腹腔镜在微创三切口食管癌根治手术中的应用  

Laparoscopy in Three-incision Minimally Invasive Esophagectomy

作　　者：蒋晓侠[1] 林治[2] 谭黎杰[3] 冯明祥[3] 汪灏[3] 梁明强[3] 王群[3] 

机构地区：[1]上海市浦南医院胸外科,上海200125 [2]福州市第二医院胸心外科,福州350007 [3]复旦大学附属中山医院胸外科,上海200032

出　　处：《中国微创外科杂志》2011年第9期825-828,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：上海市卫生局科研课题资助,项目编号:2008100

摘　　要：目的探讨腹腔镜胃游离术在食管癌根治术中的可行性、安全性和根治性。方法回顾性分析2006年5月-2010年12月151例微创三切口食管癌根治术的临床资料。均在胸腔镜下完成食管的游离,腹部手术早期采用开腹（57例）,后期采用腹腔镜手术（94例）。制作管状胃后在颈部行食管胃吻合术。结果 2组在年龄、性别、术前辅助治疗、术后病理分期的差异均无统计学意义（P〉0.05）。2组术后ICU时间、术后住院时间、腹部淋巴结切除数量、腹部淋巴结阳性率、围手术期死亡、吻合口漏、管状胃坏死、胃排空延迟、腹部切口感染率以及肺部感染发生率方面差异无统计学意义（P〉0.05）。与开腹组相比,腹腔镜组腹部手术时间更短[（54.3±21.0）min vs.（72.8±18.6）min,t=-5.489,P=0.000],腹部手术中出血量更少[（50.5±33.0）ml vs.（81.8±40.8）ml,t=-5.155,P=0.000]。结论腹腔镜技术已在当前食管癌手术的应用中初步显示出一定的优点和价值,不过仍然需要大样本的前瞻性的临床研究来验证。Objective To investigate the feasibility,safety and efficacy of laparoscopy in the three-incision minimally invasive esophagectomy（MIE）.Methods A total of 151 patients who underwent three-incision MIE from May 2006 to December 2010 were enrolled in this retrospective study.Mobilization of the intrathoracic esophagus were performed by thoracoscopy in all the patients.The abdominal procedure was performed by laparotomy in earlier stage（57 cases） and laparoscopy in the latter（94 cases）.Esophagogastrostomy was then carried out at the neck level when tubular stomach was made.Results No statistical significant difference was found in age,gender,neoadjuvant chemoradiotherapy and pathological stage between the two groups,nor in ICU stay,hospital stay,number of abdominal lymph node removed,rate of positive abdominal lymph node,perioperative mortality,anastomotic leak,necrosis of tubular stamoch,delayed gastric emptying,rate of abdominal incisional and pulmonary infection（all P0.05）.However,laparoscopy group had significantly shorter abdominal operation time [（54.3±21.0） min vs.（72.8±18.6） min,t=-5.489,P=0.000],and less blood loss during the operation [（50.5±33.0） ml vs.（81.8±40.8） ml,t=-5.155,P=0.000] than the laparotomy group.Conclusions Laparoscopy shows a better outcome than laparotomy in three-incision MIE.However,prospective randomized controlled trials with larger sample are needed to validate its merit and efficacy.

关 键 词：食管癌 腹腔镜 微创手术 

分 类 号：R735.1[医药卫生—肿瘤]