前倾左侧卧位全胸腔镜食管癌根治术  

Totally thoracscopic esophagectomy in left lateral and forward inclination position

作　　者：潘铁文[1] 吴彬[1] 徐志飞[1] 赵学维[1] 钟镭[1] 薛磊[1] 孙光远[1] 唐华[1] 陶显东[1] 

机构地区：[1]第二军医大学附属长征医院胸外科,上海200003

出　　处：《中国内镜杂志》2013年第5期499-502,共4页China Journal of Endoscopy

摘　　要：目的探讨前倾左侧卧位全胸腔镜食管癌根治术的手术方法及临床效果。方法对32例食管癌患者行全胸腔镜食管癌根治术,于前倾45°左侧卧位行全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开腹或腹腔镜胃游离及淋巴结清扫,12例腹腔镜游离胃后,正中小切口完成管状胃的制作,再将管状胃从食管床拉至颈部与颈段食管吻合。结果总手术时间174～325min,平均247min;总出血量100～800mL,平均250mL。共清扫淋巴结472枚,平均每例14.75枚;术后住院8～32d,平均12.6d。住院期间无死亡,术后并发症:肺部感染1例,颈部吻合口漏3例,声音嘶哑3例。1年生存率100%,2年生存率81.25%。结论前倾左侧卧位全胸腔镜食管癌根治术技术是可行、安全的。近期疗效同传统食管癌根治术相比无显著差异。[Objective] To study the clinical feasibility and effects of totally thoracoscopic surgery （TTS） in left lateral and forward inclination position for esophageal carcinoma. [Methods] From July 2007 to July 2011, 32 patients underwent TTS for esophageal cancer. Patients had a left lateral position and 45° forward inclination after anesthesia. Thoracic esophagus dissociation and lymph nodes dissection were finished with totally thoracoscopic surgery. After thoracic surgery was done, Supine position was needed to dissociate stomach and dissect lymph nodes through laparotomy or laparoscopic surgery. 12 patients among all underwent laparoscopic surgery to dissociate their stomachs. A small incision was made in the middle of abdomen, stomach tube was pulled through esophageal bed and was coincided with cervical esophagus at neck. [Results] Total operative time was 174～325 min, average time was 247min; Total blood loss during operation was 100～800 mL and average was 250 mL; The total number of lymph nodes dissection was 472 and 14.75 each patient in average; Total hospital stay after surgery was 8～32 d and the median was 12.6 d. Perioperative complication occurred in 7 patients, including 3 cases of cervical anastomotic leak, lung infection in 1 case and hoarseness in 3 cases 1-year survival rate was 100% and 2-year survival rate was 81.25%. [Conclusion] It is demonstrated that esophagectomy with TTS in left lateral and forward inclination position was feasible and safe technique. Its short-term effect was no significant difference with traditional esophagectomy.

关 键 词：食管癌根治术 全胸腔镜 生存率 

分 类 号：R735.1[医药卫生—肿瘤]