CAJ | 학술논문

目的探讨利用常规吻合器在胸、腹腔镜下行Ivor-Lewis食管癌根治、食管-胃胸内吻合术的短期疗效和安全性.方法 2013年2月至8月,39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,男29例,女10例,均为中下胸段食管癌.先于腹腔镜下游离胃和腹段食管,行空肠造瘘术,然后在胸腔镜下游离胸段食管,切除肿瘤,清扫纵隔和胃周淋巴结.采用普通端端吻合器行胸腔镜下食管-胃胸顶吻合.结果全组手术顺利.无术中并发症,1例中转开腹.中位手术用时245 min,出血量中位值210 ml,术后中位住院时间7天.39例均为鳞癌,切缘均阴性,淋巴结清扫平均16.5枚.术后2例胃排空障碍;1例术后14天发生吻合口瘘,发现瘘1个月后瘘口愈合;1例发生肺炎、呼吸衰竭.无术后死亡.结论常规吻合器行全腔镜下Ivor-Lewis食管癌根治术可行,能完成所有开放Ivor-Lewis手术的步骤,其远期疗效仍需前瞻性的随机对照临床试验验证.
목적 탐토이용상규문합기재흉、복강경하행Ivor-Lewis식관암근치、식관-위흉내문합술적단기료효화안전성.방법 2013년2월지8월,39례식관암환자행전강경Ivor-Lewis경로식관암절제、식관-위흉강내문합술,남29례,녀10례,균위중하흉단식관암.선우복강경하유리위화복단식관,행공장조루술,연후재흉강경하유리흉단식관,절제종류,청소종격화위주림파결.채용보통단단문합기행흉강경하식관-위흉정문합.결과 전조수술순리.무술중병발증,1례중전개복.중위수술용시245 min,출혈량중위치210 ml,술후중위주원시간7천.39례균위린암,절연균음성,림파결청소평균16.5매.술후2례위배공장애;1례술후14천발생문합구루,발현루1개월후루구유합;1례발생폐염、호흡쇠갈.무술후사망.결론 상규문합기행전강경하Ivor-Lewis식관암근치술가행,능완성소유개방Ivor-Lewis수술적보취,기원기료효잉수전첨성적수궤대조림상시험험증.
Objective Totally MIIE with per-oral placement of anvil has been reported elsewhere,but MIIE with manual pursestring and per-thoracic port placement of anvil has been seldomly reported.The feasibility of the latter technique was proved in this study.Methods Patients with mid-lower thoracic esophageal cancer were prospectively treated with totally MIIE at Shanghai Cancer Center of Fudan University from Feberay 28,2013 to August 31,2013.Laproscopic intracorporeal construction of the gastric conduit and needle catheter J-tube were performed in the first stage of MIIE.In the second stage a hand sewn pursestring was made with endostitch system and the anvil of EEA stapler was inserted via the tenth inter costal port prior to the intrathoracic anastamosis.Short-term clinicopathologic outcomes were collected.Results 39 cases were treated with totally MIIE,media age 61 years,ranged 48-69 years,10 females and 29 males.There was 1 conversion to open surgery.The median duration of operation was 245 minutes.The median intraoperative blood loss was 210 ml.All the patients were margin negative and staged from pT1N0M0 to pT3N2M0.The average lymph node yields were 16.5 per patient.The median postoperative hospital stay was 7 days.There was no mortality.Perioperative morbidity occurred in 4 patients (10％).2 patients were complicated with late stage gastric paralysis which began 2 or 3 days after oral feeding and both recovered in 1 month.1 patient was with minor anastamotic leakage which was endoscopically demonstrated on the 14th day postoperatively and the patient recovered in 1 month post leakage.1 patient was complicated with severe pneumonitus and ARDS; the ICU stay of that case was 19 days and the recovered patient was discharged 27 days postoperatively.Conclusion MIIE with regular EEA stapler and intrathoracic anastamosis is feasible in patients with thoracic esophageal cancer.Prospective randomized clinical trials could be conducted to compare the open procedure and totally MIIE with regular EEA stapler.