摘要
目的探讨全腔镜Ivor-Lewis术联合空肠造瘘术在临床上的应用及疗效。方法回顾性分析80例食管癌患者的临床资料。根据手术方式,分为全腔镜组(n=30)和小切口组(n=50)。全腔镜组采用全腔镜Ivor-Lewis术联合空肠造瘘术治疗方案;小切口组采用腹部小切口胸腹腔镜联合Ivor-Lewis术治疗方案。分别对比两组患者手术时间、术中失血量、置空肠营养管耗时、术后胸管引流量及胃肠减压管引流量、术后肺部感染、吻合口瘘等围手术期并发症发生例数、术后住院日数、术后疼痛评分、切口美容满意度等数据。结果全腔镜组手术耗时(242.00±18.69)min、术中失血量(153.83±33.37)m L、置空肠营养管耗时(14.20±3.47)min、住院日数(9.57±1.85)d、术后疼痛评分[24 h为(2.70±0.70)分,48 h为(2.10±0.71)分,72h为(1.73±0.83)分]、手术切口美容满意度均优于常规组[VAS得分为(81.53±9.35)分,Likert Scales得分为(3.93±0.785)分],均差异有统计学意义(P<0.05);两组患者在淋巴结清扫数目,术后胸管引流量及胃肠减压管引流量,二次开胸腹止血、吻合口瘘、胃壁坏死及胃残端瘘、乳糜胸、肺部感染及肺不张等并发症发生率方面,差异无统计学意义(P>0.05)。结论运用全腔镜食管癌根治术联合空肠造瘘术,保证了腹壁的完整性,手术切口瘢痕微小,术中出血减少,术后疼痛降低,有效缩短手术时间及治疗疗程,使得患者快速康复出院。
Objectives To explore the clinical applications and value of Ivor-Lewis operation in totally endoscopic esophagectomy combined with jejunostomy. Methods The clinical data of 80 patients with esophageal cancer were retrospectively analyzed. According to the types of surgical methods,they were divided into research group（ group A,n = 30） and control group（ group B,n = 50）. Group A was adopted Ivor-Lewis operation in totally endoscopic esophagectomy combined with jejunostomy. Group B was performed laparoscopy with abdominal incision combined with thoracoscope esophagectomy. In the aspects of operation time,intraoperative blood loss,time-consuming on placing jejunum nutrition tube,the postoperative hospitalization time,postoperative pain scores,postoperative chest tube and gastrointestinal decompression pipe volume of drainage,perioperative complications such as pulmonary infection and anastomotic fistula,the scores of satisfaction with surgical incisionin cosmesis of the two groups were compared. Results The operation time（ 242. 00 ± 18. 69） min was shorter and intraoperative bleeding loss（ 153. 83 ± 33. 37） m L was remarkably reduced.,The postoperative hospitalization time（ 9. 57 ± 1. 85） d was obviously shorten,postoperative pain scores（ 24 h： 2. 70 ± 0. 70,48 h： 2. 10 ± 0. 71,72 h：1. 73 ± 0. 83）,time-consuming on placing jejunum nutrition tube（ 14. 20 ± 3. 47） min were reduced,the scores of satisfaction with surgical incisionin cosmesis（ VAS： 81. 53 ± 9. 35,Likert Scales： 3. 93 ± 0. 785） was higher in group A. there was were a significantly difference（ P〈0. 05）. In the aspects of number of lymph node dissection,the incidence of secondary open chest or abdomen in order to stanch bleeding,and complications such as anastomotic fistula,pulmonary infection and chylothorax between the two groups,they were not significantly different（ P〈0. 05）. Conclusions The application of Ivor-Lewis operation in totally endoscopic esophagectomy with jejunostomy could keep
作者
肖洋
刘建
陈剑
XIAO Yang;LIU Jian;CHEN Jian(Department of Cardiothoracic Surgery,Anqing Municipal Hospital,Anqing,Anhui 246003,China)
出处
《安徽医药》
CAS
2018年第7期1321-1325,共5页
Anhui Medical and Pharmaceutical Journal
