侧俯卧位胸腔镜食管癌根治术31例临床分析  

Experience of 31 patients treated by thoracscopic esophagectomy in left lateral and forward inclination position

作　　者：胡文滕 蔡谦谦 蔺瑞江 马敏杰[2] 魏宁[2] 张瑜[2] 杨侃[2] 把海兰 韩彪[2] 

机构地区：[1]兰州大学第一临床医学院,甘肃兰州730000 [2]兰州大学第一医院胸外科,甘肃兰州730000

出　　处：《现代肿瘤医学》2016年第5期734-736,共3页Journal of Modern Oncology

基　　金：国家自然基金(面上项目)(编号:31471953);甘肃省自然科学基金(编号:1208RJZA137;096RJZA080)

摘　　要：目的:总结侧俯卧位胸腔镜食管癌根治术的临床经验。方法:回顾性分析2013年9月至2015年6月,我院全胸腔镜治疗的食管癌患者31例。采用全身麻醉,双腔管气管插管,由同一组医师行侧俯卧位胸腔镜游离胸段食管并清扫纵隔淋巴结,开腹游离胃,直线切割缝合器制作管状胃,通过胸骨后路径上提管胃,食管胃左颈部吻合。结果:中转开胸4例,手术时间(4.5±1.8)h,术中出血量(150±60)ml,术后胸腔引流管放置时间(5±3)d,术后住院时间(11±5)d。5例患者术后出现并发症,其中颈部吻合口瘘2例,颈部吻合口狭窄1例,胸腔积液1例,声音嘶哑1例。结论:侧俯卧位胸腔镜食管切除术在技术上是安全、微创、可行的。Objective: To summarize the clinical experience of thoracscopic esophagectomy in left lateral and forward inclination position. Methods: From September 2013 to June 2015,31 patients underwent thoracoscopic esophagectomy in left lateral and forward inclination position. Patients had a left lateral position and 45° forward inclination after anesthesia. Thoracic esophagus dissociation and lymph nodes dissection were finished with totally thoracoscopic surgery. After thoracic surgery was done,supine position was needed to dissociate stomach and dissect lymph nodes through laparotomy surgery. Stomach tube was pulled through after the sternum path and was coincided with cervical esophagus at neck. Results: Average operative time was( 4. 5 ± 1. 8) h,average blood loss during operation was( 150 ±60) ml. The chest tube duration was( 5 ± 3) d and postoperative hospital stay was( 11 ± 5) d. Perioperative complication occurred in 5 patients,including 2 cases of cervical anastomotic leak,anastomotic stenosis in 1 case,pleural effusion in 1 case and voice hoarse in 1 case. Conclusion: Thoracoscopic esophagectomy in left lateral and forward inclination position is technically safe,minimally invasive,feasible.

关 键 词：食管癌 侧俯卧位 胸腔镜 

分 类 号：R735.1[医药卫生—肿瘤]