CAJ | 학술논문

目的探讨食管癌根治性切除术中应用联合腔镜的可行性和近期疗效及手术适应证.方法回顾性分析2009年12月至201 1年8月139例食管癌患者施行联合腔镜食管癌切除术的临床资料.食管癌位于上段者16例,中段107例,下段者16例.手术先用胸腔镜游离胸段食管并清扫淋巴结,再用腹腔镜游离胃行食管胃左颈部吻合.术后病理分期:Ⅰ期25例(Ⅰ a期13例、Ⅰb期12例),Ⅱ期71例,Ⅲ期31例(Ⅲa期16例、Ⅲb期15例),Ⅳ期12例.结果除4例中转开胸手术,中转率2.9％外,其余全部顺利完成手术.术后出现吻合口瘘6例、心律失常4例和乳糜胸、胃排空障碍各1例,均保守治愈；吻合口狭窄2例扩张治疗后治愈；肺部感染11例,3例气管切开、呼吸机辅助呼吸,其中1例死亡(0.7％)；10例声音嘶哑.130例随访1～20个月,10例死亡,其中癌转移6例、肺部感染和精神抑郁各1例、不明原因2例.24例患者1年生存率88.9％.结论胸、腹腔镜联合行食管癌根治术在技术上足安全可行的,近期疗效满意.不仅适应于早、中期食管癌,而且适用于部分晚期病例.
목적 탐토식관암근치성절제술중응용연합강경적가행성화근기료효급수술괄응증.방법 회고성분석2009년12월지201 1년8월139례식관암환자시행연합강경식관암절제술적림상자료.식관암위우상단자16례,중단107례,하단자16례.수술선용흉강경유리흉단식관병청소림파결,재용복강경유리위행식관위좌경부문합.술후병리분기:Ⅰ기25례(Ⅰ a기13례、Ⅰb기12례),Ⅱ기71례,Ⅲ기31례(Ⅲa기16례、Ⅲb기15례),Ⅳ기12례.결과 제4례중전개흉수술,중전솔2.9％외,기여전부순리완성수술.술후출현문합구루6례、심률실상4례화유미흉、위배공장애각1례,균보수치유；문합구협착2례확장치료후치유；폐부감염11례,3례기관절개、호흡궤보조호흡,기중1례사망(0.7％)；10례성음시아.130례수방1～20개월,10례사망,기중암전이6례、폐부감염화정신억욱각1례、불명원인2례.24례환자1년생존솔88.9％.결론 흉、복강경연합행식관암근치술재기술상족안전가행적,근기료효만의.불부괄응우조、중기식관암,이차괄용우부분만기병례.
Objective To study the indication,feasibility and short-term efficacy of combined thoracoscopic and laparoscopic radical esophagectomy for the treatment of esophageal cancer.Methods Retrospective medical records analysis was conducted for 139 esophageal cancer patients who underwent combined thoracoscopic and laparoscopic esophagectomy in our department from December 2009 to August 2011.The tumors were located in upper esophagus in 16 cases,middle esophagus in 107 cases,and lower esophagus in 16 cases.The surgery started with the thoracoscopic mobilization of thoracic esophagus and lymph nodes dissection,which were followed by the laparoscopic stomach mobilization and gastroesophageal anastomosis in left neck.Postoperative pathological staging identified stage Ⅰ esophageal cancer in 25 cases ( stage Ⅰ a:13 cases,stage Ⅰ b:12 cases),stage Ⅱ esophageal cancer in 71 cases,stage Ⅲ esophageal cancer in 31 cases ( stage Ⅲ a:16 cases,stage Ⅲ b:15 cases) and stage Ⅳ esophageal cancer in 12 cases.Results Except for open conversions in 4 cases (2.9％),all surgical operations were completed smoothly.Postoperative anastomotic leak was found in 6 cases(4.3％ ),chylothorax in 1 case(0.7％ ),arrhythmia in 4 cases(2.9％ ),and dumping syndrome in 1 case( 0.7％ ).All of these complicated cases fully recovered after conservative treatments.Postoperative lung infection was found 11 cases (7.9％),3 of whom required tracheotomy and assisted ventilation and 1 case died as a result of the infection (mortality rate:0.7％ ).Ten cases(7.2％ ) presented with hoarseness postoperatively.Out of the 139 cases,130 cases were successfully followed up with durations ranged from 1 to 20 months,during of time the esophageal cancer spread to liver in 2 cases,celiac lymph nodes in 4 cases,lung in 2 cases,and bone in 1 case.Ten cases died,and all remaining cases remained alive during the follow up.The one-year survival rate was 88.9％ for these cases.Conclusion Combined thoracoscopic and laparoscopic radical esophagectomy is a technically safe and feasible treatment for esophageal cancer.The short-term efficacy results are satisfactory.This technique is indicated not only for early and middle stage esophageal cancer,but also for some of the advanced esophageal cancer cases.