONAITIS M.Minimally invasive and robotic Ivor-Lewis esophagectomy[J].J Thorac Dis,2014,6(Suppl 3):S314-S321.
[4] 马龙飞,相加庆,李鹤成,等.Ivor-Lewis手术治疗食管癌的近期临床疗效分析[J].中华医学杂志,2012,92(23):1618-1620.
[5] 杨弘,傅剑华.以手术为主的食管癌综合治疗的进展[J].世界华人消化杂志,2012,20(35):3471-3475.
[6] CHEN HX,WANG Z,YANG Z,et al.Prospective study of adjuvant radiotherapy on preventing lymph node metastasis after Ivor-lewis esophagectomy in esophageal cancer[J].Ann Surg Oncol,2013,20(8):2721-2726.
[7] 李伟学,曾涛,田宋君.食管胃结合部腺癌患者的手术方案研究[J].安徽医药,2015,19(10):1948-1950.
[8] LI B,XIANG JQ,ZHANG YW,et al.Comparison of ivor-lewis vs sweet esophagectomy for esophageal squamous cell carcinoma[J].JAMA Surg,2015,150(4):292-298.
[9] ALTORKI N.En-blocesophagectomy:the three-field dissection[J].Surg Clin North Am,2005,85(3):611-619,xi.
[10] LEWIS I.The surgical treatment of carcinoma of theoesophagus; with special reference to a new operation for growths of the middle third[J].Br J Surg,1946,34:18-31.
[11] 吴昌荣,张振斌.Ivor-Lewis食管癌切除术338例疗效分析[J].中华肿瘤杂志,1996,18(3):192-194.
[12] HULSCHERJB,VAN SANDICK JW,DE BOER AG,et al.Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus[J].N Engl J Med,2002,347(21):1662-1669.
[13] JONES DR.Minimally invasive ivor lewis esophagectomy[J].Operative Techniques in Thoracic and Cardiovascular Surgery,2013,18(4):254-263.
[14] 李刚生,刘海峰,付金书.胸部改良小切口在食管癌根治术中的应用[J].中国医学工程,2012,20(8):115,117.
[15] 蒋占鑫.小切口胸段食管癌根治术与标准开胸手术治疗食管癌的临床疗效分析[J].中国肿瘤临床与康复,2013,20(10):1128-1129.
[2] 陈克能.食管癌手术入路的百年演变及临床意义[J].中华胃肠外科杂志,2012,15(9):886-888.
[3] HUANG LL,ONAITIS M.Minimally invasive and robotic Ivor-Lewis esophagectomy[J].J Thorac Dis,2014,6(Suppl 3):S314-S321.
[4] 马龙飞,相加庆,李鹤成,等.Ivor-Lewis手术治疗食管癌的近期临床疗效分析[J].中华医学杂志,2012,92(23):1618-1620.
[5] 杨弘,傅剑华.以手术为主的食管癌综合治疗的进展[J].世界华人消化杂志,2012,20(35):3471-3475.
[6] CHEN HX,WANG Z,YANG Z,et al.Prospective study of adjuvant radiotherapy on preventing lymph node metastasis after Ivor-lewis esophagectomy in esophageal cancer[J].Ann Surg Oncol,2013,20(8):2721-2726.
[7] 李伟学,曾涛,田宋君.食管胃结合部腺癌患者的手术方案研究[J].安徽医药,2015,19(10):1948-1950.
[8] LI B,XIANG JQ,ZHANG YW,et al.Comparison of ivor-lewis vs sweet esophagectomy for esophageal squamous cell carcinoma[J].JAMA Surg,2015,150(4):292-298.
[9] ALTORKI N.En-blocesophagectomy:the three-field dissection[J].Surg Clin North Am,2005,85(3):611-619,xi.
[10] LEWIS I.The surgical treatment of carcinoma of theoesophagus; with special reference to a new operation for growths of the middle third[J].Br J Surg,1946,34:18-31.
[11] 吴昌荣,张振斌.Ivor-Lewis食管癌切除术338例疗效分析[J].中华肿瘤杂志,1996,18(3):192-194.
[12] HULSCHERJB,VAN SANDICK JW,DE BOER AG,et al.Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus[J].N Engl J Med,2002,347(21):1662-1669.
[13] JONES DR.Minimally invasive ivor lewis esophagectomy[J].Operative Techniques in Thoracic and Cardiovascular Surgery,2013,18(4):254-263.
[14] 李刚生,刘海峰,付金书.胸部改良小切口在食管癌根治术中的应用[J].中国医学工程,2012,20(8):115,117.
[15] 蒋占鑫.小切口胸段食管癌根治术与标准开胸手术治疗食管癌的临床疗效分析[J].中国肿瘤临床与康复,2013,20(10):1128-1129.