中国微创外科杂志
中國微創外科雜誌
중국미창외과잡지
Chinese Journal of Minimally Invasive Surgery
2015年
11期
968-971
,共4页
钱斌%王道猛%吴俊%张春阳
錢斌%王道猛%吳俊%張春暘
전빈%왕도맹%오준%장춘양
食管癌%胸腔镜%腹腔镜%食管切除术
食管癌%胸腔鏡%腹腔鏡%食管切除術
식관암%흉강경%복강경%식관절제술
Esophageal carcinoma%Thoracoscopy%Laparoscopy%Esophagectomy
目的：探讨微创食管癌根治术的安全性及可行性。方法回顾性分析2011年9月～2014年10月105例微创食管癌根治术的临床资料，均在胸腔镜下游离食管，2011年9月～2013年9月行开腹游离胃54例，2013年9月～2014年10月行腹腔镜下游离胃51例，制作管状胃行左颈部机械吻合术。结果无围手术期死亡，中转开放手术4例，其中开胸3例，开腹1例。胸腔镜手术时间50～100 min，平均80．4 min；腹腔镜手术时间30～80 min，平均50．6 min；颈部手术时间30～50 min，平均40．3 min。胸腔镜手术出血量60～210 ml，平均100．6 ml；腹腔镜手术出血量30～100 ml，平均50．2 ml。清扫淋巴结13～27枚，平均19．4枚。术后胸腔总引流量250～700 ml，平均340．7 ml。术后住院时间11～42 d，平均13．0 d。术后病理诊断均为鳞状细胞癌，T1～3 N0～1 M0，切缘阴性。术中并发症：主动脉食管支动脉出血1例（中转开胸），支气管动脉出血2例（中转开胸）；胸导管损伤3例（2例术中结扎，1例术后第10天二次手术腔镜结扎）；胃左血管损伤1例（中转开腹手术）。术后并发症：术后急性肾功能损伤1例，急性肝功能损伤1例，急性胃排空障碍2例，吻合口漏3例，肺部感染8例，术后喉返神经损伤10例（随访6个月恢复），术后吻合口狭窄2例（内镜下扩张3次后治愈）。105例随访1～35个月（中位随访时间16个月），3例均因肿瘤广泛转移分别于术后6、12、14个月死亡，均为低分化鳞状细胞癌伴胸腔或腹腔淋巴结转移，余102例均健在。结论微创食管癌术在技术上是安全可行的。
目的：探討微創食管癌根治術的安全性及可行性。方法迴顧性分析2011年9月～2014年10月105例微創食管癌根治術的臨床資料，均在胸腔鏡下遊離食管，2011年9月～2013年9月行開腹遊離胃54例，2013年9月～2014年10月行腹腔鏡下遊離胃51例，製作管狀胃行左頸部機械吻閤術。結果無圍手術期死亡，中轉開放手術4例，其中開胸3例，開腹1例。胸腔鏡手術時間50～100 min，平均80．4 min；腹腔鏡手術時間30～80 min，平均50．6 min；頸部手術時間30～50 min，平均40．3 min。胸腔鏡手術齣血量60～210 ml，平均100．6 ml；腹腔鏡手術齣血量30～100 ml，平均50．2 ml。清掃淋巴結13～27枚，平均19．4枚。術後胸腔總引流量250～700 ml，平均340．7 ml。術後住院時間11～42 d，平均13．0 d。術後病理診斷均為鱗狀細胞癌，T1～3 N0～1 M0，切緣陰性。術中併髮癥：主動脈食管支動脈齣血1例（中轉開胸），支氣管動脈齣血2例（中轉開胸）；胸導管損傷3例（2例術中結扎，1例術後第10天二次手術腔鏡結扎）；胃左血管損傷1例（中轉開腹手術）。術後併髮癥：術後急性腎功能損傷1例，急性肝功能損傷1例，急性胃排空障礙2例，吻閤口漏3例，肺部感染8例，術後喉返神經損傷10例（隨訪6箇月恢複），術後吻閤口狹窄2例（內鏡下擴張3次後治愈）。105例隨訪1～35箇月（中位隨訪時間16箇月），3例均因腫瘤廣汎轉移分彆于術後6、12、14箇月死亡，均為低分化鱗狀細胞癌伴胸腔或腹腔淋巴結轉移，餘102例均健在。結論微創食管癌術在技術上是安全可行的。
목적：탐토미창식관암근치술적안전성급가행성。방법회고성분석2011년9월～2014년10월105례미창식관암근치술적림상자료，균재흉강경하유리식관，2011년9월～2013년9월행개복유리위54례，2013년9월～2014년10월행복강경하유리위51례，제작관상위행좌경부궤계문합술。결과무위수술기사망，중전개방수술4례，기중개흉3례，개복1례。흉강경수술시간50～100 min，평균80．4 min；복강경수술시간30～80 min，평균50．6 min；경부수술시간30～50 min，평균40．3 min。흉강경수술출혈량60～210 ml，평균100．6 ml；복강경수술출혈량30～100 ml，평균50．2 ml。청소림파결13～27매，평균19．4매。술후흉강총인류량250～700 ml，평균340．7 ml。술후주원시간11～42 d，평균13．0 d。술후병리진단균위린상세포암，T1～3 N0～1 M0，절연음성。술중병발증：주동맥식관지동맥출혈1례（중전개흉），지기관동맥출혈2례（중전개흉）；흉도관손상3례（2례술중결찰，1례술후제10천이차수술강경결찰）；위좌혈관손상1례（중전개복수술）。술후병발증：술후급성신공능손상1례，급성간공능손상1례，급성위배공장애2례，문합구루3례，폐부감염8례，술후후반신경손상10례（수방6개월회복），술후문합구협착2례（내경하확장3차후치유）。105례수방1～35개월（중위수방시간16개월），3례균인종류엄범전이분별우술후6、12、14개월사망，균위저분화린상세포암반흉강혹복강림파결전이，여102례균건재。결론미창식관암술재기술상시안전가행적。
Objective To explore of safety and feasibility of minimally invasive esophagectomy in the treatment of esophageal carcinoma. Methods A retrospective analysis was made on 105 patients receiving minimally invasive esophagectomy between September 2011 and October 2014.The esophageal was disconnected under thoracoscopy.The stomach mobilization was performed under open surgery in 54 cases from September 2011 to September 2013, and under laparoscope in 51 cases from September 2013 to October 2014.Then a tube-like stomach was created and anastomosed to the cervical part of esophagusy by stapling. Results No perioperative death was observed in the group.Conversions to open surgery were required in 4 cases, including 3 cases of open chest surgery and 1 case of open abdominal surgery.The operation time for thoracoscopy was 50-100 min (mean, 80.4 min), and the operation time for laparoscopy was 30-80 min (mean, 50.6 min).The operation time for neck operation was 30-50 min (mean, 40.3 min).The thoracic blood loss ranged from 60 ml to 210 ml (mean, 100.6 ml) and the abdominal blood loss ranged from 30 ml to 100 ml (mean, 50.2 ml).The number of mediastinal lymph node dissected was 13-27 (mean, 19.4).The postoperative thoracic drainage was 250-700 ml (mean, 340.7 ml).The postoperative hospital stay was 11-42 days (mean, 13.0 days).All the patients were diagnosed as having esophageal squamous cell cancer after operation.According to the AJCC ( the seventh edition) TNM staging guideline of esophageal cancer, the samples were staged as T0 -T3 , N0 -N2 , and M0 .The edge of the tumor was negative. Intraoperative complications included aortic esophageal artery bleeding in 1 case ( conversion to open surgery ) , bronchial arterial hemorrhage in 2 cases ( conversions to open surgery) , thoracic duct injury in 3 cases ( intraoperative ligation in 2 cases, and secondary thoracoscopic surgery after 10 days postoperatively in 1 case ) , and left gastric blood vessel damage in 1 case ( conversion to open surgery) .Postoperative complications included acute renal dysfunction in 1 case, acute liver dysfunction in 1 case, acute gastric emptying disorder in 2 cases, anastomotic leakage in 3 cases, pulmonary infection in 8 cases, postoperative recurrent laryngeal nerve injury in 10 cases ( recovered during 6 months of follow-ups) , and anastomotic stricture in 2 cases ( cured after endoscopic dilation for 3 times) .The 105 patients were followed up for 1-35 months ( median, 16 months) .Three patients died of extensive metastases of tumor at 6, 12, and 14 months after surgery, respectively, all of which were poorly differentiated squamous cell carcinoma with pleural or abdominal lymph node metastases.The remaining 102 patients survived. Conclusion Minimally invasive esophagectomy is technically feasible and safe.
