CAJ | 학술논문

目的探索全腔镜下(胸/腹腔镜下)经口腔置入吻合器底钉座的食管癌根治手术的新方法.方法 40例食管癌患者接受经口置入钉砧头技术(OrVil技术)全腔镜下食管癌根治术.男30例,女10例,年龄42～76岁.胸食管上段癌4例,中段癌29例,下段癌7例.术前均经内镜取得病理,37例为鳞状细胞癌,3例为高级别瘤变；利用钡餐和超声内镜检查获得相对准确的术前分期.结果术中右下肺静脉破裂出血、吻合口瘘和底钉座滑入食管残端各1例；术后吻合口瘘1例,胸腔出血2例,胸腔积液5例,经正确处理后,均恢复正常.全组患者恢复良好.无手术死亡.1例术后1年死于脑转移.病理分期Ⅰb期和Ⅱ期患者均用GP方案化疗1～4个疗程,Ⅲa期患者术后1个月常规辅助放疗1次,再行GP方案化疗1～4个疗程.远期结果仍在进一步观察中.结论 OrVil技术是一种较为方便的全腔镜下食管癌根治方法,临床医师只要熟练掌握了腔镜操作的基本方法均可施行此技术.
목적 탐색전강경하(흉/복강경하)경구강치입문합기저정좌적식관암근치수술적신방법.방법 40례식관암환자접수경구치입정침두기술(OrVil기술)전강경하식관암근치술.남30례,녀10례,년령42～76세.흉식관상단암4례,중단암29례,하단암7례.술전균경내경취득병리,37례위린상세포암,3례위고급별류변；이용패찬화초성내경검사획득상대준학적술전분기.결과 술중우하폐정맥파렬출혈、문합구루화저정좌활입식관잔단각1례；술후문합구루1례,흉강출혈2례,흉강적액5례,경정학처리후,균회복정상.전조환자회복량호.무수술사망.1례술후1년사우뇌전이.병리분기Ⅰb기화Ⅱ기환자균용GP방안화료1～4개료정,Ⅲa기환자술후1개월상규보조방료1차,재행GP방안화료1～4개료정.원기결과잉재진일보관찰중.결론 OrVil기술시일충교위방편적전강경하식관암근치방법,림상의사지요숙련장악료강경조작적기본방법균가시행차기술.
Objective To investigate a new technique of putting a seat of stapler by anvil going through mouth on total thoracoscopic and laparoscopic esophagectomy.Methods Forty patients with esophageal cancers received combined thoracoscopic and laporascopic esophagectomy with OrVil technique.Results Postoperative complications are return to normal after correct treatment,including the seat of stapler sliped into Esophageal stumps (n =1),intraoperative anastomotic fistula(n =1),pleural hemorrhage(n =2),pleural effusion (n =5).37 patients recovered well without death.All patients were followed up 12 months,one died of brain metastases.chemotherapy of GP scheme(1-4 courses) was carried out in the patients who are in Ⅰ a or Ⅱ stage of TNM classification.At 1 month after surgery,patients who are in Ⅲa stage received postoperative adjuvant radiotherapy and GP scheme.Conclusion OrVil system is one of the most advanced surgery in the total thoracoscopic and laparoscopic esophagectomy.It is concluded that the surgery is reliable when performed carefully.Operator need overcome the fear of mild bleeding and wound leak.OrVil system can be accomplished smoothly with acceptable occurrence of complications,it is safe and effective technique,easy to accepted by patients.