反穿刺法微创Ivor-Lewis食管癌根治术在食管下段癌中应用的单中心回顾性分析  

Reverse-puncture anastomosis in minimally invasive Ivor-Lewis esophagectomy for lower esophageal carcinoma:A single-center retrospective study

作　　者：费翔 杨立信 李鑫 朱吉 金海 陈和忠 陆超敬 FEI Xiang;YANG Lixin;LI Xin;ZHU Ji;JIN Hai;CHEN Hezhong;LU Chaojing(Department of Thoracic Surgery,Changhai Hospital,Naval Medical University,Shanghai,200433,P.R.China)

机构地区：[1]海军军医大学附属长海医院胸外科,上海200433

出　　处：《中国胸心血管外科临床杂志》2024年第3期364-370,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金青年科学基金项目(81802288)。

摘　　要：目的探讨应用反穿刺法行微创Ivor-Lewis食管癌根治术的可行性及临床疗效。方法回顾性分析2015年5月—2020年12月因食管下段癌在海军军医大学附属长海医院行反穿刺法全腔镜Ivor-Lewis手术患者的临床资料。优化的微创Ivor-Lewis手术技术要点:(1)幽门充分游离;(2)腹腔镜下管状胃制作;(3)半俯卧位单腔气管插管,人工气胸下游离食管及胸腔淋巴结清扫;(4)支气管封堵器完成左肺单肺通气;(5)反穿刺吻合技术行食管胃胸顶部吻合。结果纳入248例患者,其中男206例、女42例,平均年龄(63.3±7.4)岁。所有患者均在腔镜下顺利完成手术。手术时间(176±35)min,术中出血量(110±70)mL,清扫淋巴结个数(24±8)个,淋巴结转移率43.1%(107/248)。肺部总并发症13.7%(34/248),其中急性呼吸窘迫综合征6例,2例行气管插管呼吸机辅助呼吸。出血5例,2例行腔镜探查止血;Ⅲ型乳糜胸1例,行胸腔镜下胸导管结扎;Ⅱ型吻合口漏3例,其中1例患者因并发急性呼吸窘迫综合征死亡;迟发性气管胸胃瘘1例,二期手术后痊愈;Ⅰ型喉返神经损伤10例,均保守治疗后痊愈。所有患者至少随访16个月,中位随访时间44个月,患者3年生存率71.8%,5年生存率57.8%。结论优化的反穿刺法微创Ivor-Lewis手术治疗食管下段癌安全可行,长期生存效果满意。Objective To investigate the clinical efficacy of minimally invasive Ivor-Lewis esophagectomy(MIILE)with reverse-puncture anastomosis.Methods Clinical data of the patients with lower esophageal carcinoma who underwent MIILE with reverse-puncture anastomosis in our department from May 2015 to December 2020 were collected.Modified MIILE consisted of several key steps:(1)pylorus fully dissociated;(2)making gastric tube under laparoscope;(3)dissection of esophagus and thoracic lymph nodes under artificial pneumothorax with single-lumen endotracheal tube intubation in semi-prone position;(4)left lung ventilation with bronchial blocker;(5)intrathoracic anastomosis with reverse-puncture anastomosis technique.Results Finally 248 patients were collected,including 206 males and 42 females,with a mean age of 63.3±7.4 years.All 248 patients underwent MIILE with reverse-puncture anastomosis successfully.The mean operation time was 176±35 min and estimated blood loss was 110±70 mL.The mean number of lymph nodes harvested from each patient was 24±8.The rate of lymph node metastasis was 43.1%(107/248).The pulmonary complication rate was 13.7%(34/248),including 6 patients of acute respiratory distress syndrome.Among the 6 patients,2 patients needed endotracheal intubation-assisted respiration.Postoperative hemorrhage was observed in 5 patients and 2 of them needed hemostasis under thoracoscopy.Thoracoscopic thoracic duct ligation was performed in 1 patient due to the typeⅢchylothorax.TypeⅡanastomotic leakage was found in 3 patients and 1 of them died of acute respiratory distress syndrome.One patient of delayed broncho-gastric fistula was cured after secondary operation.Ten patients with typeⅠrecurrent laryngeal nerve injury were cured after conservative treatment.All patients were followed up for at least 16 months.The median follow-up time was 44 months.The 3-year survival rate was 71.8%,and the 5-year survival rate was 57.8%.Conclusion The optimized MIILE with reverse-puncture anastomosis for the treatment of lower e

关 键 词：食管癌 微创食管癌切除术 Ivor-Lewis 反穿刺吻合 预后 

分 类 号：R735.1[医药卫生—肿瘤]