摘要
目的对比两种微创食管切除术(minimally invasive esophagectomy,MIE)治疗T3期中下段食管癌的疗效。方法回顾性分析食管癌数据库中2010年1月-2017年6月在国内十家医院接受MIE治疗且术后病理证实为T3期的食管癌患者资料。比较接受微创Ivor-Lewis术式(MIE-IL)与McKeown术式(MIE-MK)患者的围术期指标、术后并发症、病理指标及术后生存率。结果接受MIE-IL和MIE-MK的患者分别为338例和622例,两组患者中均以男性居多(87.0% vs 77.5%,P<0.001)。肿瘤位置主要位于胸中段(78.7% vs 84.4%,P=0.021),病理类型以鳞癌为主(97.3% vs 98.2%,P=0.659)。MIE-IL和MIE-MK组手术时间[(341.2±97.2) min vs (317.8±93.0) min,P<0.001]、术中出血量[(489.9±511.24) ml vs (364.3±428.9) ml,P<0.001]、淋巴结清扫数量[(14.9±9.23) vs (22.3±11.9),P<0.001]差异有统计学意义。两组术后住院时间[(18.5±11.6) d vs(18.8±12.8) d]差异无统计学意义,术后并发症MIE-IL组明显少于MIE-MK组,尤其在肺部炎症(9.5% vs 20.9%,P<0.001)、胸腔积液(12.7% vs 18.8%,P=0.016)方面,但是在吻合口漏(3.8% vs 6.1%)及吻合口狭窄(0.3% vs 0.3%)方面差异无统计学意义。MIE-IL组总体生存率要低于MIE-MK组(38.6% vs 61.4%;HR:1.49,95% CI:1.19 ~ 1.87;P<0.001)。结论本研究初步显示,两种术式治疗T3期食管癌均安全可行,MIE-IL组术后并发症发生率低于MIE-MK组,但MIE-MK组有更好的远期效果。
Objective To compare the outcomes of minimally invasive Ivor-Lewis esophagectomy and McKeown esophagectomy in the treatment of patients with stage T3 tumors located at middle or lower thoracic esophagus.Methods Clinical data about patients with esophageal cancer selected from esophageal cancer database who had undergone minimally invasive esophagectomy (MIE) in the department of thoracic surgery of ten hospitals in China from January 2010 to June 2017 were collected and analyzed.Baseline characteristics including perioperative indicators,postoperative complications,pathological indexes and postoperative survival outcomes were compared between the minimally invasive Ivor-Lewis esophagectomy (MIE-IL) group and the minimally invasive McKeown esophagectomy (MIE-MK) group.Results Totally 338 patients underwent MIE-IL and 622 patients underwent MIE-MK.Most of the patients in the two groups were male (87.0% vs 77.5%,P<0.001),most of the tumors were located at the middle thoracic esophagus (78.7% vs 84.4%,P=0.021),and the main pathological type was squamous cell carcinoma (97.3% vs 98.2%,P=0.659).There were significant differences between the MIE-IL group and the MIE-MK group in terms of operating time ([341.2±97.2] min vs [317.8±93.0] min,P<0.001),intra-operative blood loss ([489.9±511.24] ml vs [364.3±428.9] ml,P<0.001) and number of resected lymph nodes (14.9±9.23 vs 22.3±11.9,P<0.001).The postoperative hospital stay of the MIE-IL group was a bit shorter than that of MIE-MK group,but the difference was not significant ([18.5±11.6] d vs [18.8±12.8] d,P>0.05),The incidences of pneumonia and hydrothorax were significantly lower in the MIE-IL group than those in the MIE-MK group (9.5% vs 20.9%,P<0.001;12.7% vs 18.8%,P=0.016).There was no significant difference in anastomotic leakage (3.8% vs 6.1%) and anastomotic stenosis (0.3% vs 0.3%).The MIE-MK group had significantly higher overall survival rate compared to the MIE-IL group (61.4% vs 38.6%;HR 1.49;95% CI:1.19,1.87;P<0.001).Conclusion Our study shows that both MIE-IL and MIE-MK are safe and feasible in treatment of stage T3 esophageal cancer;however,the incidence of postoperative complications is lower in the MIE-IL group,while MIE-MK may represent preferred surgical technique for improved long-term survival.
作者
张彤
马永富
李云婧
冯长江
潘俊伊
刘阳
ZHANG Tong;MA Yongfu;LI Yunjing;FENG Changjiang;PAN Junyi;LIU Yang(Chinese PLA Medical School,Beijing 100853,China)
出处
《解放军医学院学报》
CAS
2020年第1期60-63,共4页
Academic Journal of Chinese PLA Medical School
作者简介
张彤,男,在读硕士,医师。研究方向:胸部肿瘤的微创治疗。Email:zhangtongthoracic@163.com;通信作者:刘阳,男,博士,主任医师,教授。Email:sunny301x@sina.com
