Xie Mingran, Liu Changqing, Sun Xiaohui, Guo Mingfa, Wu Hanran, Xu Meiqing
Department of Thoracic Surgery, Anhui Provincial Hospital Affiliated with Anhui Medical University, Hefei 230000, China.
Department of Thoracic Surgery, Anhui Provincial Hospital Affiliated with Anhui Medical University, Hefei 230000, China; Email:
Zhonghua Wai Ke Za Zhi. 2015 Jul 1;53(7):508-12.
To describe the technique for minimally invasive Ivor Lewis esophagectomy (MIILE) and to evaluate the feasibility, safety and the short-term clinical outcomes of this approach.
The clinical data of 309 patients with locally advanced esophageal cancer who received Ivor Lewis esophagectomy between October 2011 and October 2013 was analyzed retrospectively. Of those 309 patients, 112 underwent MIILE and 197 underwent open Ivor Lewis esophagectomy (OILE). The clinicopathologic factors, operational factors and postoperative complications of the two groups were compared by t test and χ² test.
The two groups were similar in terms of gender, age, American Society of Anesthesiologists grade, tumor location, preoperative staging and incidence of comorbidities (P>0.05). The MIILE approach was associated with a significant decrease in surgical blood loss ((186 ± 45) ml vs. (198 ± 47) ml, t=2.086, P=0.039), chest tube duration ((9 ± 5) days vs. (11 ± 6) days, t=2.760, P=0.005) and postoperative stay ((12 ± 6) days vs. (14 ± 7) days, t=2.932, P=0.005) relative to the OILE approach. There was no significant difference between the two groups in the number of total lymph nodes dissected or the stations of the total lymph nodes dissected (P>0.05). The postoperative in-hospital mortality and total morbidity did not differ between the two groups (P>0.05). The MIILE approach was associated with significantly fewer wound infections than the OILE approach (0 vs.4.6%, P=0.029).
Our MIILE technique for locally advanced esophageal cancer can be safely and effectively performed for intrathoracic anastomosis during esophageal surgeries with favorable early outcomes.
描述微创Ivor Lewis食管癌切除术（MIILE）技术，并评估该方法的可行性、安全性及短期临床疗效。
回顾性分析2011年10月至2013年10月期间接受Ivor Lewis食管癌切除术的309例局部晚期食管癌患者的临床资料。其中112例行MIILE，197例行开放Ivor Lewis食管癌切除术（OILE）。采用t检验和χ²检验比较两组的临床病理因素、手术因素及术后并发症。
两组在性别、年龄、美国麻醉医师协会分级、肿瘤位置、术前分期及合并症发生率方面相似（P>0.05）。与OILE方法相比，MIILE方法的手术失血量显著减少（（186±45）ml对（198±47）ml，t=2.086，P=0.039），胸管留置时间显著缩短（（9±5）天对（11±6）天，t=2.760，P=0.005），术后住院时间显著缩短（（12±6）天对（14±7）天，t=2.932，P=0.005）。两组清扫的总淋巴结数目及清扫淋巴结的站别无显著差异（P>0.05）。两组术后院内死亡率及总发病率无差异（P>0.05）。MIILE方法的伤口感染发生率显著低于OILE方法（0对4.6%，P=0.029）。
我们的局部晚期食管癌MIILE技术可在食管手术中安全有效地用于胸内吻合，早期效果良好。
