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摘要:
目的 评价完全胸腹腔镜联合Mckeown食管癌根治术的安全性、可行性和近期疗效。 方法 回顾性分析安徽医科大学附属安徽省立医院胸外科2013年10月至2014年4月接受微创Mckeown食管癌根治术的88例患者，其中46例患者施行完全胸腹腔镜联合Mckeown食管癌根治术（total endoscopy Mckeown esophagectomy，TEME），42例施行胸腔镜联合上腹、左颈切口Mckeown食管癌根治术（thoracoscope combined with laparotomy Mckeown esophagectomy，TLME）。比较分析两组患者的临床病理资料、围手术期相关资料及术后并发症发生率。 结果 两组患者在性别、年龄、肿瘤部位、术前ASA分级、术前TNM分期及术前合并疾病方面无明显差异。TEME组的腹部出血量和术后疼痛评级均较TLME组患者低（P < 0.05），住院总费用稍高于TLME组（P < 0.05）。两组患者在肿瘤的组织学类型、术后TNM分期、腹部手术时间、术后重症监护时间、胸引管留置时间、术后住院时间、淋巴结清扫的枚数及站数、淋巴结转移率方面两组无明显差异（P >0.05）。TEME组术后总并发症和呼吸系统并发症发生率低于TLME组（P < 0.05）。TEME组的微小并发症中肺炎、心律失常、切口感染发生率较TLME组低（P < 0.05），重大并发症中肺炎的发生率低于TLME组（P < 0.05）。 结论 TEME是安全可行的，近期效果满意。 Abstract:Objective To investigate the feasibility, safety, and short-term effect of minimally invasive McKeown esophagectomy. Methods We conducted a retrospective evaluation of 88 patients with esophageal carcinoma who received minimally invasive esophagectomy in our center from October 2013 to April 2014. Among the 88 patients, 46 patients underwent total endoscopy McKeown esophagectomy (TEME) and 42 patients underwent thoracoscope combined with laparotomy Mckeown esophagectomy (TLME). The clinicopathologic factors, operational factors, and postoperative complications of the two approaches were compared. Results The two groups were similar in terms of age, sex, American Society of Anesthesiologists grade, tumor location, preoperative staging, and comorbidity. The TEME approach was associated with a significant decrease in abdominal blood loss and postoperative pain relative to the TEME approach (P < 0.05). No significant differences were found between the two groups in terms of histologic type, postoperation TNM staging, abdominal operation time, intensive care unit stay, chest tube duration, postoperative stay, the number of total lymph nodes dissected or the stations of the total lymph nodes dissected, and lymph metastasis rate (P >0.05). The total morbidity and total respiratory complications in the TEME group were lower than those in the TLME group (P < 0.05). Incidences of pneumonia, arrhythmia, wound infection of minor complications, and pneumonia of major complications were relatively low in the TEME approach. Conclusion Our TEME technique can be safely and effectively performed for cervical anastomosis during esophageal surgeries to achieve favorable early outcomes. -
Key words:
- esophageal cancer /
- thoracoscopes /
- laparoscopes /
- cervical anastomosis
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表 1 两组患者的临床相关资料 %
Table 1. Clinical characteristics of the patients Characteristics
表 2 两组患者的围手术期相关资料
Table 2. Surgical and pathologic data
表 3 两组患者的术后并发症情况 %
Table 3. Postoperative complications
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[1] 陈保富, 朱成楚, 王春国, 等.胸腔镜腹腔镜联合手术与开放手术治疗食管癌的同期临床对照研究[J].中华外科杂志, 2010, 48(16):1206-1209. doi: 10.3760/cma.j.issn.0529-5815.2010.16.002Chen BF, Zhu CC, Wang CG, et al. Clinical comparative study of minimally invasive esophagectomy versus open esophagectomy for esophageal carcinoma[J]. Chin J Surg, 2010, 48(16):1206-1209. doi: 10.3760/cma.j.issn.0529-5815.2010.16.002 [2] Schoppmann SF, Prager G, Langer F, et al. Fifty-five minimally invasive Esophagectomies: a single centre experience[J]. Anticancer Res, 2009, 29(7):2719-2725. http://cn.bing.com/academic/profile?id=110d301f6212df8319240e5fcc2fbd17&encoded=0&v=paper_preview&mkt=zh-cn [3] 刘宝兴, 李印, 秦建军, 等.微创McKeown术与左胸径路食管切除术治疗胸中下段食管癌的比较[J].中华胸心血管外科杂志, 2013, 29(6):342-345. doi: 10.3760/cma.j.issn.1001-4497.2013.06.007Liu VX, Li Y, Qin JJ, et al. Comparison of modified Mckeown minimally invasive approach and the left chest-neck incision approach esophagectomy to treat cancer of mid-to-distal thoracic esophagus[J]. Chin J Thorac Cardiovasc Surg, 2013, 29(6):342-345. doi: 10.3760/cma.j.issn.1001-4497.2013.06.007 [4] Watanabe M, Baba Y, Nagai Y, et al. Minimally invasive esophagectomy for esophageal cancer: an updated review[J]. Surg Today, 2013, 43(3):237-244. doi: 10.1007/s00595-012-0300-z [5] Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM[J]. Ann Surg Oncol, 2010, 17(6):1471-1474. doi: 10.1245/s10434-010-0985-4 [6] Xie MR, Liu CQ, Guo MF, et al. Short-term outcomes of minimally invasive ivor-lewis esophagectomy for esophageal cancer[J].Ann Thorac Surg, 2014, 97(5):1721-1727. doi: 10.1016/j.athoracsur.2014.01.054 [7] Fernando HC, Christie NA, Luketich JD.Thoracoscopic and laparoscopic esophagectomy[J]. Semin Thorac Cardiovasc Surg, 2000, 12(3): 195-200. doi: 10.1053/stcs.2000.9599 [8] Pham TH, Perry KA, Dolan JP, et al. Comparison of perioperative outcomes after combined thoracoscopic-laparoscopic esophagectomy and open Ivor-Lewis esophagectomy[J]. Am J Surg, 2010, 195(5): 594-598. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=bce705fcd9f4ed16461e2f409f6ea64a [9] Kinjo Y, Kurita N, Nakamura F, et al. Effectiveness of combined thoracoscopic-laparoscopic esophagectomy: comparison of postoperative complications and midterm oncological outcomes in patients with esophageal cancer[J]. Surg Endosc, 2012, 26(2):381-390. http://cn.bing.com/academic/profile?id=7945e123a7e5a510d414d48aecf87c44&encoded=0&v=paper_preview&mkt=zh-cn [10] Hamouda AH, Forshaw MJ, Tsigritis K, et al. Perioperative outcomes after transition from conventional to minimally invasive Ivor-Lewis esophagectomy in a specialized center[J]. Surg Endosc, 2010, 24(4):865-869. doi: 10.1007/s00464-009-0679-9 [11] 陈安国, 张仁泉, 夏万里, 等.胸腹腔镜联合食管癌根治术右胸内吻合38例[J].中华胸心血管外科杂志, 2013, 29(9):525-527. doi: 10.3760/cma.j.issn.1001-4497.2013.09.004Chen AG, Zhang RQ, Xia WL, et al. Combined laparoscopic and thoracoscopic esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity: analysis of 38 cases[J]. Chin J Thorac Cardiovasc Surg, 2013, 29(9):525-527. doi: 10.3760/cma.j.issn.1001-4497.2013.09.004 [12] Khan O, Nizar S, Vasilikostas G, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial[J]. J Thorac Dis, 2012, 4(5): 465-466. http://cn.bing.com/academic/profile?id=a5fbec81459cf380cf0d6fbf6467249c&encoded=0&v=paper_preview&mkt=zh-cn [13] 蒋晓侠, 林治, 谭黎杰, 等.腹腔镜在微创三切口食管癌根治手术中的应用[J].中国微创外科杂志, 2011, 11(9):825-828. doi: 10.3969/j.issn.1009-6604.2011.09.019Jiang XX, Lin Z, Tan LJ, et al. Laparoscopy in three-incision minimally invasive esophagectomy[J]. Chin J Min Inv Surg, 2011, 11(9): 825-828. doi: 10.3969/j.issn.1009-6604.2011.09.019 [14] 方卫民, 阮伟忠, 朱坤寿.腹腔镜在IvorLewis食管癌根治术中的应用[J].中国癌症杂志, 2012, 22(7):528-532. doi: 10.3969/j.issn.1007-3969.2012.07.009Fang WM, Ruan WZ, Zhu KS. The application of laparoscopic-assisted modified Ivor-Lewis on esophageal cancer resection[J]. China oncology, 2012, 22(7):528-532. doi: 10.3969/j.issn.1007-3969.2012.07.009 [15] 解明然, 林鹏, 张旭, 等.胸中段食管鳞癌淋巴结转移度及合理清扫范围的临床研究[J].中国肿瘤临床杂志, 2009, 36 (23):1325-1328. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgzllc200923002Xie MR, Lin P, Zhang X, et al. Clinical study of lymph node metastasis and optimal lymphadenectomy for middle third thoracic esophageal squamous cell carcinoma[J]. Chin J Oncol, 2009, 36(23): 1325-1328. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgzllc200923002 [16] Smithers BM GDC, Martin L et al.Comparison of the outcomes between open and minimally invasive esophagectomy[J]. Ann Surg, 2008, 247(2):397-397. doi: 10.1097/SLA.0b013e31816402ef [17] 茅腾, 方文涛, 谷志涛, 等.腔镜微创与开放食管癌根治术围手术期并发症和淋巴结清扫的比较研究[J].中华胃肠外科杂志, 2012, 15(9):922-925. doi: 10.3760/cma.j.issn.1671-0274.2012.09.014Mao T, Fang WT, Gu ZT, et al. Comparative study of perioperative complications and lymphadenectomy between minimally invasive esophagectomy and open procedure[J]. Chin J Gastrointest Surg, 2012, 15(9):922-925. doi: 10.3760/cma.j.issn.1671-0274.2012.09.014 [18] 孙翔翔, 徐美青, 郭明发, 等.胸腔镜辅助食管癌根治并胸内吻合术临床分析[J].中华外科杂志, 2013, 51(4):354-357. doi: 10.3760/cma.j.issn.0529-5815.2013.04.017Sun XX, Xu MQ, Guo MF, et al. Video-assisted thoracoscopic esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in thoracic cavity: analysis of 60 cases[J]. Chin J Surg, 2013, 51(4):354-357. doi: 10.3760/cma.j.issn.0529-5815.2013.04.017 [19] Sihag S, Wright CD, Wain JC, et al. Comparison of perioperative outcomes following open versus minimally invasive Ivor Lewis oesophagectomy at a single, high-volume centre[J]. Eur J Cardiothorac Surg, 2012, 42(3):430-437. doi: 10.1093/ejcts/ezs031 -
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