右支气管封堵及气胸下微创食管癌根治术  

Minimally invasive esophagectomy with right bronchial occlusion under artificial pneumothorax

作　　者：张毅[1] 魏翔[2] 朱学海[2] 程才[2] 潘铁成[2] 

机构地区：[1]江汉大学附属第三医院胸心外科,湖北武汉430300 [2]华中科技大学同济医学院附属同济医院心胸外科,湖北武汉430030

出　　处：《中国内镜杂志》2013年第8期789-792,共4页China Journal of Endoscopy

摘　　要：目的初步总结右侧支气管封堵、左侧半俯卧位及气胸条件下胸腹腔镜联合食管次全切除及选择性三野淋巴结清扫手术的临床经验。方法手术治疗食管癌患者166例,均采用右侧支气管封堵、左侧半俯卧位及气胸条件下胸腹腔镜联合食管次全切除及选择性三野淋巴结清扫手术。结果 166例均采用右侧支气管封堵、左侧半俯卧位及气胸条件同时应用胸腹腔镜联合食管次全切除,109例行二野淋巴结清扫,57例行三野淋巴结清扫。平均手术时间（202.5±21.3）min,其中胸腔镜游离时间平均（98.4±15.5）min,术中平均出血量（39.6±4.2）mL,均无术中输血,平均每例清扫淋巴结（28.4±5.2）个,住院时间平均11.3（7~95）d。术后发生并发症49例（29.5%）：吻合口瘘11例（6.6%）,喉返神经损伤14例（8.4%）,心血管并发症16例（9.6%）,肺部并发症11例（6.6%）;死亡2例（1.2%）,死因为肺部感染。结论采用右侧支气管封堵、左侧半俯卧位及气胸条件下胸腹腔镜联合食管次全切除及选择性三野淋巴结清扫治疗食管癌在技术上是安全可行的手术方式。【Objective】To assess the safety and feasibility of thoracoscope-laparoscopic subtotal esophagectomy and selective three-field lymphadenectomy with the right bronchial occlusion in left semiprone position under artificial pneumothorax for esophageal carcinoma.【Methods】166 esophageal carcinoma patients were performed thoracoscope-laparoscopic subtotal esophagectomy and selective three-field lymphadenectomy with the right bronchial occlusion in left semiprone position under artificial pneumothorax.【Results】All the patients underwent thoracoscopelaparoscopic subtotal esophagectomy were conducted successfully in leftward semiprone position under artificial pneumothorax.Among them,109 patients received two-field lymphadenectomy and 57 received three-field lymphadenectomy.The average operative time was（202.5 ±21.3） min,the average thoracoscopic operative time was（98.4±15.5） min,and the blood loss was（39.6±4.2） mL,and no blood transfusion during the surgery.Mean lymph node harvest was（28.4±5.2） nodes.Hospital stay ranged from 7 to 95 days and the average was 11.3 days.The postoperative complication rate was 29.5%,including 11（6.6%） of anastomotic leakage,14（8.4%） of recurrent laryngeal nerve injury,16（9.6%） of cardiovascular complication and 11（6.6%） of pulmonary complications.Two patients died of the pulmonary infection,and the mortality rate was 1.2%.【Conclusions】It is feasible and safe for us to take thoracoscope-laparoscopic subtotal esophagectomy and selective three-field lymphadenectomy with the right bronchial occlusion in left semiprone position under artificial pneumothorax for esophageal carcinoma,and deserves to be popularize.

关 键 词：支气管封堵 人工气胸 微创 食管切除术 

分 类 号：R655.4[医药卫生—外科学]