非开胸食管内翻拔脱术治疗食管癌105例  

Transhiatal Esophagectomy without Thoracotomy in 105 Patients with Esophageal Cancer

作　　者：翁文俊[1] 张石江[1] 邵永丰[1] 章斌[1] 

机构地区：[1]南京医科大学第一附属医院心胸外科,南京210029

出　　处：《中国胸心血管外科临床杂志》2013年第1期59-62,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨非开胸食管内翻拔脱术治疗食管癌的适应证、手术技巧及并发症处理。方法回顾性分析2002年7月至2010年7月南京医科大学第一附属医院105例食管癌患者行食管内翻拔脱术(其中28例辅助使用电视纵隔镜)的临床资料,其中男59例,女46例;年龄63(48～81)岁。食管上段癌51例,中段癌18例,下段癌36例;分析手术效果和安全性。结果手术时间153(140～210)min,术中出血量150(100～250)ml,住院时间15(10～35)d。全组无手术死亡,残端未见肿瘤细胞残留。27例术后发生并发症,其中3例吻合口瘘,4例喉返神经损伤,5例胸腔积液,2例气胸,3例合并肺部感染,3例心律失常,1例乳糜胸,2例切口感染,2例胃排空障碍,2例吻合口狭窄,经治疗后均痊愈。术后随访16个月～5年,随访97例,失访8例,已生存1年以上患者94例,生存3年以上67例,生存5年以上34例,部分患者待进一步随访。结论食管内翻拔脱术损伤小、恢复快,可使不能耐受经胸或不宜经胸手术的Ⅱ期及更早的食管癌患者获益。Objective To investigate the indications, surgical techniques and postoperative complication manage- ment of transhiatal esophagectomy without thoracotomy for patients with esophageal cancer. Methods We retrospec- tively analyzed the clinical records of 105 patients with esophageal cancer who underwent transhiatal esophagectomy with- out thoracotomy in the First Affiliated Hospital of Nanjing Medical University between July 2002 and July 2010, including 28 patients who received video-assisted mediastinoscopy. There were 59 male patients and 46 female patients with their average age of 63 （48-81 ） years. There were 51 patients with upper thoracic esophageal cancer, 18 patients with mid- dle thoracic esophageal cancer and 36 patients with lower thoracic esophageal cancer. Surgical outcomes and safety were evaluated. Results Mean operation time was 153 （ 140-210） minutes, mean intraoperative blood loss was 150 （ 100 to 250） ml, and mean hospital stay was 15 （ 10-35 ） days. There was no in-hospital death or residual tumor cells in esophagus stumps. Twenty-seven patients had postoperative complications, including 3 patients with anastomotic leakage at neck, 4 patients with recurrent laryngeal nerve injury, 5 patients with pleural effusion, 2 patients with pneumothorax, 3 patients with pneumonia, 3 patients with arrhythmia, 1 patient with chylothorax, 2 patients with incision infection, 2 patients with delayed gastric emptying, and 2 patients with anastomotic stenosis, who were all cured after treatment. Ninety-seven patients were followed up from 16 months to 5 years, and 8 patients were lost during follow-up. During follow-up, there were 94 patients who had lived for 1 year, 67 patients who had lived for 3 years, and 34 patients who had lived for 5 years postoperatively, and some patients needed further follow-up. Conclusion Transhiatal esophagectomy without thora- cotomy is a minimally traumatic procedure and can provide fast postoperative recovery. It is especially suitable for patients with stage �

关 键 词：食管内翻拔脱术 食管癌 电视纵隔镜 

分 类 号：R735.1[医药卫生—肿瘤]