胸腔镜食管癌手术上纵隔缝合方法及经验总结  

Cinical experience of upper mediastinum suture in thoracoscopic radical resection of esophageal carcinoma

作　　者：孙超[1] 石维平[1] 吕小夏[1] 邹辉[1] 束余声[1] 陆世春[1] 金卫国[1] 王霄霖 

机构地区：[1]江苏省苏北人民医院胸心外科,扬州225001

出　　处：《中华腔镜外科杂志（电子版）》2017年第4期226-229,共4页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的介绍胸腔镜食管癌根治术中上纵隔的缝合方法,评判其操作的可行性及必要性。方法回顾性分析2015年7月至2017年6月期间扬州市苏北人民医院胸心外科收治的行胸腔镜食管癌手术的248例患者,对其中245例患者在术中胸胃上提至颈部吻合后行胸腔镜下上纵隔缝合,总结并分析术中发现胸腔出血、管状胃扭转和术后并发症发生情况。结果术中行胸腔镜下上纵隔缝合时发现纵隔床出血2例,管状胃切缘出血2例,管状胃扭转1例,及时做出相应处理。术后未发生因胸腔出血的二次手术、未发生上纵隔管状胃扩张。吻合口瘘入胸腔2例(均局限于胸顶部)。结论胸腔镜食管癌根治术中可以顺利完成上纵隔的缝合,并通过再次观察胸腔情况可以减少术后出血、胃扭转、胃扩张、吻合口瘘入胸腔等严重并发症的发生。Objective To introduce the suture method of upper mediastinum in thoracoscopic radical resection of esophageal carcinoma,and to evaluate the feasibility and necessity of the technique.Methods A total of 248 patients undergoing thoracoscopic esophagectomy were retrospectively included in this study from Jul. 2015 to Jun. 2017 in Department of Cardithoracic Surgery of Northern Jiangsu People＇s Hospital. 245 patients were underwent upper thoracoscopic mediastinal suture. Summarize and analyze the incidence of the intraoperative bleeding, volvulus of tubular stomach, postoperative complications.Results 2 cases of mediastinal hemorrhage,2 cases of the margin of tubular stomach and 1 case of volvulus of tubular stomach were found while stitching the upper mediastinum. There was no reoperation because of bleeding after operation,and there was no dilatation of tubular stomach in the upper mediastinum. There were 2 cases of anastomotic leakage occurred in the thoracic cavity（ both confined to the top of the chest）.Conclusions The suture of the upper mediastinum can be successfully completed in thoracoscopic resection of esophageal cancer. By observing the chest cavity again,the incidence of postoperative bleeding,volvulus of tubular stomach,dilatation of the stomach and intrathoracic anastomotic leakage can be reduced.

关 键 词：胸腔镜 食管癌切除术 并发症 

分 类 号：R735.1[医药卫生—肿瘤]