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目的:总结74例微创Mc Keown食管癌根治术(minimally invasive Mc Keown esophagectomy,MIE-Mc Keown)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-Mc Keown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-Mc Keown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-Mc Keown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:MIEMc Keown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。
OBJECTIVE: To summarize the experience and experience of minimally invasive Mc Keown esophagectomy (MIE-Mc Keown) in 74 patients with minimally invasive Mc Keown and compare with classic Ivor-Lewis esophagectomy (ILE) The immediate effect of surgery. Methods: The clinical data of 74 patients who underwent MIE-McKown’s thoracic surgery at Xiangya Hospital of Central South University from November 2014 to July 2016 were retrospectively analyzed. Totally 85 patients with esophageal cancer who underwent ILE in the same period were selected as the control group. The two recent curative effect. Results: Compared with the ILE group, the MIE-Mc Keown group had less intraoperative blood loss, lower incidence of postoperative pulmonary infection, longer esophageal resection, and more lymph node clearance groups and numbers, but surgery Time and postoperative hospital stay longer, postoperative anastomotic fistula and anastomotic stenosis were higher, the differences were statistically significant (P <0.05). Overall lymph node metastasis was 52.8% in both groups and 9.5% in cervical lymph nodes in the MIE-Mc Keown group. In both groups, 16 cases were found with multi-center lesions of the esophagus, 7 cases with the next tumor located above the main tumor, and the distance (D) between the distal margin of the second tumor and the main tumor center was 20-85 (50.7 ± 23.0) mm. 9 cases under the tumor, D value of 30 ~ 90 (57.8 ± 20.5) mm. Conclusions: The resection of MIEMC Keown lesion is more complete and the degree of lymphadenectomy is higher. It is safe, less traumatic and has short-term effect. It is a suitable surgical method to treat esophageal cancer. However, the incidence of anastomotic fistula and anastomotic stenosis needs further optimization.