单中心单医疗组微创 McKeown 食管癌切除术的临床分析。
Clinical analysis of minimally invasive McKeown esophagectomy in a single center by a single medical group.
机构信息
Department of Thoracic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
出版信息
J Zhejiang Univ Sci B. 2018;19(9):718-725. doi: 10.1631/jzus.B1800329.
OBJECTIVE
McKeown esophagectomy followed by cervical and abdominal procedures has been commonly used for invasive esophageal carcinoma. This minimally-invasive operative procedure in the lateral prone position has been considered to be the most appropriate method. We describe our experiences in minimally invasive McKeown esophagectomy (MIME) for esophageal cancer.
METHODS
Between March 2016 and February 2018, a total of 82 patients underwent MIME by a single group in our department (a single center). All procedure, operation, oncology, and complication data were reviewed.
RESULTS
All MIME procedures were completed successfully, with no conversions to open surgery. The median operative time was 260 min, and median blood loss was 100 ml. The average number of total harvested lymph nodes was 20.1 in the chest and 13.5 in the abdomen. There were no deaths within 30 postoperative days. Twenty cases (24.4%) developed postoperative complications, including anastomotic leak in 4 (4.9%), single lateral recurrent nerve palsy in 4 (4.9%), bilateral recurrent nerve palsy in 1 (1.2%), pulmonary problems in 3 (3.7%), chyle leak in 1 (1.2%), and other complications in 7 (including pleural effusions in 4, incomplete ileus in 2, and neck incision infection in 1; 8.54%). Average postoperative hospitalization time was 12 d. Blood loss, operation time, morbidity rate, and the number of harvested lymph nodes were analyzed by evaluating learning curves in different periods. Significant differences were found in operative time (P=0.006), postoperative hospitalization days (P=0.015), total harvested lymph nodes (P=0.003), harvested thoracic lymph nodes (P=0.006), and harvested abdominal lymph nodes (P=0.022) among different periods.
CONCLUSIONS
Surgical outcomes following MIME for esophageal cancer are safe and acceptable. The MIME procedure for stages I and II could be performed proficiently and reached an experience plateau after approximately 25 cases.
目的
麦氏食管癌切除术加颈、腹部手术已广泛应用于侵袭性食管癌。这种侧卧位的微创手术被认为是最合适的方法。我们介绍了我们在食管癌微创麦氏手术（MIME）方面的经验。
方法
2016 年 3 月至 2018 年 2 月，我科（单中心）共对 82 例患者进行了 MIME。回顾所有手术、操作、肿瘤学和并发症数据。
结果
所有 MIME 手术均顺利完成，无中转开放手术。中位手术时间为 260 分钟，中位出血量为 100 毫升。胸部总采集淋巴结数平均为 20.1 个，腹部为 13.5 个。术后 30 天内无死亡。20 例（24.4%）发生术后并发症，包括吻合口漏 4 例（4.9%）、单侧喉返神经麻痹 4 例（4.9%）、双侧喉返神经麻痹 1 例（1.2%）、肺部问题 3 例（3.7%）、乳糜漏 1 例（1.2%）和其他并发症 7 例（包括胸腔积液 4 例、不完全性肠梗阻 2 例、颈部切口感染 1 例；8.54%）。平均术后住院时间为 12 天。通过评估不同时期的学习曲线，分析失血量、手术时间、发病率和采集的淋巴结数量。手术时间（P=0.006）、术后住院天数（P=0.015）、总采集淋巴结数（P=0.003）、采集的胸内淋巴结数（P=0.006）和采集的腹部淋巴结数（P=0.022）在不同时期差异有统计学意义。
结论
MIME 治疗食管癌的手术效果安全、可接受。对于Ⅰ期和Ⅱ期的 MIME 手术，大约完成 25 例后可熟练进行，达到经验平台期。
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