先腹后胸改良McKeown入路的全腔镜食管癌切除  

Primary experience of a modified totally thoraco-laparoscopic McKeown procedure for esophageal cancer

作　　者：李剑锋[1] 赵辉[1] 刘彦国[1] 杨帆[1] 陈克终[1] 杨锋[1] 曹家顺 王俊[1] 

机构地区：[1]北京大学人民医院胸外科,北京100044

出　　处：《中华胸心血管外科杂志》2015年第11期653-655,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨先腹腔镜再胸腔镜、完全摒弃腹部小切VI的改良全腔镜三切口食管癌切除手术方法，进一步减少切口创伤，并评价其安全性和可行性。方法2011年7月至2014年10月，对34例食管中、上段癌采用改良MeKeown入路，先平卧位行腹腔镜操作，游离胃并镜下制作管状胃，置入空肠营养管，然后改侧俯卧位经胸腔镜完成食管游离、淋巴结清扫，最后在右颈部完成管状胃和食管的吻合。结果成功完成32例，2例因肿瘤外侵与左主支气管膜部关系密切而中转开胸。全组平均手术时间388．6min，平均出血337．2ml，平均清扫淋巴结26枚，平均术后住院16．3天。术后并发症发生率28．1％，无手术死亡。结论该手术方法实现了无腹部附加小切口的完全胸、腹腔镜操作，术后疼痛轻，并发症少，符合肿瘤治疗原则，是一种可选择的改良方案。Objective To evaluate the safety and efficacy of a modified procedure of totally minimally invasive esophage- etomy（MIE） which is designed to avoid mini-laparotomy and reduce postoperative pain. Methods From July 2011 to October 2014, 34 patients were selected to receive the modified method of MIE due to cancer in middle or upper part of esophagus. The sequence of McKeown procedure was partially changed. First, the stomach was mobilized and gastric tube was made through laparoscopy. Meanwhile, tube jejunostomy was added in the latest cases. Then, the patient was changed to left semi-prone po- sition. The esophagus was mobilized and lymph nodes were radically resected. Anastomosis of gastric tube and remaining e- sophagus was eventually performed at right side of the neck. Results 32 patients successfully undergone the modified proce- dure except 2 reversed to thoracotomy. Mean operative duration was 388.6 min. Mean blood lose was 337.2 ml. 26 lymphan- odes were harvested in each patient. Mean postoperative stay was 16.3 days. The modality rate was 28.1%. There was no mortality in this group. Conclusion This new procedure has made it possible to accomplish MIE without additional abdominal incision so as to further reduce mobidity rate and pain. It may become a modified method of McKeown procedure with equal re- quirement of oncology.

关 键 词：食管肿瘤 三切口食管切除术 胸腔镜 腹腔镜 

分 类 号：R655.4[医药卫生—外科学]