联合腔镜食管癌根治术后并发症  

Prevention and treatment of major complications of combined thoracoscopic and laparoscopic esophagectomy for esophagealcarcinoma

作　　者：张仁泉[1] 夏万里[1] 于在诚[1] 王云海[1] 左剑辉[1] 康宁宁[1] 刘伟[1] 陈安国[1] 

机构地区：[1]安徽医科大学第一附属医院普胸外科一病区,合肥230022

出　　处：《中华胸心血管外科杂志》2013年第3期129-131,137,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的总结联合腔镜食管癌根治术后主要并发症并探讨其防治方法。方法回顾性分析2009年12月至2012年7月291例行联合腔镜食管癌根治术患者的临床资料。肿瘤位于食管上段者20例，中段239例，下段者32例。行胸腹腔镜联合颈部吻合（McKeown术）230例；胸腹腔镜联合右胸内吻合（微创IvorLewis术）61例。术后病理分期：Ⅰ期55例（Ⅰa期28例、Ⅰb期27例）Ⅱ,期109例，Ⅲ期69例（Ⅲa期36例、Ⅲb期33例），Ⅳ期58例。结果除4例中转手术（1．4％）外，其余全部顺利完成手术。术后主要并发症：吻合口瘘13例（4．5％），吻合口狭窄5例（1．7％），肺部感染54例（18．6％）、7例并发呼吸衰竭行气管切开、呼吸机辅助呼吸，其中4例死亡（1．4％），心律失常8例（2．7％），乳糜胸9例（3．1％）、喉返神经损伤、声音嘶哑33例（11．3％）。随访1-32个月，274例成功随访（94．1％）；42例死亡。随访中8例肝转移，10例腹腔淋巴结转移，4例肺转移，3例骨转移，1例脑转移，余者生存。结论胸、腹腔镜联合行食管癌根治术是一种安全的手术方式，其主要并发症发生率在可接受范围。腔镜外科技术经验的积累有助于进一步降低并发症发生率。Objective To study the major complications of combined thoracoscopic and laparoscopic esophagectomy for esophageal carcinoma and explore the methods for prevention and treatment. Methods Retrospective medical records analysis was conducted for 291 esophagealcancer patients who underwent combined thoracoscopic and lapamseopie esophageetomy in our department from December 2009 to July 2012. The tumors were located in upper esophagus in 20 cases, middle esophagus in 239 cases, and lower esophagus in 32 cases. 230 cases gastroesophageal anastomosis was made in left neck and 61 cases in right thoracic cavity. Postoperative pathological staging identified stage Ⅰ esophageal cancer in 55 cases （stage Ⅰ a ：28 cases, stage I b：27 cases）, stage Ⅱ esophageal cancer in 109 cases, stage Ⅲ esophageal cancer in 69 cases （stage Ⅲa： 36 cases, stage Ⅰ b： 33 cases） and stage Ⅳ esophageal cancer in 58 cases. Results Except for open conversions in 4 cases （ 1.4% ）, all surgical opergtions were completed smoothly. Postoperative complications： anastomotic leakage was found in 13 cases （4.5%）, anastomotic stricture in 5 cases（ 1.7% ）, lung infection in 54 cases（ 15.6% ）, 7 of whom required tracheotomy and mechanical ventilation for respiratory failure. Arrhythmia was observed in 8 cases（2.7% ） and chylothorax in 9 case（3.1% ）, recurrent laryngeal nerve injury （hoarseness） in 33 cases （ 11.3 % ）. 4 patients died in perioperative period （ mortality 1.4% ）. Out of the 291 cases, 274 cases were successfully followed up with durations ranged from 1 to 32 months. Cancer spreading to liver , celiac lymph nodes , lung, bone and brain were observed in 8 cases, 10 cases, 4 cases, 3 cases and lcase, respective- ly. 42 cases died, and all remaining cases remained alive during the follow up. Conclusion Combined thoracoscopic and lap- aroscopic esophagectomy is a technically safe alternative for esophageal cancer with an acceptable complication incidence. The accumulation of operativ

关 键 词：食管肿瘤 手术后并发症 胸外科手术 电视辅助 腹腔镜检查 

分 类 号：R735.1[医药卫生—肿瘤]