Zhou J M, Jing S J, Lu Q T, Chu X, Xue T
Department of Cardiothoracic Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing 210009, China.
Zhonghua Zhong Liu Za Zhi. 2022 Jun 23;44(6):577-580. doi: 10.3760/cma.j.cn112152-20200704-00626.
To compare and analyze the perioperative clinical effects of minimally invasive Ivor-Lewis esophagectomy (MIE-Ivor-Lewis) and minimally invasive McKeown esophagectomy (MIE-McKeown). A total of 147 patients who underwent endoscopic esophageal cancer surgery from April 2018 to August 2019 were selected, including 85 patients undergoing MIE-McKeown surgery and 62 patients undergoing MIE-Ivor-Lewis surgery. The measurement data were expressed as (±), the comparison of normally distributed measurement data was performed by independent sample -test, and the comparison of count data was performed by (2) test or Fisher's exact test. The operation time of McKeown (M) group and Ivor-Lewis (IL) group were (219.2±72.4) minutes and (225.8±65.3) minutes. The mediastinal lymph node dissection number of M and IL groups were 13.3±4.8 and 11.6±6.5, respectively. The number of left recurrent laryngeal nerve lymph node dissection were 3.5±1.2 and 3.1±1.4, respectively. The intraoperative blood loss were (178.3±41.3) ml and (163.2±64.1) ml, respectively. The number of patients reoperated for postoperative bleeding were 1 and 0, respectively. The number of patients with postoperative gastric bleeding were 0 and 1, respectively. The postoperative chest tube retention time were (2.8±1.3) days and (3.1±1.2) days, respectively. The number of patients with anastomotic leakage were 7 and 1, respectively. The number of patients with lung infection were 13 and 5, respectively, and with chylothorax were 2 and 1, respectively, without statistically significant difference (>0.05). The number of patients with hoarseness were 11 and 3, respectively. The total incidence of complication were 41.2% (35/85) and 17.7% (11/62), and the postoperative hospital stay were (14.7±6.5) days and (12.3±2.3) days, with statistical difference (<0.05). MIE-Ivor-Lewis and MIE-McKeown are safe and effective in treating esophageal cancer, but the complication of MIE-Ivor-Lewis is less than that of MIE-Mckeown, and the perioperative clinical effect of MIE-Ivor-Lewis is better than that of MIE-McKeown.
比较分析微创Ivor-Lewis食管癌切除术（MIE-Ivor-Lewis）与微创McKeown食管癌切除术（MIE-McKeown）的围手术期临床效果。选取2018年4月至2019年8月期间行内镜食管癌手术的147例患者，其中85例行MIE-McKeown手术，62例行MIE-Ivor-Lewis手术。计量资料以（±）表示，正态分布计量资料比较采用独立样本t检验，计数资料比较采用χ²检验或Fisher确切概率法。McKeown（M）组和Ivor-Lewis（IL）组手术时间分别为（219.2±72.4）分钟和（225.8±65.3）分钟。M组和IL组纵隔淋巴结清扫数分别为13.3±4.8枚和11.6±6.5枚。左喉返神经旁淋巴结清扫数分别为3.5±1.2枚和3.1±1.4枚。术中出血量分别为（178.3±41.3）ml和（163.2±64.1）ml。术后因出血再次手术的患者分别为1例和0例。术后胃出血患者分别为0例和1例。术后胸腔闭式引流管留置时间分别为（2.8±1.3）天和（3.1±1.2）天。吻合口漏患者分别为7例和1例。肺部感染患者分别为13例和5例，乳糜胸患者分别为2例和1例，差异均无统计学意义（P>0.05）。声音嘶哑患者分别为11例和3例。并发症总发生率分别为41.2%（35/85）和17.7%（11/62），术后住院时间分别为（14.7±6.5）天和（12.3±2.3）天，差异有统计学意义（P<0.05）。MIE-Ivor-Lewis和MIE-McKeown治疗食管癌均安全有效，但MIE-Ivor-Lewis的并发症少于MIE-McKeown，且MIE-Ivor-Lewis的围手术期临床效果优于MIE-McKeown。
