经典Ivor—Lewis手术与改良Ivor—Lewis手术治疗中下段食管癌的比较分析

目的通过对中下段食管癌经典Ivor-Lewis术式与改良Ivor．Lewis术式的治疗效果进行比较，重新评价经典Ivor—Lewis术式的临床应用价值。方法收集在南京医科大学第一附属医院胸心外科2009年3月至2010年3月间接受改良Ivor-Lewis手术的140例（改良组）和2010年4月至2011年4月期间接受经典Ivor-Lewis手术的112例（经典组）食管中下段癌患者的临床资料。比较两组手术时间、术后并发症、淋巴结清扫数量、转移淋巴结数量及术后病理分期。结果经典组平均手术时间为（212．0±39．5）mini含（22．0±3．4）min的重新消毒时间]，稍长于改良组的（195．0±51．6）min，但差异并无统计学意义（P〉0．05）。两组患者术中清扫淋巴结总数的差异无统计学意义（21．2±3．2）枚／例比（18．6±5．5）枚／例，P〉0．05]，但对于上纵隔淋巴结，经典组清扫数量明显多于改良组（8．0±2．1）枚／例比（3．1±0．6）枚／例，P〈0．05]。经典组术后检出有淋巴结转移者的比例明显高于改良组41．1％（46／112）比27．9％（39／140）。P〈0．05]。结论对于中下段食管癌，经典lvor—Lewis术式在上纵隔淋巴结清扫效果及术后病理N分期的准确性方面较改良Ivor。Lewis术式更具优势，因而更符合肿瘤治疗原则。

Comparative analysis on the classic and modified Ivor-Lewis procedure in the treatment of midlow thoracic esophageal carcinoma

Objective To retrospectively evaluate the efficacy of classic and modified Ivor-Lewis surgical procedure in the treatment of mid-low thoracic esophageal cancer. Methods Clinical data of 140 patients with middle-lower thoracic esophageal cancer undergoing modified Ivor-Lewis esophagectomy from March 2009 to April 2010 （modified group） and 112 patients with same disease undergoing classic Ivor- Lewis esophagectomy from April 2010 to April 2011 in our department were collected. Operative time, surgical complications, total number of harvested lymph node, distribution of lymph nodes, lymph node metastasis rate, as well as postoperative pathological stage were compared between two groups. Results There were no significant differences between two groups in general informations, operative time and surgical complications （P〉0.05）. The number of harvested superior mediastinum lymph nodes in classic Ivor-Lewis group was significantly more than that in modified group （8.0±2.1 vs. 3.1±0.6, P〈0.05）. Ratio of postoperative positive lymph node metastasis was significantly higher in classic Ivor-Lewis group as compared to modified group 41.1%（46/112） vs. 27.9%（39/140）, P〈0.05]. Conclusion As compared to modified Ivor-Lewis procedure, classic Ivor-Lewis procedure is better in the resection of superior mediastinum lymph node and the evaluation of postoperative pathological stage, therefore it conforms better to the principle of cancer treatment of esophageal carcinoma.