微创McKeown食管癌根治术与Ivor-Lewis手术治疗食管癌的近期疗效对比

目的：总结74例微创McKeown食管癌根治术(minimally invasive McKeown esophagectomy，MIE-McKeown)经验及体会，并与经典Ivor-Lewis食管癌手术(Ivor-Lewis esophagectomy，ILE)比较，探讨二者手术的近期疗效。方法：回顾性分析2014年11月至2016年7月期间在中南大学湘雅医院胸外科接受MIE-McKeown的74例患者的临床资料，选择同期接受ILE的食管癌患者85例作为对照，比较二者近期疗效。结果：与ILE组相比，MIE-McKeown组患者术中出血量更少，术后肺部感染发生率更低，手术切除食管长度更长，淋巴结清除组数及个数更多，但手术时间和术后住院时间更长，术后吻合口瘘和吻合口狭窄发生率更高，差异均有统计学意义(P<0.05)。两组整体淋巴结转移率52.8%，MIE-McKeown组的颈部淋巴结转移率9.5%。两组共发现食管多中心病灶16例，次瘤位于主瘤上方者7例，次瘤远侧缘距主瘤中心的距离(D)为20~85(50.7±23.0) mm，次瘤位于主瘤下方者9例，D值为30~90(57.8±20.5) mm。结论：MIEMcKeown病灶切除更彻底，淋巴结清除度较高，安全、创伤小、短期效果好，是治疗食管癌的适合术式，但吻合口瘘及吻合口狭窄发生率较高，需进一步优化。

Comparison of short-term outcomes between minimallyinvasive McKeown esophagectomy and Ivor-Lewisesophagectomy for esophageal cancer

Objective: To summarize the outcomes of 74 patients with minimally invasive McKeownesophagectomy (MIE-McKeown), and to discuss the short-term outcomes by comparing with Ivor-Lewis esophagectomy (ILE) procedure.Methods: A total of 74 patients with esophageal carcinoma underwent MIE-McKeown in XiangyaHospital from November 2014 to July 2016 were retrospectively reviewed, and 85 patientsunderwent ILE procedure were selected as a control group. Perioperative and short-term outcomeswere analyzed.Results: Compared with the ILE group, patients underwent MIE-McKeown had less blood loss,less pulmonary infection, longer resection length and more harvested lymph nodes (P<0.05), butthey had more anastomotic leakage and stricture rate, longer operation time and hospital stay aswell (P<0.05). The total rate of lymph node metastatic in all patients was 52.8%, and the rate ofcervical lymph node metastases was 9.5% in the MIE-McKeown group. Multiple carcinomas werefound in 16 cases, and 7 were proximally located. The distance from the distal margin of the secondlesion to the center of the main lesion was 20-85 (50.7±23.0) mm, while the distance in 9 secondcarcinomas distally located was 30-90 (57.8±20.5) mm.Conclusion: Compared with Ivor-Lewis esophagectomy procedure, MIE-McKeown procedure hasa more complete lesion dissection and more harvested lymph nodes with smaller incisions, bettershort-term outcomes and more safety. It is an appropriate procedure for esophagectomy. However,it should be optimized for its high rate of anastomotic leakage and stricture.