单孔充气式纵隔镜联合腹腔镜食管癌根治术的应用价值  

Application value of single-port inflatable mediastinoscopy combined with laparoscopy in the radical resection of esophageal cancer

作　　者：何伟[1] 乔志雄 何进喜[1] 蔡宝宁[1] 韩育宁[1] 陆相杨[1] He Wei;Qiao Zhixiong;He Jinxi;Cai Baoning;Han Yuning;Lu Xiangyang(Department of Thoracic Surgery,General Hospital of Ningxia Medical University,Yinchuan 750001,China)

机构地区：[1]宁夏医科大学总医院普胸外科,银川750001

出　　处：《中华消化外科杂志》2018年第9期954-958,共5页Chinese Journal of Digestive Surgery

基　　金：宁夏回族自治区自然科学基金（NZl5136）

摘　　要：目的探讨单孔充气式纵隔镜联合腹腔镜食管癌根治术的应用价值。方法采用回顾性描述研究方法，收集2016年9月至2018年4月宁夏医科大学总医院收治的27例行单孔充气式纵隔镜联合腹腔镜食管癌根治术患者的临床病理资料。手术操作者分为两组，一组行颈部操作，一组行腹部操作。利用一根“Y”型管，给予纵隔及腹部同时进行CO，充气，气体压力值为12~16mmHg（1mmHg=0．133kPa）。双侧相向游离食管并会师，剑突下作小切口，白贲门处离断食管，残胃制作直径3～5cm管状胃，于管状胃最高点缝线，同时自颈部提出食管，食管上端吻合器头予以荷包缝合，经纵隔食管床将管状胃牵拉至左颈行胃食管手工吻合或器械吻合。观察指标：（1）手术和术后恢复情况。（2）随访和生存情况。采用电话或门诊方式随访．了解患者生存情况。随访时间截至2018年5月。正态分布的计量资料以x±s表示，偏态分布的计量资料以肘（范围）表示。结果（1）手术和术后恢复情况：27例患者顺利完成行单孔充气式纵隔镜联合腹腔镜食管癌根治术，无中转开胸，完整切除肿瘤；术中心电监测均未出现心律失常或心肌缺血，27例患者中5例术中发生胸膜破裂，3例因显著的血流动力学变化而问断停用CO2充气。患者手术时间为（121±21）min，术中出血量为（100±30）mL。27例患者无胸部切口，术后疼痛明显降低，术后第1天下床活动。患者术后纵隔引流管引流量为（40±10）mL，常规进食1周后拔除纵隔引流管。27例患者中5例出现胸腔积液，给予穿刺引流后治愈；2例出现吻合口瘘，其中l例发生于术后12d，颈部切口皮下少量积气，未予特殊治疗，患者继续经口进食后自愈，另1例发生于术后1个月，为患者进食硬质食物后出现颈部皮下少量积气，继续进食流质食物1周后愈合：1例出现吻�Objective To explore the application value of single-port inflatable mediastinoscopy combined with laparoscopy in the radical resection of esophageal cancer. Methods The retrospective descriptive study was conducted. The clinicopathological data of 27 patients who underwent single-port inflatable mediastinoscopic and laparoscopic radical resection of esophageal cancer in the General Hospital of Ningxia Medical University between September 2016 and April 2018 were collected. The surgical operators were divided into neck operation group and abdomen operation group. A “Y” tube was used to inflate the abdomen and mediastinum simultaneously with CO2, and the gas pressure was 12-16 mmHg （ 1 mmHg = 0.133 kPa）. Bilateral exchange free and join forces with the esophagus and xiphoid process operating small incision, the severed esophagus cardia; residual stomach was made into a 3-5 cm tubular stomach and was sutured at the top point; at the same time, esophagus was brought up from the neck, with a pouch suture between upper esophageal and stapling head; the tubular stomach through mediastinum-esophagus bed was pulled to the left neck and then gastroesophageal anastomosis manually or instrument was performed. Observation indicators ： （ 1 ） surgical and postoperative recovery; （2） follow-up and survival situations. Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to May 2018. The measurement data with normal distribution were represented as x±s. The measurement data with skewed distribution were described as M （range）. Results （1） Surgical and postoperative recovery： all the 27 patients underwent successful single-port inflatable mediastinoscopic and laparoscopic radical resection of esophageal cancer, with complete tumor resection and without conversion to open surgery. There was no arrhythmia or myocardial ischemia through intraoperative electrocardiography. Among 27 patients, 5 had intraoperative rupture of the pleura and 3 stoppe

关 键 词：食管肿瘤 联合手术 根治术 纵隔镜检查 腹腔镜检查 

分 类 号：R735.1[医药卫生—肿瘤]