CAJ | 학술논문

目的评估应用胸、腹腔镜联合手术治疗食管癌的可行性和疗效.方法回顾分析2007年7月至2009年12月,81例在电视胸腔镜、腹腔镜联合辅助下经右胸、腹、左颈,行食管次全切除术及纵隔区、腹区两野淋巴结清扫术病人的临床资料.结果所有病例均在胸、腹腔镜联合下完成食管癌根治术.全组总手术196～315 min,平均每例270.5 min,腹腔镜下胃游离及腹区淋巴结清扫40～90 min,平均约64.5 min;胸腔镜食管游离及纵隔淋巴结清扫60～125 min,平均81.2 min.全组共清扫淋巴结1652枚,平均每例20.4枚(5～41枚),转移率30.9%(25/81例);纵隔区淋巴结1012枚,平均每例12.5枚;清扫腹区淋巴结591枚、平均每例7.3枚.术中无大出血,腹腔出血30～100 ml,平均42.4 ml;胸腔出血60～300 ml,平均121.5 ml.术后住院8～45天,平均9.2天.术后早期并发症发生率为27.2%,呼吸衰竭1例死亡.肺部感染10例、喉返神经损伤5例、颈部吻合口瘘3例、乳糜胸2例、管状胃瘘1例和胸胃扩张各1例.术后79例随访2～31个月,平均14.2个月;死亡7例,总体生存率为91.1%.近中期并发症发生率为27.8%,其中反流性食管炎12例、复发或转移6例、吻合口狭窄5例.结论胸、腹腔镜联合手术治疗食管癌创伤小,并发症低,生活质量改善.该术式技术上可行,其达到肿瘤根治目的及临床疗效方面是有效的.
목적 평고응용흉、복강경연합수술치료식관암적가행성화료효.방법 회고분석2007년7월지2009년12월,81례재전시흉강경、복강경연합보조하경우흉、복、좌경,행식관차전절제술급종격구、복구량야림파결청소술병인적림상자료.결과 소유병례균재흉、복강경연합하완성식관암근치술.전조총수술196～315 min,평균매례270.5 min,복강경하위유리급복구림파결청소40～90 min,평균약64.5 min;흉강경식관유리급종격림파결청소60～125 min,평균81.2 min.전조공청소림파결1652매,평균매례20.4매(5～41매),전이솔30.9%(25/81례);종격구림파결1012매,평균매례12.5매;청소복구림파결591매、평균매례7.3매.술중무대출혈,복강출혈30～100 ml,평균42.4 ml;흉강출혈60～300 ml,평균121.5 ml.술후주원8～45천,평균9.2천.술후조기병발증발생솔위27.2%,호흡쇠갈1례사망.폐부감염10례、후반신경손상5례、경부문합구루3례、유미흉2례、관상위루1례화흉위확장각1례.술후79례수방2～31개월,평균14.2개월;사망7례,총체생존솔위91.1%.근중기병발증발생솔위27.8%,기중반류성식관염12례、복발혹전이6례、문합구협착5례.결론 흉、복강경연합수술치료식관암창상소,병발증저,생활질량개선.해술식기술상가행,기체도종류근치목적 급림상료효방면시유효적.
Objective To assess the feasibility and clinical efficacy of minimally invasive esophagectomy for esophageal cancer.Methods From July 2007 to December 2009,eighty-one patients with esophageal cancer received combined thoracoscopic and laparoscopic esophagectomy with anastomosis in the neck.All clinical data were retrospectively reviewed.Results The median operative time was 270.5 min (range 196-315 min).The median time of gastric mobilization and abdominal lymph node dissection was 64.5 min,and the median time of esophageal dissection and mediastinall lymph node dissection was 81.2 min.The median blood loss was 121.5 ml for the thoracic phase and 42.4 ml for abdomen phase.The mean number of disected lymph nodes was 20.4 (range 5-41) with metastastic rate of 30.9% (25/81).The mean harvest lymph node was 12.5 in chest and 7.3 in abdomen.Perioperative complications rate was 27.2%,including respiratory failure in 1 case,pulmonary infection in 10,anastomotic leak in 3,chylothorax in 2,gastric tube dilatation in 1,gastric tube leak in 1.And recurrent laryneal nerve injury in 5 .Seventy-nine patients were followed up withmMean follow up time of 14.2 months( range 2-31 months).The overall one-year survival rate was 91.1%.Postoperative complications included anastomotic stenosis in 5 cases (6.3%),reflux esophagitis in 12 (15.2%) and recurrence or metastasis in 6 (7.6%).Conclusion Minimally invasive esophagectomy for esophageal cancer can mimimus trauma,reduce post-operative complications,improve the quality of life,which is feasible and effective from the point of the clinical efficacy and the purpose of tumor therapy.