CAJ | 학술논문

食管胃结合部肿瘤可以经胸或经腹进行根治手术.经腹手术可以达到更为理想的腹腔淋巴结清扫效果,同时对呼吸功能损伤较小.因此,对于高龄、肺功能差的食管胃结合部肿瘤患者,经腹手术是一种较好的选择.目前经典的腹腔镜手术常常需要在腹上区做1个辅助小切口,在体外完成管状胃制作和放置吻合器机身.2011年11月首都医科大学附属北京朝阳医院对1例65岁男性低肺功能食管胃结合部肿瘤患者改良了腹部辅助小切口,采用经主操作孔施行全腹腔镜食管胃结合部肿瘤根治术.术中经食管裂孔向上游离胸段食管约5 cm,牵拉至腹腔后横断.经口抵钉座置入系统(OrVil)后,在腹部经主操作孔放入食管吻合器将食管与残冒进行吻合.手术顺利,吻合方便快捷.患者术后恢复良好,随访16个月肿瘤无局部复发及转移征象.
식관위결합부종류가이경흉혹경복진행근치수술.경복수술가이체도경위이상적복강림파결청소효과,동시대호흡공능손상교소.인차,대우고령、폐공능차적식관위결합부종류환자,경복수술시일충교호적선택.목전경전적복강경수술상상수요재복상구주1개보조소절구,재체외완성관상위제작화방치문합기궤신.2011년11월수도의과대학부속북경조양의원대1례65세남성저폐공능식관위결합부종류환자개량료복부보조소절구,채용경주조작공시행전복강경식관위결합부종류근치술.술중경식관렬공향상유리흉단식관약5 cm,견랍지복강후횡단.경구저정좌치입계통(OrVil)후,재복부경주조작공방입식관문합기장식관여잔모진행문합.수술순리,문합방편쾌첩.환자술후회복량호,수방16개월종류무국부복발급전이정상.
Carcinoma of the esophagogastric junction can be radically resected through thorax or abdomen.Because abdominal operation can achieve more ideal abdominal lymph node dissection and less injury of respiratory function,it is ideal for the elderly patients and patients with poor pulmonary function.The classic laparoscopic radical gastrectomy needs a small abdominal incision for making tubular stomach and installation of stapling devices.All the procedures were completed via the main operating trocar.In November of 2011,a 65-year-old male patient with poor pulmonary function and carcinoma of the esophagogastric junction underwent modified total laparoscopic esophagogastric anastomosis.During the operation,the thorax esophagus was mobilized about 5 cm above the esophageal hiatus,then it was pulled to the abdominal cavity and transected.After inserting the OrVil via the mouth,the esophagogastric anastomosis was done.The operation went through smoothly and the procedure was completed conveniently and quickly.The patient recovered well after operation with no local recurrence and metastasis.