CAJ | 학술논문

目的探讨全腔镜下食管癌切除并利用经口输送钉砧头系统完成右侧胸腔内食管-胃吻合的可行性,并报告近期疗效.方法 2011年1至12月,30例食管癌患者行全腔镜Ivor Lewis径路食管癌切除食管-胃胸腔内吻合术.手术先在腹腔镜下游离胃和腹段食管,然后在胸腔镜下游离胸段食管并切除食管癌,采用经口输送钉砧头系统行胸腔镜下食管-胃胸腔内吻合.结果病变均位于食管中下段,平均长度3.8cm.全组手术均顺利,无术中并发症和中转开腹,开胸者.平均腹腔镜操作95min,胸腔镜操作177 min；术中平均出血量310ml.术后平均5.6天进食.术后病理诊断25例鳞状细胞癌,5例腺癌,切缘均阴性.胸部和腹部淋巴结每例平均清扫10.6和4.9枚.术后切口感染4例,乳糜胸1例,经保守治疗后好转；1例术后第6天因左侧膈疝行剖腹膈疝修补；无吻合口痿.结论利用经口输送钉砧头系统行全腔镜下食管癌切除胸腔内吻合术创伤小,术后恢复快,未发生吻合口瘘.全腔镜Lvor Lewis食管癌根治术足一种安全可行的手术方式.
목적 탐토전강경하식관암절제병이용경구수송정침두계통완성우측흉강내식관-위문합적가행성,병보고근기료효.방법 2011년1지12월,30례식관암환자행전강경Ivor Lewis경로식관암절제식관-위흉강내문합술.수술선재복강경하유리위화복단식관,연후재흉강경하유리흉단식관병절제식관암,채용경구수송정침두계통행흉강경하식관-위흉강내문합.결과 병변균위우식관중하단,평균장도3.8cm.전조수술균순리,무술중병발증화중전개복,개흉자.평균복강경조작95min,흉강경조작177 min；술중평균출혈량310ml.술후평균5.6천진식.술후병리진단25례린상세포암,5례선암,절연균음성.흉부화복부림파결매례평균청소10.6화4.9매.술후절구감염4례,유미흉1례,경보수치료후호전；1례술후제6천인좌측격산행부복격산수보；무문합구위.결론 이용경구수송정침두계통행전강경하식관암절제흉강내문합술창상소,술후회복쾌,미발생문합구루.전강경Lvor Lewis식관암근치술족일충안전가행적수술방식.
Objective To explore the feasibility and short-term efficacy of laparoscopic and thoracoscopic Ivor Lewis esophagectomy using a circular-stapled anastomosis with trans-oral anvil in treating esophageal carcinoma.Methods 30 consecutive patients with esophageal cancer received minimally invasive Ivor Lewis esophagectomy from January 2011 to December 2011.Operations of all the cases comprised of both abdominal and thoracic procedures which were performed with Iaparoscopic and thoracoscopic techniques respectively.The intrathoracic esophago-gastric anastomosis was created using a circular-stapled anastomosis with trans-oral anvil technique.Results There were 24 males and 6 female with median age of 62.5-year-old (from 47 to 82).The lesions located in middle and/or lower portion of the esophagus.25 patients with esophageal squamous cell cancer (n =25) and 5 patients with adenocarcinoma (n =5) underwent an Ivor Lewis esophagectomy.All the operations were successfully performed without intra-operative technical failures of the anastomosis or deaths.The mean operation time was 95 minutes in abdomen and 177 minutes in thorax.The mean blood loss was 310 ml.The mean number of harvested lymph nodes was 10.6 from thorax and 4.9 from abdomen.Postoperalively,there were thoracic wound infections in 4 patients.One patient had a left diaphragmatic hernia and was successfully treated by re-operation 6 days after first operation.One patient had chylothorax and recovered without surgery.There was no anastomotic leak and the patients were able to have spoon meat at 5.6 postoperative days.Conclusion Laparoscopic and thoracoscopic Ivor Lewis esophagectomy can be accomplished smoothly with acceptable occurrence of complications.The circular-stapled anastomosis with the trans-oral anvil is an efficient,safe and reproducible technique for intrathoracic esophago-gastric anastomosis.