摘要
目的:比较经典Ivor-Lewis手术与改良IvorLewis手术治疗对中下段食管癌患者肺功能和术后肺部并发症的影响,为中下段食管癌术式的选择提供依据.方法:收集2010-01/2013-12于河南省南阳市中心医院接受经典Ivor-Lewis手术的67例(经典组)或改良Ivor-Lewis手术的66例(改良组)中下段食管癌患者的临床资料.分析两组的手术时间、淋巴结清扫数量及术后病理情况,检测两组术前1 wk、1 d及术后2 wk的肺功能指标[呼吸频率、肺活量(vital capacity,VC)、一秒用力呼气容积(forced expiratory volume in one second,FEV1)及最大通气量(maximal voluntary ventilation,MVV)],同时记录两组的术后并发症.结果:经典组和改良组的手术时间为204.7 min±42.1 min和改良组192.5 min±38.7 min,差异无统计学意义(P>0.05);两组清扫淋巴总数的差异无统计学意义,但经典组上纵隔淋巴结清扫数目多于改良组(8.02±1.65 vs 3.73±0.89,P<0.05),且术后淋巴结转移率及N1的比例高于改良组(23.88%vs 12.12%,P<0.05);两组术后的呼吸频率高于术前,且VC、FEV1及M V V水平低于术前,且经典组术后的呼吸频率、VC及FEV1均优于改良组,差异均有统计学意义(P<0.05).两组术后乳糜胸、喉返神经损伤和吻合口瘘发生率的差异无统计学意义(P>0.05),但经典组的术后肺部并发症的差异低于改良组(2.99%vs 12.12%,P<0.05).结论:经典Ivor-Lewis手术对于中下段食管癌的上纵隔淋巴结清扫效果较好,且在降低肺损伤及术后并发症上有优势,更符合食管癌手术治疗原则.
AIM： To compare the influence of classic vs modified Ivor-Lewis procedure on lung function and postoperative complications in patients with middle-lower thoracic esophageal carcinoma.
METHODS： Clinical data for 67 patients with middle-lower thoracic esophageal cancer undergoing classic Ivor-Lewis esophagectomy and 66 patients with middle-lower thoracic esophageal cancer undergoing modified Ivor-Lewis esophagectomy from January 2010 to December 2013 were collected. The operative time, number of resected lymph nodes and postoperative pathology were compared between the two groups. The lung function, including respiratory rate, vital capacity （VC）, forced expiratory volume in one second （FEV1） and maximal ventilatory volume （MVV）, was investigated 1 wk and 1 d preoperatively and 2 wk postoperatively. Postoperative complications were recorded.
RESULTS： The operative time did not differ significantly between the classic group and modified group （204.7 min ± 42.1 min vs 192.5 min ± 38.7 min, P 〉 0.05）. No statistically significant difference was found in the total number of resected lymph nodes between the two groups, although a higher number of mediastinal lymph nodes were dissected in the classic group （8.02 ± 1.65 vs 3.73 ± 0.89, P 〈 0.05）. The postoperative lymph node metastasis rate was significantly higher in the classic group （23.88% vs 12.12%, P 〈 0.05）. The respiratory rate, VC and FEV1 of the classic group were superior to those of the modified group （P 〈 0.05）. Similar incidence rates of postoperative chylothorax, recurrent laryngeal nerve injury and anastomotic leakage were observed between groups, but there was a significantly lower rate of postoperative pulmonary complications in the classic group than in the modified group （2.99% vs 12.12%, P 〈 0.05）.
CONCLUSION： Classic Ivor-Lewis procedure has more satisfying clinical effects in terms of mediastinal lymph node dissection, decreased lung injury and postoperative complications.
出处
《世界华人消化杂志》
CAS
北大核心
2014年第36期5675-5679,共5页
World Chinese Journal of Digestology
