全腔镜Ivor-Lewis术对食管癌根治术病人应激反应及胃肠功能的影响

doi:10.3969/j.issn.1005-6483.2021.08.009

摘要/Abstract

摘要： 目的:对比全腔镜IvorLewis术和腔镜联合上腹部小切口IvorLewis术对食管癌根治术病人应激反应及胃肠功能的影响。方法:2017年1月～2019年4月收治的食管中下段癌根治术病人86例，根据手术方法分为两组，全腔镜组46例，行全腔镜IvorLewis术；腔镜联合切口组40例，行腔镜联合上腹部小切口IvorLewis手术。对比两组病人手术指标、并发症、应激指标及胃肠功能指标和预后。结果:全腔镜组术后住院时间及术后首次排气时间分别为(12.2±2.4)天和(2.8±1.2)天，腔镜联合切口组分别为(14.6±2.6)天、(3.9±1.4)天，两组比较差异有统计学意义(P＜0.05)，两组住院费用、术中出血量、手术时间、淋巴结清扫数目比较差异无统计学意义(P>0.05)。全腔镜组并发症发生率(8.7%）与腔镜联合切口组（12.5%）比较，差异无统计学意义（P>0.05)。手术后全腔镜组丙二醛（ＭＤＡ）为(7.90±2.26)μmol/L，腔镜联合切口组为(9.29±2.78)μmol/L，两组比较差异有统计学意义(P＜0.05)。手术后全腔镜组超氧化物歧化酶（ＳＯＤ）为(73.62±7.54)U/L，胃动素为(124.11±11.00)ng/L，胃泌素为(64.22±6.82)ng/L，腔镜联合切口组分别为(62.97±6.46)U/L、(100.51±11.78)ng/L和(51.11±5.59)ng/L，两组比较差异有统计学意义(P＜0.05)。两组复发率(13.9%比10.8%)、转移率(9.3%比8.1%)及死亡率(4.6%比2.7%)比较差异无统计学意义(P>0.05)。结论:全腔镜IvorLewis术具有恢复快、对胃肠功能及应激反应影响小的优点，近期效果显著。

关键词: 全腔镜, IvorLewis术, 食管癌根治术, 应激反应, 胃肠功能, 预后

Abstract: Objective:To compare the effects of total laparoscopic IvorLewis surgery and laparoscopic combined with small upper abdominal incision IvorLewis surgery on stress response and gastrointestinal function in patients undergoing radical esophagectomy.Methods:The clinical data of 86 patients with radical esophagectomy in middle and lower esophagus treated in our hospital from January 2017 to April 2019 were retrospectively analyzed.According to the surgical method,they were divided into the total endoscopic group(46 cases,full endoscopic IvorLewis Surgery) and laparoscopic combined incision group(40 cases,IvorLewis operation combined with laparoscopic combined small incision in upper abdomen).The difference of operation index,complication,stress index,gastrointestinal function index and prognosis between the two groups were compared.Results:The postoperative hospital stay(12.2±2.4)d and the first postoperative exhaust time(2.8±1.2)d in the full endoscopic group were shorter than those in the endoscopic combined incision group[(14.6±2.6)d,(3.9±1.4)d](P＜0.05).There were no significant differences in hospitalization expenses,intraoperative blood loss,operation time,and the number of lymph node dissections between the two groups(P>0.05).After surgery,the MDA of the total endoscopic group was (7.90±2.26)μmol/L,which was lower than that of the combined incision group[(9.29±2.78)μmol/L,P＜0.05].SOD of the total endoscopic group was(73.62±7.54)U/L,motilin was (124.11±11.00)ng/L,gastrin was(64.22±6.82)ng/L,which was higher than the endoscopic combined incision group[(62.97±6.46)U/L,(100.51±11.78)ng/L,(51.11±5.59)ng/L](P＜0.05).There was no significant difference in recurrence rate(13.9% vs.10.8%),metastasis rate(9.3% vs.8.1%) and mortality(4.6% vs.2.7%) between the two groups(P>0.05).Conclusion:IvorLewis surgery has the advantages of fast recovery,and little effect on gastrointestinal function and stress response.The shortterm effect is remarkable.

Key words: holoscope, IvorLewis operation, radical esophagectomy, stress response, gastrointestinal function, prognosis

杨晓光, 苏鹏, 陈海洋. 全腔镜Ivor-Lewis术对食管癌根治术病人应激反应及胃肠功能的影响[J]. 临床外科杂志, 2021, 29(8): 726-729.

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