The Value Of Modified MIE McKeown Surgical Technique In The Treatment Of Thoracic Esophageal Carcinoma

BackgroundEsophageal cancer is one of the worldwide common malignant tumors of digestive tract,the incidence and mortality in China and abroad have increased year by year,and our country in the world ranked first.According to the status of Chinese cancer report shows that in China,the incidence of esophageal cancer in all kinds of malignant tumor mortality rate,were ranked in fifth and fourth,both the death toll,or the number of patients,more than 50%.of esophageal cancer globally the number is currently used in the comprehensive treatment of surgery,radiotherapy and chemotherapy.The esophageal carcinoma resection and reconstruction of digestive tract is a classic esophageal cancer surgery,and thoracic surgeons in nineteenth Century Surgical treatment of 80 s successfully carried out the world’s first cases of esophageal cancer,surgery after a period of slow and long development process,from the initial simple resection of esophageal cancer at present after resection of esophageal tumors and systematic lymph node dissection.Surgical reconstruction of digestive tract after esophageal resection is still the preferred treatment to cure patients with resectable esophageal cancer.Many surgical methods of esophageal carcinoma resection,traditional surgical resection is as follows: first thoracic surgery under the esophageal tumor,after digestive tract reconstruction surgery,the surgical approach including the left chest and neck SWEET surgery or the right chest chest,abdomen Two IVOR-lewis incision,thoracic,abdominal,neck incision surgery three McKeown.20 at the end of the century,with the development of medical devices,the progress of science and technology in foreign countries,minimally invasive esophagectomy under endoscopic application(minimally invasive esophagectomy,MIE)has developed more and more rapidly,the majority of thoracic surgeons recognition is widely used in more and more countries and regions,China is no exception,in 2005 have been reported,28 provinces and autonomous regions nationwide more than 400 The students to participate in the operation of hand assisted thoracoscopic resection of esophageal cancer,20 major hospitals have been carried out in this work.After the minimally invasive surgery of esophageal carcinoma has been rapid development,with the introduction of equipment and technology level,the rapid improvement of minimally invasive esophagectomy,currently the leading position in the world.But the operation minimally invasive esophageal cancer in technological development in different regions in China is unbalanced,the operation of a variety of ways,no unified operation mode,there are many hybrid operation,with thoracoscopic esophageal free,laparoscopic gastric tissue from lower abdomen,small incision for resection of esophageal cancer,gastric tube,stomach and neck anastomosis MIE McKeown are commonly used.ObjectiveComparison and analysis of modified MIE McKeown operation and traditional MIE McKeown operation indicators and data,and then compare the advantages and disadvantages of the traditional MIE McKeown and modified MIE McKeown operation,the indicators are compared and analyzed in detail.To evaluate the clinical efficacy and safety.Materials and MethodsClinical data of 185 patients with esophageal cancer undergoing surgery in our group from July 2015 to October 2016,were retrospectively analyzed.75 patients in the group received traditional MIE McKeown esophagectomy and 110 patients underwent modified MIE McKeown esophagectomy,All the patients divided into two groups according to different operative techniques,The operation time,the recurrent laryngeal nerve lymph node dissection and the incidence of recurrent laryngeal nerve injury were compared between the two groups.ResultsThe modified group in anastomotic leakage,anastomotic stenosis,left recurrent laryngeal nerve lymph node metastasis rate and lymph node metastasis of left recurrent laryngeal nerve and recurrent laryngeal nerve injury,has the obvious difference with the traditional group.Compared with the traditional group,modified group significantly reduced the incidence of anastomotic fistula,but a higher incidence of anastomotic stenosis;the operation time is shortened,with a significant difference;cardiovascular complications,perioperative mortality had no significant difference.Conclusion1.In the modified MIE McKeown,the hanging method,the root seeking method,the bare left and right recurrent laryngeal nerve lymph node and the tubular anastomosis embedding method are safe and feasible in the radical resection of esophageal carcinoma.2.The use of suspension method modified MIE McKeown technique,the search method of cleaning the bare left and right recurrent laryngeal nerve anastomosis after lymph node and tubular sleeve type embedding method can effectively improve the left recurrent laryngeal nerve lymph node number,reduce the incidence of esophageal and gastric tube anastomotic fistula and recurrent laryngeal nerve injury in moderate.