Department of Clinical Medicine, Jining Medical University, Jining, Shandong Province, China.
Thoracic Surgery Department, Jining No. 1 People's Hospital, Jining, Shandong Province, China.
J Int Med Res. 2021 May;49(5):3000605211010081. doi: 10.1177/03000605211010081.
Standard minimally invasive McKeown three-field esophagectomy (SMIE) results in high perioperative risk and poor postoperative quality of life owing to considerable surgical damage and numerous postoperative complications. We created a modified procedure, functional minimally invasive esophagectomy (FMIE), which preserves the azygos arch, bronchial artery, pulmonary branch of the vagus nerve, and the mediastinal pleura. Our aim was to evaluate the efficacy and safety of FMIE and to determine whether it has limited invasiveness.
Between 2018 and 2020, FMIE was performed for 48 patients who were compared with 76 SMIE cases; 44 paired cases were matched using propensity score matching.
Operation time, extubation time, and postoperative hospital stay were significantly lower in the FMIE group. FMIE was also associated with fewer pulmonary infections. Postoperative drainage volume on postoperative day (POD) 1 and POD 2, and white blood cell counts on POD 2 and POD 4 were also significantly lower in the FMIE group. There was no statistically significant difference in the number of dissected lymph nodes, short-term recurrence, metastasis rates, or survival rate between the two groups.
FMIE is a less invasive procedure and may be a suitable alternative for lower and early middle esophageal carcinoma.
标准的微创 McKeown 三野食管切除术（SMIE）由于手术损伤大、术后并发症多，导致围手术期风险高、术后生活质量差。我们创建了一种改良术式，即功能性微创食管切除术（FMIE），该术式保留奇静脉弓、支气管动脉、迷走神经肺支和纵隔胸膜。我们旨在评估 FMIE 的疗效和安全性，并确定其是否具有微创性。
2018 年至 2020 年，我们对 48 例患者进行了 FMIE 治疗，并与 76 例 SMIE 病例进行了比较；通过倾向评分匹配，我们对 44 对匹配病例进行了比较。
FMIE 组的手术时间、拔管时间和术后住院时间明显更短。FMIE 组肺部感染也更少。FMIE 组术后第 1 天和第 2 天的术后引流量以及术后第 2 天和第 4 天的白细胞计数也明显更低。两组间淋巴结清扫数量、短期复发率、转移率和生存率无统计学差异。
FMIE 是一种创伤较小的手术，可能是下段和早期中段食管癌的一种合适选择。
