电视胸腹腔镜联合食管癌切除术38例临床分析  

Clinical Analysis of 38 Patients with Esophageal Carcinoma Undergoing Thoracoscopic and Laparoscopic Esophagectomy

作　　者：余鑫[1] 刘懿[1] 杜铭[2] 王易林[1] 向舒[1] 

机构地区：[1]重庆三峡中心医院普胸外科,重庆404000 [2]重庆医科大学附属第一医院胸心外科,重庆400042

出　　处：《中国胸心血管外科临床杂志》2015年第5期467-470,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：重庆市万州区科委科研项目(201203004)~~

摘　　要：目的探讨胸腔镜联合腹腔镜食管癌切除术的临床效果。方法回顾性分析2011年3月至2013年3月行胸腔镜联合腹腔镜食管癌切除术38例食管癌患者的临床资料,其中男25例、女13例,年龄45-79（64.25±7.68）岁。手术采用左侧卧位胸腔镜下游离食管及清扫淋巴结,在腹腔镜下游离胃部,经纵隔食管床隧道上提胃至颈部进行胃-食管吻合。结果 38例患者均顺利完成手术,无术中死亡及术中大出血。总手术时间250-340 min,术中出血量80-350 ml。术中清扫淋巴结7-15（10.24±2.04）枚,其中8例发现淋巴结转移。术后病理分期T1N0M0 8例,T2N0M0 16例,T2N1M0 5例,T3N0M0 6例,T3N1M0 3例。术后发生颈部吻合口瘘4例,乳糜胸1例,肺部感染2例。术后随访3-12（6.31±2.18）个月,随访38例患者,失访1例,2例术后颈部吻合口瘘患者因胸部感染死亡,余患者均未出现肿瘤转移、复发或死亡。结论与常规开放手术相比,胸腔镜联合腹腔镜食管癌切除术的术中、术后并发症并未明显增加,甚至较前者更少,未来可在地区性大型综合医院进一步推广和应用。Objective To summarize the clinical experience of thoracoscopic and laparoscopic esophagectomy for esophageal carcinoma. Method We retrospectively analyzed the clinical data of 38 patients with esophageal carcinoma undergoing thoracoscopic and laparoscopic esophagectomy in Central Hospital of Chongqing Three Gorges between March 2011 and March 2013. There were 25 males and 13 females aged 64.25±7.68 years（ranged 45-79 years）. The esophagus was freed and the lymph nodes were cleaned under the thoracoscope in the left lateral position. Then the stomach was freed under laparoscope and lifted up to anastomose with the esophagus through the passageway behind the sternal bone. Results All surgical process progressed successfully without intraoperative death or major hemorrhage. The total operating time ranged from 250 to 340 minutes. The intraoperative hemorrhage ranged from 80 to 350 ml. The number of lymph nodes cleaned ranged from 7 to 15（10.24±2.04） and a total of 8 patients were found of tumor metastasis. Postoperative stage grading indicated 8 patients of T1N0M0, 16 patients of T2N0M0, 5 patients of T2N1M0, 6 patients of T3N0M0 and 3 patients of T3N1M0. Postoperative complications included chylothorax in 1 patient, pulmonary infection in 4 patients, and cervical anastomotic leakage in 4 patients. All 38 patients were followed up for 3 to 12（6.31±2.18） months, and 1 patient was lost. Two patients died from cervical anastomotic leakage resulting in chest infection. The other all achieved recoveries without metastatic or recurrence of tumor. Conclusion The intraoperative and postoperative complications of thoracoscopic and laparoscopic esophagectomy for esophageal carcinoma are less frequently than traditional surgery, so it＇s worthy of promotion in large regional general hospitals.

关 键 词：食管癌 电视胸腔镜 电视腹腔镜 微创手术 

分 类 号：R735.1[医药卫生—肿瘤]