经口输送钉砧头系统行全腔镜IvorLewis食管癌根治术30例  

Laparoscopic and thoracoscopic Ivor Lewis esophagectomy using a circular-stapled anastomosis with tram-oral anvil： 30 cases report

作　　者：沈钢[1] 吴明[1] 王琪[1] 张赛[1] 范军强[1] 柴 

机构地区：[1]浙江大学医学院附属第二医院胸外科,杭州310009

出　　处：《中华胸心血管外科杂志》2012年第5期265-267,277,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨全腔镜下食管癌切除并利用经口输送钉砧头系统完成右侧胸腔内食管一胃吻合的可行性，并报告近期疗效。方法2011年1至12月，30例食管癌患者行全腔镜IvorLewis径路食管癌切除食管-胃胸腔内吻合术。手术先在腹腔镜下游离胃和腹段食管，然后在胸腔镜下游离胸段食管并切除食管癌，采用经口输送钉砧头系统行胸腔镜下食管-胃胸腔内吻合。结果病变均位于食管中下段，平均长度3．8cm。全组手术均顺利，无术中并发症和中转开腹、开胸者。平均腹腔镜操作95min，胸腔镜操作177min；术中平均出血量310ml。术后平均5．6天进食。术后病理诊断25例鳞状细胞癌，5例腺癌，切缘均阴性。胸部和腹部淋巴结每例平均清扫10．6和4．9枚。术后切口感染4例，乳糜胸1例，经保守治疗后好转；1例术后第6天因左侧膈疝行剖腹膈疝修补；无吻合口瘘。结论利用经口输送钉砧头系统行全腔镜下食管癌切除胸腔内吻合术创伤小，术后恢复快，未发生吻合口瘘。全腔镜LvorLewis食管癌根治术是一种安全可行的手术方式。Objective To explore the feasibility and short-term efficacy of laparoscopic and thoracoscopic Ivor Lewis esophagectomy using a circular-stapled anastomosis with trans-oral anvil in treating esophageal carcinoma. Methods 30 con- secutive patients with esophageal cancer received minimally invasive Ivor Lewis esophagectomy from January 2011 to December 2011. Operations of all the cases comprised of both abdominal and thoracic procedures which were performed with laparoscopic and thoracoscopic techniques respectively. The intrathoracic esophago-gastric anastomosis was created using a circular-stapled anastomosis with trans-oral anvil technique. Results There were 24 males and 6 female with median age of 62.5-year-old （from 47 to 82）. The lesions located in middle and/or lower portion of the esophagus. 25 patients with esophageal squamous cell cancer （ n = 25 ） and 5 patients with adenocarcinoma （ n = 5 ） underwent an Ivor Lewis esophagectomy. All the operations were successfully performed without intra-operative technical failures of the anastomosis or deaths. The mean operation time was 95 minutes in abdomen and 177 minutes in thorax. The mean blood loss was 310 ml. The mean number of harvested lymph nodes was 10.6 from thorax and 4.9 from abdomen. Postoperatively, there were thoracic wound infections in 4 patients. One patient had a left diaphragmatic hernia and was successfully treated by re-operation 6 days after first operation. One patient bad chylothorax and recovered without surgery. There was no anastomotic leak and the patients were able to have spoon meat at 5.6 postoperative days. Conclusion Laparoscopic and thoracoscopic Ivor Lewis esophagectomy can be accomplished smoothly with acceptable occurrence of complications. The circular-stapled anastomosis with the trans-oral anvil is an efficient, safe and reproducible technique for intrathoracic esophago-gastric anastomosis.

关 键 词：食管肿瘤 Ivor Lewis食管切除术 胸腹腔镜 食管-胃吻合 

分 类 号：R735.1[医药卫生—肿瘤]