CAJ | 학술논문

目的总结联合腔镜食管癌根治术后主要并发症并探讨其防治方法.方法回顾性分析2009年12月至2012年7月291例行联合腔镜食管癌根治术患者的临床资料.肿瘤位于食管上段者20例,中段239例,下段者32例.行胸腹腔镜联合颈部吻合(McKeown术)230例；胸腹腔镜联合右胸内吻合(微创Ivor Lewis术)61例.术后病理分期:Ⅰ期55例(Ⅰ a期28例、Ⅰ b期27例),Ⅱ期109例,Ⅲ期69例(Ⅲa期36例、Ⅲb期33例),Ⅳ期58例.结果除4例中转手术(1.4％)外,其余全部顺利完成手术.术后主要并发症:吻合口瘘13例(4.5％),吻合口狭窄5例(1.7％),肺部感染54例(18.6％)、7例并发呼吸衰竭行气管切开、呼吸机辅助呼吸,其中4例死亡(1.4％),心律失常8例(2.7％),乳糜胸9例(3.1％)、喉返神经损伤、声音嘶哑33例(11.3％).随访1 ～ 32个月,274例成功随访(94.1％)；42例死亡.随访中8例肝转移,10例腹腔淋巴结转移,4例肺转移,3例骨转移,1例脑转移,余者生存.结论胸、腹腔镜联合行食管癌根治术是一种安全的手术方式,其主要并发症发生率在可接受范围.腔镜外科技术经验的积累有助于进一步降低并发症发生率.
목적 총결연합강경식관암근치술후주요병발증병탐토기방치방법.방법 회고성분석2009년12월지2012년7월291례행연합강경식관암근치술환자적림상자료.종류위우식관상단자20례,중단239례,하단자32례.행흉복강경연합경부문합(McKeown술)230례；흉복강경연합우흉내문합(미창Ivor Lewis술)61례.술후병리분기:Ⅰ기55례(Ⅰ a기28례、Ⅰ b기27례),Ⅱ기109례,Ⅲ기69례(Ⅲa기36례、Ⅲb기33례),Ⅳ기58례.결과 제4례중전수술(1.4％)외,기여전부순리완성수술.술후주요병발증:문합구루13례(4.5％),문합구협착5례(1.7％),폐부감염54례(18.6％)、7례병발호흡쇠갈행기관절개、호흡궤보조호흡,기중4례사망(1.4％),심률실상8례(2.7％),유미흉9례(3.1％)、후반신경손상、성음시아33례(11.3％).수방1 ～ 32개월,274례성공수방(94.1％)；42례사망.수방중8례간전이,10례복강림파결전이,4례폐전이,3례골전이,1례뇌전이,여자생존.결론 흉、복강경연합행식관암근치술시일충안전적수술방식,기주요병발증발생솔재가접수범위.강경외과기술경험적적루유조우진일보강저병발증발생솔.
Objective To study the major complications of combined thoracoscopic and laparoscopic esophagectomy for esophageal carcinoma and explore the methods for prevention and treatment.Methods Retrospective medical records analysis was conducted for 291 esophagealcancer patients who underwent combined thoracoscopic and laparoscopic esophagectomy in our department from December 2009 to July 2012.The tumors were located in upper esophagus in 20 cases,middle esophagus in 239 cases,and lower esophagus in 32 cases.230 cases gastroesophageal anastomosis was made in left neck and 61 cases in fight thoracic cavity.Postoperative pathological staging identified stage Ⅰ esophageal cancer in 55 cases (stage Ⅰ a:28 cases,stage Ⅰ b:27 cases),stage Ⅱ esophageal cancer in 109 cases,stage Ⅲ esophageal cancer in 69 cases (stage Ⅲa:36 cases,stage Ⅲ b:33 cases) and stage Ⅳ esophageal cancer in 58 cases.Results Except for open conversions in 4 cases (1.4％),all surgical operations were completed smoothly.Postoperative complications:anastomotic leakage was found in 13 eases (4.5％),anastomotic stricture in 5 cases(1.7％),lung infection in 54 cases(18.6％),7 of whom required tracheotomy and mechanical ventilation for respiratory failure.Arrhythmia was observed in 8 cases(2.7％) and chylothorax in 9 case(3.1％),recurrent laryngeal nerve injury (hoarseness) in 33 cases(11.3％).4 patients died in perioperative period(mortality 1.4％).Out of the 291 cases,274 cases were successfully followed up with durations ranged from 1 to 32 months.Cancer spreading to liver,celiac lymph nodes,lung,bone and brain were observed in 8 cases,10 cases,4 cases,3 cases and 1case,respectively.42 cases died,and all remaining cases remained alive during the follow up.Conclusion Combined thoracoscopic and laparoscopic esophagectomy is a technically safe alternative for esophageal cancer with an acceptable complication incidence.The accumulation of operative technology will further decrease the incidence.