中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

食管癌手术中保留与切除奇静脉、胸导管及周围组织的临床研究

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目的 比较保留奇静脉、胸导管及周围组织的改良 Ivor-Lewis 术式与切除这些组织的经典 Ivor-Lewis 手术治疗食管鳞癌的临床效果,评价食管癌手术是否需要切除奇静脉、胸导管及周围组织。 方法 选取 2011 年 6 月至 2013 年 6 月期间,在四川省肿瘤医院胸外科拟行手术治疗的胸段食管鳞癌患者,随机分为保留组和切除组两组,每组各 100 例。其中保留组男 87 例、女 13 例,平均年龄(60.53±7.72)岁;切除组男 80 例、女 20 例;平均年龄(60.69±7.69)岁。比较两组患者临床结果。 结果 两组患者在一般资料、术前分期、淋巴结清扫数目、术后病理分期等指标差异无统计学意义(P>0.05)。保留组较切除组手术时间短、术中出血量少、术后前 3 日胸腔引流量少,差异具有统计学意义(P<0.05)。两组患者复发转移类型及部位无明显差别,差异也无统计学意义(P<0.05)。保留组与切除组术后 1、3、5 年生存率(78.7%vs 81.3%,39.4% vs 37.5%,23.4% vs 17.7%)差异无统计学意义(P>0.05)。 结论 保留奇静脉、胸导管及周围组织的改良 Ivor-Lewis 术式减少了食管癌手术创伤,不增加术后复发转移,可获得和扩大手术同样的远期疗效。

Objective To compare the clinical efficacy of modified Ivor-Lewis esophagectomy, which preserves azygos vein, thoracic duct and peripheral tissues, and classic Ivor-Lewis esophagectomy, which resects these tissues, in the treatment of esophageal cancer, so as to evaluate whether it is necessary to resect azygos vein, thoracic duct and peripheral tissues in esophagectomy for esophageal cancer. Methods Patients scheduled for surgical treatment of thoracic ESCC in Department of Thoracic Surgery of Sichuan Cancer Hospital from June 2011 to June 2013 were randomly assigned to the retention group and the resection group, each including 100 patients. The retention group included 87 males and 13 females with an average age of 60.53±7.72 years. In the resection group, there were 80 males and 20 females with an average age of 60.69+7.69 years. Patients in the two groups were compared for the duration of surgery, intraoperative blood loss, postoperative thoracic drainage volume, postoperative complications, and number of dissected lymph nodes, etc; postoperative relapse and survival rates at 1, 3 and 5 years postoperatively were also followed up and compared for patients in the two groups. Results There were no statistically significant differences between the two groups in general patient characteristics, number of dissected lymph nodes,or postoperative pathological stage, etc. (P>0.05). Compared to the resection group, there were shorter duration of surgery, less intraoperative blood loss, and less thoracic drainage volume in the first 3 days following surgery in the retention group, with statistically significant differences (P<0.05). There were no significant differences between the two groups in the types or sites of relapse or metastasis, without statistically significant differences (P<0.05). The survival rates at 1, 3, and 5 years postoperatively were 78.7%vs 81.3%, 39.4% vs 37.5%, and 23.4% vs 17.7%, respectively, in retention group and the resection group, without statistically significant differences (P>0.05). Conclusion Modified Ivor-Lewis esophagectomy preserving azygos vein, thoracic duct and peripheral tissues could reduce surgical trauma, would not increase postoperative relapse or metastasis, and could produce the long-term efficacy comparable to that of extended resection.

关键词: 食管鳞状细胞癌; 改良 Ivor-Lewis 手术; 复发转移; 生存率

Key words: Esophageal squamous cell carcinoma; modified Ivor-Lewis esophagectomy; relapse and metastasis; survival rate

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