摘要
目的对比胸中下段食管癌患者行微创和开放Ivor-Lewis食管切除术治疗的可行性、安全性和近中期治疗效果。方法回顾分析接受微创Ivor-Lewis及开放Ivor-Lewis食管切除术的294例患者临床及随访资料,其中微创组180例,开放组114例。结果微创组与开放组比较,术后吻合口瘘[10例(3.3%)比16例(4.4%),P=0.013]、喉返神经损伤[6例(3.3%)比13例(11.4%),P=0.006]及吻合口狭窄[(5例(2.8%)比11例(9.6%),P=0.011)]的发生率均较低。294例患者中,随访271例(92.2%),中位随访时间为34个月。全组患者的中位生存时间及1、2、3年生存率分别为44.5个月、95.9%、80.2%和61.9%。其中微创组患者的中位生存时间及1、2、3年生存率分别为45个月、96.1%、81.8%、62.5%。开放组患者的中位生存时间为41个月,1、2、3年生存率分别为95.6%、77.8%、61.2%。MIILE组患者生存率和OILE组患者总生存率差异无统计学意义(P=0.976)。在随访过程中发现,294例患者局部复发或远处转移150(51.0%)例,其中死亡102例。微创组180例患者中局部复发或远处转移79(43.8%)例,其中死亡59例。开放组114例患者中局部复发或远处转移52(45.6%)例,其中死亡43例。两组患者比较,差异无统计学意义(P=0.539)。T分期、有无淋巴结转移、肿瘤分化程度为食管癌患者的独立预后因素(均P<0.05),预后与患者的年龄、性别、手术方式、肿瘤位置无明显相关(P>0.05)。结论微创Ivor-Lewis食管切除术与开放Ivor-Lewis食管切除术治疗胸中下段食管癌中期总生存率效果相似,但微创Ivor-Lewis食管切除术在吻合口瘘、喉返神经损伤及吻合口狭窄方面优于开放术式。
Objective To compare the feasibility,safety and middle-term outcomes of minimally invasive IvorLewis esophagectomy and and open Ivor-Lewis esophagectomy. Methods A total of 294 esophageal cancer were collected,including 180 patients of minimally invasive Ivor-Lewis esophagectomy and 114 open Ivor-Lewis esophagectomy. Results The incidence rate of anastomotic leakage[10 patients( 3. 3%) VS. 16 patients( 4. 4%),P = 0. 013],recurrent laryngeal nerve injury[6 patients( 3. 3%) VS. 13 patients( 11. 4%),P = 0. 006],and anastomotic stricture[( 5 patients( 2. 8%) VS. 11 patients( 9. 6%),P = 0. 011) ] in MIILE group was lower than those in OILE group. Among all the 294 patients,271 cases were followed up and the follow-up rate was 92. 2%. The median follow-up time was 34 months and median survival time was 44. 5 months. The overall survival rate of 1,2 and 3 years was 95. 9%,80. 2% and 61. 9% respectively. In MIILE group,the median survival time of MIILE was 45 months,the overall survival rate of 1,2 and 3 years was 96. 1%,81. 8% and 62. 5% respectively. In OIILE group,the median survival time was 41 months,the overall survival rate of 1,2 and 3 years was 95. 6%,77. 8% and 61. 2% respectively. There was no significant difference in overall survival rate of MILLE and OILE. One hundred and fifty( 51. 0%) patients had local recurrence and 102 patients were dead during the follow-up period. At the same time,the patients of local recurrence with MIILE were 79( 43. 8%) and 59 patients died. The patients of local recurrence in OILE was 52( 45. 6%) and 43 patients were dead. T stage,metastasis of lymph node,and tumor differentiation are independent prognostic factors for the overallsurvival( P <0. 05) and has no significant connection with age,sex,modus operandi and location of the tumor( P > 0. 05). Conclusions There is no significant difference of middle-term overall survival rate between minimally invasive and open IvorLewis esophagectomy. The anastomotic leakage,injury of recurrent laryngeal nerve,and anastomotic stenosis of minimally invasive Ivor-Lewis surgery are low.
出处
《中国临床保健杂志》
CAS
2017年第6期689-692,共4页
Chinese Journal of Clinical Healthcare
基金
安徽省科技攻关项目(1501041143)
关键词
食管肿瘤
食管切除术
外科手术
微创性
预后
Esophageal neoplasms
Esophagectomy
Surgical procedures
minimally invasive
Prognosis
