中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2013年
10期
750-753
,共4页
郭伟%邹瀛波%刘学海%蒋耀光%王如文%马铮
郭偉%鄒瀛波%劉學海%蔣耀光%王如文%馬錚
곽위%추영파%류학해%장요광%왕여문%마쟁
食管肿瘤%胸腔镜检查%食管切除
食管腫瘤%胸腔鏡檢查%食管切除
식관종류%흉강경검사%식관절제
Esophageal neoplasms%Thoracoscopy%Esophageal resection
目的 评价模块化胸腔镜食管癌切除在微创食管癌切除术中的应用价值.方法 回顾性分析2011年12月至2012年12月第三军医大学大坪医院收治的45例胸段食管癌患者的临床资料,采用模块化手术流程行胸腔镜食管癌切除+胃食管颈部吻合术.患者按食管癌术前准备,行电视胸腔镜联合腹腔镜食管癌切除术或电视胸腔镜食管癌切除+开腹游离胃手术.胸腔镜食管游离及纵隔淋巴结清扫按照模块化流程(针对患者情况进行灵活排列组合)进行:(1)下肺韧带游离及下段食管旁、下肺韧带(第8L、9组)淋巴结清扫.(2)奇静脉弓下食管的游离.(3)游离奇静脉弓上食管.(4)奇静脉弓的离断.(5)胸段食管的完全游离.(6)结扎胸导管.(7)清扫下气管旁、主肺动脉窗、隆凸下、双侧肺门以及左侧喉返神经旁(第4、5、7、10、2L组)淋巴结.采用电话或信件联系方式对患者术后进行随访.术后1年内每3个月门诊复查胸腹部CT及纤维胃镜了解有无肿瘤复发及转移,超过1年后每半年检查1次.随访时间截至2013年2月.结果 45患者中,行电视胸腔镜联合腹腔镜食管癌切除术29例,电视胸腔镜食管癌切除+开腹游离胃手术16例.肿瘤长度为(4.2 ±2.5)cm,AJCC分期T1、T2、T3、T4期患者分别为7、14、15、9例,NO、N1、N2、N3期患者分别为23、13、7、2例.45例患者胸腔内操作时间为(72±13) min,总手术时间为(249 ± 39) min,术中出血量为(183±62) ml,术中清扫淋巴结数目为(27±7)枚,术后住院时间为(18 ±7)d.2例患者中转开胸手术.45例患者均无术后死亡发生,术后发生并发症11例次(2例患者出现两种并发症),6例发生颈部吻合口瘘,4例出现吻合口狭窄,3例出现声音嘶哑.45例患者均获得随访,随访时间为1.5 ～14.0个月,平均随访时间为8个月.1例患者于术后12个月因上消化道大出血死亡,1例患者于术后8个月因肝转移引发MODS死亡,其余43例均生存.结论 电视胸腔镜食管癌切除术中采用模块化手术流程安全、可行,具有良好的近期效果.
目的 評價模塊化胸腔鏡食管癌切除在微創食管癌切除術中的應用價值.方法 迴顧性分析2011年12月至2012年12月第三軍醫大學大坪醫院收治的45例胸段食管癌患者的臨床資料,採用模塊化手術流程行胸腔鏡食管癌切除+胃食管頸部吻閤術.患者按食管癌術前準備,行電視胸腔鏡聯閤腹腔鏡食管癌切除術或電視胸腔鏡食管癌切除+開腹遊離胃手術.胸腔鏡食管遊離及縱隔淋巴結清掃按照模塊化流程(針對患者情況進行靈活排列組閤)進行:(1)下肺韌帶遊離及下段食管徬、下肺韌帶(第8L、9組)淋巴結清掃.(2)奇靜脈弓下食管的遊離.(3)遊離奇靜脈弓上食管.(4)奇靜脈弓的離斷.(5)胸段食管的完全遊離.(6)結扎胸導管.(7)清掃下氣管徬、主肺動脈窗、隆凸下、雙側肺門以及左側喉返神經徬(第4、5、7、10、2L組)淋巴結.採用電話或信件聯繫方式對患者術後進行隨訪.術後1年內每3箇月門診複查胸腹部CT及纖維胃鏡瞭解有無腫瘤複髮及轉移,超過1年後每半年檢查1次.隨訪時間截至2013年2月.結果 45患者中,行電視胸腔鏡聯閤腹腔鏡食管癌切除術29例,電視胸腔鏡食管癌切除+開腹遊離胃手術16例.腫瘤長度為(4.2 ±2.5)cm,AJCC分期T1、T2、T3、T4期患者分彆為7、14、15、9例,NO、N1、N2、N3期患者分彆為23、13、7、2例.45例患者胸腔內操作時間為(72±13) min,總手術時間為(249 ± 39) min,術中齣血量為(183±62) ml,術中清掃淋巴結數目為(27±7)枚,術後住院時間為(18 ±7)d.2例患者中轉開胸手術.45例患者均無術後死亡髮生,術後髮生併髮癥11例次(2例患者齣現兩種併髮癥),6例髮生頸部吻閤口瘺,4例齣現吻閤口狹窄,3例齣現聲音嘶啞.45例患者均穫得隨訪,隨訪時間為1.5 ～14.0箇月,平均隨訪時間為8箇月.1例患者于術後12箇月因上消化道大齣血死亡,1例患者于術後8箇月因肝轉移引髮MODS死亡,其餘43例均生存.結論 電視胸腔鏡食管癌切除術中採用模塊化手術流程安全、可行,具有良好的近期效果.
목적 평개모괴화흉강경식관암절제재미창식관암절제술중적응용개치.방법 회고성분석2011년12월지2012년12월제삼군의대학대평의원수치적45례흉단식관암환자적림상자료,채용모괴화수술류정행흉강경식관암절제+위식관경부문합술.환자안식관암술전준비,행전시흉강경연합복강경식관암절제술혹전시흉강경식관암절제+개복유리위수술.흉강경식관유리급종격림파결청소안조모괴화류정(침대환자정황진행령활배렬조합)진행:(1)하폐인대유리급하단식관방、하폐인대(제8L、9조)림파결청소.(2)기정맥궁하식관적유리.(3)유리기정맥궁상식관.(4)기정맥궁적리단.(5)흉단식관적완전유리.(6)결찰흉도관.(7)청소하기관방、주폐동맥창、륭철하、쌍측폐문이급좌측후반신경방(제4、5、7、10、2L조)림파결.채용전화혹신건련계방식대환자술후진행수방.술후1년내매3개월문진복사흉복부CT급섬유위경료해유무종류복발급전이,초과1년후매반년검사1차.수방시간절지2013년2월.결과 45환자중,행전시흉강경연합복강경식관암절제술29례,전시흉강경식관암절제+개복유리위수술16례.종류장도위(4.2 ±2.5)cm,AJCC분기T1、T2、T3、T4기환자분별위7、14、15、9례,NO、N1、N2、N3기환자분별위23、13、7、2례.45례환자흉강내조작시간위(72±13) min,총수술시간위(249 ± 39) min,술중출혈량위(183±62) ml,술중청소림파결수목위(27±7)매,술후주원시간위(18 ±7)d.2례환자중전개흉수술.45례환자균무술후사망발생,술후발생병발증11례차(2례환자출현량충병발증),6례발생경부문합구루,4례출현문합구협착,3례출현성음시아.45례환자균획득수방,수방시간위1.5 ～14.0개월,평균수방시간위8개월.1례환자우술후12개월인상소화도대출혈사망,1례환자우술후8개월인간전이인발MODS사망,기여43례균생존.결론 전시흉강경식관암절제술중채용모괴화수술류정안전、가행,구유량호적근기효과.
Objective To evaluate the modularized operative process during video-assisted thoracoscopic esophagectomy for esophageal cancer.Methods The clinical data of 45 patients with esophageal cancer who were admitted to the Daping Hospital from December 2011 to December 2012 were retrospectively analyzed.The influence of modularized operative process on the intra-and post-operative condition and short-term complications after videoassisted thoracoscopic esophagectomy + esophagogastric anastomosis were analyzed to investigate the efficacy and value of modularized operative process.Patients received video-assisted thoracoscopic and laparoscopic resection of esophageal carcinoma or thoracoscopic resection of esophageal carcinoma + gastric mobilization.Thoracoscopic esophageal mobilization and mediastinal lymph nodes dissection were done according to the modularized operative process:(1) Pulmonary ligament mobilization and groups 8L and 9 lymph nodes dissection.(2) Mobilization of the esophagus under the arcus venae azygos.(3) Mobilization of esophagus above the arcus venae azygos.(4) Transection of the arcus venae azygos.(5) Complete removal of thorax esophgus.(6) Ligation of thoracic duct.(7) Dissection of groups 4,5,7,10 and 2L lymph nodes.All the patients were followed up via phone call or mail till February 2013.Patients received thoracoabdominal computed tomography and gastrofiberscopy to detect tumor recurrence or metastasis every 3 months within the first year after the operation,and they were re-examinated every half year at 1 year later.Results Of the 45 patients,29 received video-assisted thoracoscopic and laparoscopic resection of esophageal carcinoma and 16 received video-assisted thoracoscopic resection of esophageal carcinoma + gastric mobilization.The length of the tumor was (4.2 ± 2.5) cm.The numbers of patients in AJCC T1,T2,T3 and T4 stages were 7,14,15 and 9,and the number of patients with AJCC N0,N1,N2,N3 stages were 23,13,7,2,respectively.The intrathoracic operation time,total operation time,volume of intraoperative blood loss,number of lymph node resected and postoperative duration of hospital stay were (72 ± 13)minutes,(249 ± 39) minutes,(183 ± 62) ml,27 ± 7,(18 ± 7) days,respectively.Two patients were transferred to open surgery.No patient died postoperatively,and 11 complications were detected after the operation.Six patients were complicated with cervical anastomotic fistula,4 with anastomotic stricture and 3 with hoarseness.Forty-five patients were followed for 1.5-14.0 months with the median follow-up time of 8 months.One patient died of upper gastrointestinal hemorrhage at postoperative month 12,and 1 died of multi-organ dysfunction syndrome at postoperative month 8.The remaining 43 patients survived.Conclusions The modularized operative process for thoraeoscopic esophagectomy is safe and effective,its short-term efficacy is satisfactory.
