[Clinical observation on perioperative complications of minimally invasive Ivor-Lewis and minimally invasive McKeown esophagectomy].

Objective: To compare and analyze the perioperative clinical effects of minimally invasive Ivor-Lewis esophagectomy (MIE-Ivor-Lewis) and minimally invasive McKeown esophagectomy (MIE-McKeown). Methods: A total of 147 patients who underwent endoscopic esophageal cancer surgery from April 2018 to August 2019 were selected, including 85 patients undergoing MIE-McKeown surgery and 62 patients undergoing MIE-Ivor-Lewis surgery. The measurement data were expressed as (x±s), the comparison of normally distributed measurement data was performed by independent sample t-test, and the comparison of count data was performed by χ(2) test or Fisher's exact test. Results: The operation time of McKeown (M) group and Ivor-Lewis (IL) group were (219.2±72.4) minutes and (225.8±65.3) minutes. The mediastinal lymph node dissection number of M and IL groups were 13.3±4.8 and 11.6±6.5, respectively. The number of left recurrent laryngeal nerve lymph node dissection were 3.5±1.2 and 3.1±1.4, respectively. The intraoperative blood loss were (178.3±41.3) ml and (163.2±64.1) ml, respectively. The number of patients reoperated for postoperative bleeding were 1 and 0, respectively. The number of patients with postoperative gastric bleeding were 0 and 1, respectively. The postoperative chest tube retention time were (2.8±1.3) days and (3.1±1.2) days, respectively. The number of patients with anastomotic leakage were 7 and 1, respectively. The number of patients with lung infection were 13 and 5, respectively, and with chylothorax were 2 and 1, respectively, without statistically significant difference (P>0.05). The number of patients with hoarseness were 11 and 3, respectively. The total incidence of complication were 41.2% (35/85) and 17.7% (11/62), and the postoperative hospital stay were (14.7±6.5) days and (12.3±2.3) days, with statistical difference (P<0.05). Conclusion: MIE-Ivor-Lewis and MIE-McKeown are safe and effective in treating esophageal cancer, but the complication of MIE-Ivor-Lewis is less than that of MIE-Mckeown, and the perioperative clinical effect of MIE-Ivor-Lewis is better than that of MIE-McKeown.目的： 探讨微创Ivor-Lewis(MIE-Ivor-Lewis)与微创McKeown(MIE-McKeown)术式治疗食管癌的围手术期临床效果。 方法： 选取2018年4月至2019年8月于东南大学附属中大医院接受全腔镜食管癌根治术患者147例，MIE-McKeown手术(McKeown组)患者85例，MIE-Ivor-Lewis手术(Ivor-Lewis组)患者62例。计量资料以(x±s)表示，呈正态分布的计量资料的比较采用独立样本t检验，计数资料的比较采用χ(2)检验或Fisher精确检验。 结果： McKeown组和Ivor-Lewis组患者手术时间[分别为(219.2±72.4)min和(225.8±65.3)min]、纵隔淋巴结清扫数[分别为(13.3±4.8)枚和(11.6±6.5)枚]、左喉返淋巴结清扫数[分别为(3.5±1.2)枚和(3.1±1.4)枚]、术中出血量[分别为(178.3±41.3)ml和(163.2±64.1)ml]、术后出血再手术患者数(分别为1和0例)、术后胃出血患者数(分别为0和1例)、术后胸管留置时间[分别为(2.8±1.3)d和(3.1±1.2)d]、吻合口瘘患者数[分别为7和1例]、肺部感染患者数(分别为13和5例)和乳糜胸患者数(分别为2和1例)差异均无统计学意义(均P>0.05)。McKeown组和Ivor-Lewis组患者声音嘶哑[分别为11和3例]、总并发症发生率[分别为41.2%(35/85)和17.7%(11/62)]和术后住院时间[分别为(14.7±6.5)d和(12.3±2.3)d]差异均有统计学意义(均P<0.05)。 结论： MIE-Ivor-Lewis术与MIE-McKeown术治疗食管癌安全有效，但MIE-Ivor-Lewis术较MIE-Mckeown术并发症少，MIE-Ivor-Lewis术围手术期临床效果优于MIE-McKeown术。.