侧俯卧位胸、腹腔镜联合食管癌根治术治疗食管癌46例临床分析  

Thoracoscopic and laparoscopic esophagectomy for esophageal cancer in lateral prone position:a report of 46 cases

作　　者：徐驰[1] 曾志勇[1] 杨胜生[1] 庄聪文[1] 叶仕新[1] 杨鲸蓉[1] 连铎煌[1] 

机构地区：[1]南京军区福州总医院胸心外科,福建福州350025

出　　处：《中国内镜杂志》2012年第10期1077-1079,共3页China Journal of Endoscopy

摘　　要：目的探讨侧俯卧位胸、腹腔镜联合食道癌根治术的临床效果。方法对46例食管癌行侧俯卧位胸腹腔镜联合食管癌根治术:先左侧侧俯卧位行胸腔镜下胸段食管的游离及淋巴结清扫;胸部手术完成后改平卧位行腹腔镜下胃的游离及淋巴结清扫;胃游离后剑突下小切口完成管状胃的制作,再将管状胃经食管床拉至左颈部与颈段食管行端侧吻合。结果无中转开胸及开腹。总手术时间:210～330min,平均266min;腹腔镜手术时间45～120min,平均78min;胸腔镜手术时间65～125min,平均87min。术中无大出血,总出血量80～180mL,平均135mL,其中腹腔出血10～30mL,平均15mL。共清扫纵隔淋巴结429枚,平均每例9.3枚;清扫胃左动脉旁、贲门旁淋巴结159枚,平均每例3.5枚。术后住院9～13d,平均9.6d。住院期间患者无死亡。术后并发症:无吻合口漏,快速房颤2例,肺部感染3例。结论侧俯卧位胸腹腔镜联合食道癌根治术在技术上是可行的,并且是安全的。[Objective] To investigate the clinical results of thoracoscopic and laparoscopic in lateral prone position with esophagectomy for esophageal cancer.[Methods] Thoracoscopic and laparoscopic operation were carried out in lateral prone position on 16 patients with esophageal cancer：Each patient was given thoracoscopic esophagus mobilization in lateral-prone position,which was followed by lymphadenectomy;laparoscopic mobilization of stomach and lymphadenectomy in a supine position was then conducted after thoracic operation;When the stomach had been completely mobilized,a subxiphoid small incision was made to allow the gastric tube production.A gastric tube was then pulled to the left cervix through esophageal bed by side-to-side cervical esophageal anastomosis.[Results] No thoracotomy or laparotomy was conducted.Duration of surgery in total：210～330 min,266 min on average;duration of laparoscopic surgery：45 ～ 120 min,78 min on average;duration of thoracoscopic surgery：65～125 min,87min on average without massive hemorrhage.Total blood loss：80～180 ml,135ml on average;Abdominal bleeding：10～30 ml,15ml on average.Totally 429 mediastinum lymph nodes,9.3 per case on average;159 left gastric artery lymph nodes and paracardial lymph nodes,3.5 per case on average.Postoperative hospital stay：9～13d,9.6d on average.No patients died during hospitalization.Postoperative complications：no anastomotic leakage,2 case of atrial fibrillation,3 case of pulmonary infection.[Conclusion] The thoracoscopic and laparoscopic esophagectomy for esophageal cancer using the lateral prone position is technically feasible and safe.

关 键 词：侧俯卧位 食管癌手术 胸腔镜 腹腔镜 

分 类 号：R655.4[医药卫生—外科学]