366例电视胸腔镜食管癌切除术中及术后并发症分析  

Analysis of the intraoperative and postoperative complications for 366 thoracoscopic esophagectomies

作　　者：郭伟[1] 龚太乾[1] 蒋耀光[1] 王如文[1] 马铮[1] 牛会军[1] 刘学海[1] 杨帆[1] 孟胜蓝[1] 

机构地区：[1]第三军医大学附属医院野战外科研究所胸外科,重庆400042

出　　处：《中华胸心血管外科杂志》2014年第3期145-148,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 分析电视胸腔镜食管癌切除术中及术后并发症发生的特点.方法 回顾自2009年1月至2012年12月366例接受电视胸腔镜食管癌切除术的胸段食管癌患者临床资料,分析围术期情况.男278例,女88例;年龄（60.9±8.3）岁.病变长度（4.6±2.0）cm.行胸腔镜加开腹手术269例,胸腹腔镜联合手术97例.结果 全组手术时间（304.3 ±66.2）min;术中失血量（299.0±197.5） ml;清扫淋巴结（19.1±5.9）个.31例（8.5％）中转开放手术.术后死亡9例（2.5％）.术中并发症19例（5.2％）,术后并发症162例（44.3％）.结论 本组电视胸腔镜食管癌切除术中最常见并发症是出血（3.6％）,术后最常见的并发症是颈部吻合口瘘（16.7％）.患者术后死亡原因主要为吻合口-胸腔瘘及吻合口-气管瘘.Objective As one of the common approaches in minimally invasive esophagectomy （MIE）,thoracoscopic esophagectomy （TE）,was developed to reduce the trauma resulting from the surgical treatment of esophageal cancer.The aim of this study is to retrospectively analyze the clinicopathologic factors and perioperitive complieations of 366 patients underwent TE,evaluate the characteristic of complications after TE by reviewing the records.Methods From Jan 2009 to Dec 2012,366consecutive TE for esophageal cancer were performed in our department.The demographic characteristics,as well as the intraoperative and postoperative variables were collected retrospectively and evaluated.Among these 366 cases,278 were male and 88 were female.The mean age was （60.9 ± 8.3） years,with （4.6 ± 2.0） cm for mean length of lesion.Totally,there were 269 cases of TE and 97 cases of thoracolaparoscopic esophagectomy （TLE） were performed.Results The total operative time was （304.3 ±66.2） min.The mean blood loss was （299.0 ± 197.5） ml,while 19.1 ±5.9 retrieved nodes were harvested.In these patients,31 cases （8.5％） need conversion to thoracotomy during operation.Nine postoperative deaths were observed,and the operative mortality was 2.5％ （9/366）.Totally,the incidence of intraoperative complication was 5.2％（19/366）,and the postoperative mobidity was 44.3％ （162/366）.Conclusion The most common intraoperative complication of TE in this study is bleeding （with incidence of 3.6％,13/366）,while the anastomotic leakage （16.7％,61/366） is the most common postoperative complication.Among our patients in this study,the major cause of postoperative death is anastomotic stoma-thoracic fistula and anastomotic stoma-tracheal fistula.

关 键 词：食管肿瘤 胸外科手术 电视辅助 腹腔镜 食管切除术 手术后并发症 

分 类 号：R735.1[医药卫生—肿瘤]