摘要
目的探讨胸腔镜联合腹腔镜食管癌切除的临床经验。方法从2008年11月至2009年9月我们采用胸腔镜联合腹腔镜食管癌切除术治疗食管癌患者40例。其中男性30例,女性10例,年龄52～78岁。平均65岁。病变部位:食管上段癌2例,中段癌32例,下段癌6例;病理类型为鳞癌39例,腺癌1例。在胸腔镜下游离食管及清扫淋巴结,在腹腔镜下游离胃,经胸骨后隧道上提至颈部行食管胃吻合。结果3例因胸腔粘连,1例因肿瘤明显外侵而胸部中转辅助小切口,腹部无中转开腹。全组手术时间240～320min,平均270min,胸腔镜时间45～90min,平均60min,腹腔镜时间45～90min,平均60min。术中出血150～300ml,平均200ml。淋巴结切除8～20枚,平均11.8枚。术后住院10～13d,平均11d。术中无出血并发症。术后并发症:颈部吻合口瘘6例(术后第8～14天),经伤口换药均能痊愈;术后无乳糜胸、肺部感染、肺功能不全。术后病理分期:Ⅰ期1例,Ⅱ期34例,Ⅲ期5例。随访患者39例,失访1例。随访时间3～12个月,平均7.3个月。结论按照此设计进行胸腹腔镜食管癌切除术,可最大限度地减小创伤及并发症,操作简单易行,容易推广。
Objective To explore the clinical experience of thoracoscopic and laparoscopic esophagectomy for esophageal carcinoma.MethodsFrom November 2008 to September 2009,40 cases of esophageal carcinoma were performed in our department by this way.Forty patients were 30 males and 10 females,and aged from 52 to 78（average 65）.There were 2 cases of carcinoma of the upper esophagus,32 cases of carcinoma of the middle esophagus,and 6 cases of carcinoma of the next segment.The pathological types were 39 cases of squamous cell carcinoma and 1 case of adenocarcinoma.Video-assisted thoracoscopic surgical approach was used to free the esophagus and lymph node dissection,and laparoscopic surgical approach was to free the stomach,through the retrosternal tunnel raised to the neck line of esophagogastric anastomosis.ResultsAmong the 40 cases,because of 3 cases of pleural adhesion and 1 case of clearly outside the tumor invasion,we had to converse to transit-assisted small incision in the chest.All operative time was 240 to 320 min,with an average of 270 min,thoracoscopic time 45 to 90 min with an average of 60 min,and laparoscopic time 45 to 90 min with an average of 60 min.Intraoperative blood loss was 150 to 300 ml with an average of 200 ml.There were 8 to 20 pieces of lymph nodes removed,with an average of 11.8.All patients were hospitalized from 10 to 13 d,with an average of 11 d.There was no bleeding during operation.Postoperative complications included anastomotic fistula of 6 cases in the neck after the first 8 to 14 d,which were healed after dressing.No postoperative chylothorax,lung infection or respiratory insufficiency was found.ConclusionWith this thoracoscopic and laparoscopic esophagectomy,we minimize the trauma and complications after operation.This approach has no significant difference with other surgical methods in tumor resection and lymph node dissection,and is simple and easy to perform.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2010年第7期722-724,共3页
Journal of Third Military Medical University
作者简介
[通信作者]陈焕文，电话：（023）89011131，E—mail：coolstar9527@sina．com.
