| Objective: Different radical resection methods of esophageal cancer were compared and analyzed in aspects of postoperative complications,short-term prognosis,quality of life,etc.,so as to provide a more reasonable surgical plan for clinical esophageal cancer,so as to improve the prognosis and quality of life of patients.Methods: Choose 2013 jan 01 solstice on June 1,2020 in shaanxi province people’s hospital during the period of the same team of esophageal thoracic surgery in274 cases of breast of esophageal cancer patients as the research object,according to the operation and anastomosis site is divided into the chest,laparoscopic joint right thoracic esophageal cancer effect a radical cure chest top 45 ° anastomosis(Ivor-Lewis MIE)group,the left thoracic esophageal cancer effect a radical cure bow on45 ° anastomosis(Sweet)group,chest laparoscopic combined by 45 ° right thoracic esophageal cancer effect a radical cure cervical anastomosis(Mc Keown MIE)group.Ivor-Lewis MIE group included 123 patients,73 in the middle thoracic segment and 50 in the lower thoracic segment.In the Sweet group,there were 68 cases,including 39 cases in the middle thoracic segment and 29 cases in the lower thoracic segment.In the Mc Keown MIE group,there were 83 cases,including 54 cases in the middle thoracic segment and 29 cases in the lower thoracic segment.The two surgical methods of intrathoracic anastomosis and the two surgical methods of right thoracic approach were respectively compared and studied,and the clinical data of these patients were retrospectively analyzed in combination with the general information of the patients,the surgical methods,the intraoperative and postoperative recovery.Results:1.There were no statistically significant differences in gender,age,complicated underlying diseases,tumor location,tumor differentiation,clinical stage,FEV1,FEV1/FVC and other indicators between the Ivor-Lewis MIE group and the Sweet group(P > 0.05).In terms of operative time,number and station of mediastinal lymph node dissection,number of abdominal lymph node dissection,time of thoracic drainage tube and postoperative hospital stay,P < 0.05,there were statistical differences.There was no significant difference in the incidence of postoperative anastomotic/tubular gastric fistula,chylothorax,recurrent laryngeal nerve injury,incision infection and deep vein thrombosis(P > 0.05).There was statistical difference in the incidence of postoperative pulmonary infection,arrhythmia,gastric emptying disorder and P < 0.05.Postoperative follow-up: 110 cases in Ivor-Lewis MIE group and 58 cases in Sweet group.The incidence of chest pain was statistically significant(P < 0.05).There was no significant difference in the incidence of anastomotic stenosis,choking sensation,acid reflux,cough,nausea and vomiting,shortness of breath,etc.2.There was no statistical difference between the Ivor-Lewis MIE group and Mc Keown MIE patients in gender,age,complicated underlying diseases,tumor location,tumor differentiation,clinical stage,FEV1,FEV1/FVC and other indicators(P >0.05).The placement time of thoracic drainage tube in the Ivor-Lewis MIE group(6.9±2.2)was shorter than that in the Mc Keown MIE group(7.9±1.7),P < 0.05,indicating a statistical difference.In terms of operation time,number and station of mediastinal lymph node dissection,number and station of abdominal lymph node dissection,time of thoracic drainage tube and postoperative hospital stay,P > 0.05 showed no statistical difference.There was no statistical difference in the incidence of postoperative pulmonary infection,gastric emptied disorder,chylothorax,arrhythmia and deep vein thrombosis(P > 0.05).The incidence of anastomotic/tubular gastric fistula,incision infection and recurrent laryngeal nerve injury was statistically significant(P < 0.05).Postoperative follow-up: 110 cases in the Ivor-Lewis MIE group and 76 cases in the Mc Keown MIE group.There was no significant difference in the incidence of chest pain,nausea,vomiting and shortness of breath(P > 0.05).In the anastomotic stenosis,acid reflux,cough and eating choking sensation and other symptoms,P < 0.05,there was a statistical difference.Conclusion: Compared with the 45° anastomosis above the arch for radical resection of right thoracic esophageal cancer by thoracoscopic laparoscopy,thoracic laparoscopy has the advantages of thorough lymph node dissection,less trauma,faster recovery,and lower postoperative complications.The major postoperative complications,such as anastomotic/tubular gastric fistula,pulmonary infection,recurrent laryngeal nerve injury and anastomotic stenosis,were lower than those of thoracic laparoscopy combined with right thoracic esophageal cancer radical resection of neck at 45°.It is more suitable for patients with middle and lower thoracic esophageal cancer whose tumor is located below the lower edge of the aortic arch and without cervical lymph node enlargement(no need for cervical lymph node dissection).Oblique gastro-esophageal anastomosis at 45° may reduce the incidence of anastomotic stenosis after esophageal cancer surgery. |
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