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目的评价Ivor-Lewis手术治疗食管癌的安全性和区域淋巴结清扫的效果。方法收集2012年9月-2014年3月行Ivor-Lewis手术的78例食管癌患者临床资料,以同一时期行Sweet手术的86例食管癌患者作为对照,对两组患者手术时间、术中出血量,术后主要并发症和不同区域淋巴结转移情况进行比较。结果 Ivor-Lewis组平均手术时间[(254.5±38.4)min]稍长于Sweet组[(216.7±31.3)min],平均术中出血量[(165.5±40.3)m L]高于Sweet组[(148.7±35.4)m L],差异有统计学意义(P<0.05);两组术后住院时间比较差异均无统计学意义(P>0.05);Ivor-Lewis组术后声嘶发生率显著高于Sweet组(P<0.05);其他并发症两组间差异无统计学意义(P>0.05);Ivor-Lewis组患者淋巴结阳性率(60.3%,47/78)显著高于Sweet组(26.7%,23/86),差异有统计学意义(P<0.05);Ivor-Lewis组患者平均淋巴结清扫数[(21.5±5.3)枚]显著高于Sweet组[(10.6±4.1)枚];右喉返神经旁淋巴结是Ivor-Lewis组最常见的淋巴结转移部位,而Sweet组由于难以对该区域淋巴结进行清扫,因此无法明确该区域淋巴结转移情况。结论 Ivor-Lewis手术是一种安全的手术方式,相对Sweet手术而言,在胸、腹腔淋巴结清扫方面具有明显优势。
Objective To evaluate the safety of Ivor-Lewis surgery for esophageal cancer and the effect of regional lymph node dissection. Methods The clinical data of 78 patients with esophageal cancer who underwent Ivor-Lewis surgery from September 2012 to March 2014 were collected. 86 patients with esophageal cancer who underwent Sweet operation during the same period were used as controls. The operation time and intraoperative blood loss were compared between the two groups. Volume, postoperative major complications and regional lymph node metastases were compared. Results The mean operation time [(254.5±38.4) min] was slightly longer in the Ivor-Lewis group than in the Sweet group [(216.7±31.3) min], and the average intraoperative blood loss [(165.5±40.3) m L] was higher than that of the Sweet group [(148.7). ±35.4) m L], the difference was statistically significant (P<0.05); there was no significant difference in postoperative hospital stay between the two groups (P>0.05); the incidence of postoperative hoarseness was significantly higher in the Ivor-Lewis group. In the Sweet group (P<0.05), there was no significant difference in other complications between the two groups (P>0.05). The lymph node positive rate in the Ivor-Lewis group (60.3%, 47/78) was significantly higher than that in the Sweet group (26.7%, 23/86), the difference was statistically significant (P<0.05); the average number of lymph node dissections in the Ivor-Lewis group [(21.5±5.3) pieces] was significantly higher than that in the Sweet group [(10.6±4.1) pieces]; Paraneoplastic lymph nodes were the most common site of lymph node metastasis in the Ivor-Lewis group, and the Sweet group was unable to clear lymph node metastases in the region because of the difficulty in the clearance of the regional lymph nodes. Conclusion Ivor-Lewis surgery is a safe surgical method. Compared with Sweet surgery, it has obvious advantages in the thoracic and abdominal lymph node dissection.