全胸腔镜下食管胃胸内吻合术治疗中下段食管癌的技术探讨  

Total Thoracoscopic Anastomosis of Tube-like Stomach and Esophagus in Chest Cavity for the Treatment of Esophageal Carcinoma

作　　者：艾波[1] 廖永德[1] 付向宁[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院胸外科卫生部临床重点专科建设项目,武汉430030

出　　处：《中国微创外科杂志》2013年第5期394-397,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨全胸腔镜下食管胃胸内吻合术治疗中下段食管癌的可行性。方法我科单医疗组2012年3～8月在20例食管中下段癌根治术中行全胸腔镜下食管胃胸内吻合,运用普通胃肠吻合器(强生管型吻合器)行食管胃右胸内吻合以重建消化道,并腔镜下行吻合口减张缝合及大网膜包埋。结果 20例均获成功,无中转开胸。手术时间270～350min,平均310 min,其中胸腔镜胸部操作时间150～220 min,平均200 min,术中出血250～480 ml,平均350 ml。每例清除淋巴结11～27枚,平均19.9枚,阳性4例6枚(阳性率1.5%,6/398)。无围手术期死亡,术后2天即可下床活动。1例吻合口漏(1/20,5%),保守治愈。其余19例术后住院时间10～16 d,平均12 d。随访1～6个月,无死亡,无复发,进普食。结论全胸腔镜下食管胃胸内吻合术微创治疗中下段食管癌可行。Objective To explore the feasibility of total thoracoscopic anastomosis of tube-like stomach and esophagus in chest cavity in minimally invasive esophagectomy of middle-lower part of esophageal cancer. Methods Twenty patients with middle- lower esophageal cancer underwent total thoracoscopic anastomosis of tube-like stomach and esophagus in chest cavity between March 2012 and August 2012. Common gastrointestinal anastomat was used in digestive tract reconstruction. The surgical skills and short-term results were analyzed. Results No case was converted to open csophagectomy. The total operation time ranged from 270 to 350 min with a mean time of 310 min, and the VATS time was from 150 to 220 min with a mean time of 200 min. The operative blood loss was from 250 to 480 ml with a mean blood loss of 350 ml. 11 to 27 lymphnodes were removed in each patient（ 19.9 per patient in average） , and the total 6 lymphnodes in 4 cases turned out to be positive （ positive rate was 1. 5% , 6/398 ）. No patient died during hospitalization. The postoperative pain diminished significantly, and the patients could leave bed 2 days after operation. One case suffered anastomotic leak（ 1/20,5% ） , which was cured by conservative therapy. The postoperative hospital stay of the other 19 cases was from 10 to 16 days with a mean of 12 days. All of the patients received a follow-up from 1 to 6 months,during which, no death and recurrence were observed, and the patients reeoverd normal diet. Conclusions Total thoraeoscopic anastomosis of tube-like stomach and esophagus in chest cavity is feasible in minimally invasive esophagectomy of middle-lower esophageal cancer. It has less trauma and is worthy of wide clinical practice.

关 键 词：胸腔镜 胸内吻合术 食管癌 微创手术 

分 类 号：R735.1[医药卫生—肿瘤]