旋转变换体位胸腹联合切口治疗胸段食管癌  

Study on thoracoabdominal incision for thoracic esophageal carcinoma by rotation position

作　　者：柴立勋[1] 冯云[1] 白晓鸣[1] 

机构地区：[1]山西省人民医院胸外科,太原030012

出　　处：《中华医学杂志》2011年第27期1926-1928,共3页National Medical Journal of China

摘　　要：目的探讨旋转变换体位胸腹联合切口治疗胸段食管癌的可行性。方法2004年1月至2007年12月山西省人民医院胸外科采用旋转变换体位胸腹联合切口治疗胸段食管癌126例，男75例、女51例，年龄46～78岁，食管中段癌74例，食管下段癌52例。手术胸、腹部分期进行。患者基本体位采用左侧卧后仰30°～45°，取右胸第5肋间进胸，此时手术床向左旋转30°～45°，使胸部呈左侧位，开腹时手术床再向后旋30°～45°，使腹部近乎水平位，使胸腹部手术野均能够达到良好显露，如需颈部吻合或颈淋巴结清扫可一并同期完成。上述病例与同期行左胸及两切口手术的食管癌病例进行随机对照研究。结果本组均顺利完成手术，食管胃右胸顶吻合74例，奇静脉弓水平吻合52例，两野淋巴结清扫平均25．6枚（16—32枚）。无手术死亡，主要并发症：肺部感染5例，切口感染2例，喉返神经损伤5例，心律失常2例。采用旋转变换体位组的手术时间明显缩短，胸腹腔淋巴结清扫数目明显增加，无病生存期左胸组低于两切口组和旋转组，术中出血量、住院时间和术后胸腔引流差异无统计学意义。结论胸段食管癌采用旋转变换体位胸腹联合切口胸顶部吻合可达到传统翻转体位手术的同样手术效果，术野暴露清楚，手术简便、省时、安全，为食管癌两野淋巴结清扫提供了一种可供选择的手术径路。Objective To explore the clinical feasibility of thoracoabdominal incision for thoracic esophageal carcinoma by rotation position. Methods From January 2004 to December 2007,126 patients with thoracic esophageal carcinoma performed operation by rotation position. There were 75 males and 51 females aged 46 to 78 years. Tumor was located mid-esophagus in 74 patients, whereas sub-esophagus was present in 52 patients. All patients underwent esophagectomy by rotation position （thoracoabdominal incision ）. Thoracic and abdominal cavity were exposed well. Results All operations were completed successful. Anastomotic stoma was located right thorax. The mean number of tow-field lymph node dissection was 25.6. There was no mortality. Postoperative complication include pulmonary complication, incision infection, recurrent laryneal nerve damage, arrhythmia. The operation time was significantly shortened by rotation position. The number of lymph node dissection was significantly increased. Conclusion The results of this study demonstrated that thoracoabdominal incision for thoracic esophageal carcinoma by rotation position exposes the operation fields clearly and make radical lymphadenectomy thoroughly. Disease-free survival is significantly improved.

关 键 词：食管肿瘤 体位 治疗 

分 类 号：R735.1[医药卫生—肿瘤]