菱形吻合技术在胸腔镜和腹腔镜联合治疗中下段食管癌中的应用  

Diamond.shaped anastomosis in Ivor Lewis minimally invasive esophagectomy for esophageal carcinoma

作　　者：李力[1] 秦应之[1] 何嘉[1] 马冬捷[1] 田震寰[1] 黄诚[1] 陈野野[1] 李单青[1] 

机构地区：[1]中国医学科学院北京协和医院胸外科,100730

出　　处：《中华普通外科杂志》2017年第6期485-487,共3页Chinese Journal of General Surgery

摘　　要：目的探讨菱形吻合技术在经腹、右胸微创手术治疗中下段食管癌中的应用及其近期效果。方法回顾性分析北京协和医院2015年12月至2016年11月期间采用菱形吻合技术完成的12例经腹、右胸微创食管癌切除术患者的临床资料。结果12例中下段食管癌患者的手术均在联合胸腔镜和腹腔镜下完成，平均手术时间为（378±56）min，术中平均出血量为（280±120）ml，平均术后住院（12.2±2.0）d，无食管切缘肿瘤残留，无围手术期死亡。术后发生1例肺不张合并肺部感染，1例单侧喉返神经损伤，无吻合口瘘或狭窄。中位随访时间7个月（1 ～15个月），1例发生腹壁皮下转移结节，再次手术切除；其余11例均未出现手术相关远期并发症及肿瘤进展。结论菱形吻合技术治疗中下段食管癌操作相对方便，安全可靠，初步治疗效果较满意。Objective To evaluate initial results of Ivor Lewis minimally invasive esophagectomy （MIE） for esophageal carcinoma using a diamond-shaped anastomosis with 45 mm linear-stapler. Methods Clinical data of 12 patients diagnosed middle to distal esophageal carcinoma and undergoing Ivor Lewis minimally invasive esophagetomy using a diamond-shaped anastomosis technique during Dec. 2015 and Nov. 2016 in Peking Union Medical College Hospital were collected and analyzed retrospectively. Results The mean operation time was （378 ± 56） min, the mean blood loss was （280 ± 120） ml, and the mean postoperative hospital stay was （12.2± 2.0） days. No positive margin, no peri-operative death occurred. Postoperative complication included atelectasis and pulmonary infection in 1 patient, paresis of left recurrent laryngeal nerve in 1 patient. No anastomotic leak or constriction occurred. Median follow up was 7 months, 11 patients had no evidence of disease progress, 1 patient had subeutanecous metastasis and was reoperated. Conclusion The diamond anastomosis technique utilizing in Ivor Lewis MIE for esophageal carcinoma is feasible, easy to manipulate, safe and reliable.

关 键 词：食管肿瘤 吻合术 外科 食管切除术 胸腔镜 腹腔镜 

分 类 号：R735.1[医药卫生—肿瘤]