CAJ | 학술논문

目的探讨食管及其周围结构的微创解剖特点在胸腹腔镜下食管癌三野淋巴结清扫术中的应用.方法回顾性分析2011年7月至2012年9月间汕头市中心医院收治的67例食管癌患者的临床资料,所有病例均行三野淋巴结清扫术,根据食管系膜的微创解剖学特点选择恰当的操作平面;胸腔镜下以奇静脉为界,将操作空间分为上、下食管三角；胰腺是腹腔镜下胃游离的关键解剖标志,胰周间隙是腹腔镜手术和天然外科平面；椎前筋膜是颈部清扫的底面,两侧则以颈动脉鞘为界.结果全组手术时间220～320(平均251.6)min,术中出血量为40～320(平均105.6)ml.共清扫淋巴结1949枚,每例13～46(平均29.1)枚,其中胸区淋巴结平均15.1枚/例,腹区8.2枚/例,颈区5.8枚/例.无围手术期死亡病例.术后随访2～14(平均8.2)月,随访率98.5％(66/67),受访患者均存活,出现反流性食管炎10例,吻合口狭窄3例.结论建立腔镜下整体解剖观念、明确食管系膜的解剖层面和镜下定位,有助于提高腔镜食管癌根治术的安全性和根治性.
목적 탐토식관급기주위결구적미창해부특점재흉복강경하식관암삼야림파결청소술중적응용.방법 회고성분석2011년7월지2012년9월간산두시중심의원수치적67례식관암환자적림상자료,소유병례균행삼야림파결청소술,근거식관계막적미창해부학특점선택흡당적조작평면;흉강경하이기정맥위계,장조작공간분위상、하식관삼각；이선시복강경하위유리적관건해부표지,이주간극시복강경수술화천연외과평면；추전근막시경부청소적저면,량측칙이경동맥초위계.결과 전조수술시간220～320(평균251.6)min,술중출혈량위40～320(평균105.6)ml.공청소림파결1949매,매례13～46(평균29.1)매,기중흉구림파결평균15.1매/례,복구8.2매/례,경구5.8매/례.무위수술기사망병례.술후수방2～14(평균8.2)월,수방솔98.5％(66/67),수방환자균존활,출현반류성식관염10례,문합구협착3례.결론 건립강경하정체해부관념、명학식관계막적해부층면화경하정위,유조우제고강경식관암근치술적안전성화근치성.
Objective To explore the anatomic features of mesoesophagus in combined thoracoscopic and lapamscopic esophagectomy with three-fields lymphadenectomy.Methods Clinical data of 67 patients undergoing thoracoscopic and laparoscopic esophagectomy with three-fields lymphadenectomy from July 2011 to September 2012 were analyzed retrospectively.All the patients underwent three-fields lymphadenectomy.Proper surgical planes were selected according to anatomy of mesoesophagus.Thoracoscopic surgical space was bounded on azygotic vein and divided into upper and low esophageal triangle.Pancreas was the key anatomical mark for laparoscopic gastric dissection,and peripancreatic space was the natural laparoscopic surgical plane.Prevertebral fascia was bottom surface of neck dissection and carotid sheath was the boundary of two sides.Results The median operative time was 251.6 min(range,220 to 320 min).The median operative blood loss was 105.6 ml (range,40 to 320 ml).The median number of lymph nodes dissected was 29.1 (range,13 to 46,totally 1949).There was no perioperative death.Sixtysix patients were followed up with a mean follow-up time of 8.2 months (range,2 to 14 months).Postoperative complications included reflux esophagitis in 10 and anastomotic stenosis in 3 cases.Conclusion It is safe and more radical for minimally invasive esophagectomy that overall concept of minimally invasive anatomy of mesoesophagus is applied to identify the anatomic plane and landmark during operation.