胸腹腔镜联合食管癌根治术右胸内吻合38例  

Combined laparoscopic and thoracoscopic esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity ： analysis of 38 cases

作　　者：陈安国[1] 张仁泉[1] 夏万里[1] 康宁宁[1] 葛威[1] 朱克超[1] 于在诚[1] 

机构地区：[1]安徽医科大学第一附属医院普胸外科,合肥230022

出　　处：《中华胸心血管外科杂志》2013年第9期525-527,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨胸腹腔镜经右胸食管癌根治术并右胸内吻合的手术方法及可行性。方法回顾性分析全胸腹腔镜下食管癌根治并右胸内吻合术的38例患者，腹腔镜下游离胃，腔内直线切割缝合器行管状胃成形并空肠造瘘；胸腔镜下游离中下段食管，将胃提至奇静脉弓水平，使用吻合器行胃一食管吻合。结果手术平均280min，过程顺利，无中转开胸、腹手术病例。术中出血平均约120ml，所有病例均无肺部并发症，无吻合口瘘。1例出现胃排空障碍，1例出现乳糜胸，无死亡病例，均治愈出院。结论胸腹腔镜经右胸食管癌根治术并胸内吻合手术是安全可行的，并且具有创伤小、术中出血少、痛苦轻、术后恢复快等优点。Objective To investigate the feasibility of combined laparoscopic and thoracoscopic esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity. Methods We retrospectively analyzed the clinical data of 38 patients who underwent esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity from October 2011 to August 2012. To remove the stomach in laparoscopie and the esophagus in thoracoscopy. The main portion of a gastric conduit is created using three to four firings of a linear stapler（ Ethicon Endo-surgery, Cincinati, OH） and jejunum stoma. Gastric conduit was pulled into the chest cavity and anastomosed to the esophagus. Results The av- erage operative time was 280 minutes, the mean operative blood loss was 120 ml. No patient required laparotomy. No pulmona- ry complications or anastomotic leaks occurred. One had gastric retention, another one had chylous hydrothorax. All patients were cured, no one dead in hospital. Conclusion Combined laparoscopic and thoracoscopic esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity is technically feasible and safe, minimized trauma, less op- erative blood loss and quick recovery.

关 键 词：食管肿瘤 食管切除术 胸腔镜 腹腔镜 胸内吻合 

分 类 号：R735.1[医药卫生—肿瘤]