空肠造瘘术分别联合Ivor-Lewis术与McKeown术治疗中下段食管癌的短期效果

目的探讨空肠造瘘术分别联合Ivor-Lewis术与McKeown术治疗中下段食管癌的短期效果。方法回顾性分析127例中下段食管癌患者的临床资料,按照手术方式分为Ivor-Lewis组(IL组,72例)与McKeown组(MK组,55例)。IL组行空肠造瘘术联合Ivor-Lewis术,MK组行空肠造瘘术联合McKeown术。比较2组患者手术指标、术后炎症因子水平、术后并发症及复发情况。结果IL组患者手术时间、术后进食时间及术后住院时间均显著短于MK组,胸腔引流管留置时间长于MK组,住院费用高于MK组,差异均有统计学意义(P<0.05);2组患者术中失血量、淋巴结清扫数目比较,差异无统计学意义(P>0.05)。重复测量方差分析显示,时点效应可显著影响肿瘤坏死因子-α(TNFα)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)的水平;而手术方式、时点以及手术方式交互效应均不会影响TNF-α、IL-6、IL-8水平。2组患者术后并发症发生率及术后6个月内复发率比较,差异均无统计学意义(P>0.05)。结论空肠造瘘术联合Ivor-Lewis术与空肠造瘘术联合McKeown术治疗中下段食管癌短期效果相当,但空肠造瘘术联合Ivor-Lewis术手术时间、术后进食时间、术后住院时间较短,胸腔引流管留置时间较长,住院费用较高。

Short-term effect of jejunostomy combined with Ivor-Lewis operation and McKeown operation on middle and lower esophageal cancer

Objective To investigate the short-term effect of jejunostomy combined with Ivor-Lewis operation and McKeown operation respectively in the treatment of middle and lower esophageal cancer.Methods The clinical data of 127 patients with middle and lower esophageal cancer were retrospectively analyzed.These patients were divided into the Ivor-Lewis group(IL group,72 cases)and the McKeown group(MK group,55 cases)according to surgical method.The IL group received jejunostomy combined with Ivor-Lewis operation,while the MK group received jejunostomy combined with McKeown operation.The operation indexes,postoperative inflammatory factors,postoperative complications and disease recurrence between the two groups were compared.Results The operation time,postoperative feeding time and postoperative hospital stay of IL group were significantly shorter than those of MK group,the indwelling time of thoracic drainage tube was longer than that of MK group,and the hospitalization cost was higher than that of MK group,and the differences were statistically significant(P<0.05).There was no significant difference in intraoperative blood loss and number of lymph node dissection between the two groups(P>0.05).The analysis of variance showed that the time effect could significantly affect the levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-8(IL-8)in the two groups at different time points after operation,while the interaction effect of operation mode,time point and operation mode did not affect the levels of TNF-α,IL-6 and IL-8.There was no significant difference in the incidence of postoperative complications or recurrence rate within 6 months between the two groups(P>0.05).Conclusion The short-term effect of jejunostomy combined with Ivor-Lewis operation and jejunostomy combined with McKeown operation is equivalent for the treatment of middle and lower esophageal cancer,but jejunostomy combined with Ivor-Lewis operation has shorter operation time,shorter postoperative feeding time,shorter postoperative hospitalization time,longer indwelling time of thoracic drainage tube and higer hospitalization cost.