胸、腹腔镜联合治疗食管癌术后并发症的观察与护理

目的探讨电视胸、腹腔镜联合手术治疗食管癌术后主要并发症的预防以及综合护理干预在术后并发症护理中的应用。方法对2007年7月～2009年12月我院81例行电视胸、腹腔镜联合食管癌根治术的患者术后主要并发症的预防与综合护理干预进行系统回顾性研究。结果全组患者术后主要并发症发生率为24.7%(20/81):其中肺部感染10例;颈部吻合口瘘3例;管状胃瘘1例;胸胃扩张1例;乳糜胸2例;喉返神经损伤3例。在术后常规外科护理基础上给予心理干预、疼痛干预及康复训练等综合护理干预,经积极处理和治疗,全部康复出院。结论对行胸、腹腔镜联合食管癌根治术患者尤其是出现并发症者,加强外科基础护理以及给予多方面综合护理干预,能有效地保证手术成功率,有利患者康复,减少术后病死率,提高患者生活质量。     

胸腹腔镜联合手术治疗食管癌

目的探讨胸、腹腔镜联合手术在食管癌治疗中的安全性、手术方法及临床效果。方法对40例食管癌患者行电视胸腔镜联合腹腔镜下食管癌根治术。于左侧卧位行胸腔镜下胸段食管的游离及淋巴结清扫,胸部手术完成后改平卧位行腹腔镜下胃游离及淋巴结清扫,胃游离后剑突下小切口完成管状胃的制作,再将管状胃从食管床拉至颈部与颈段食管吻合。结果 2例因单肺通气不成功中转开胸。总手术时间215～400 min,平均280 min;术中无大出血,总出血量100～800 ml,平均227 ml。共清扫淋巴结413枚,平均每例10.3枚;术后住院8～30 d,平均13.6 d。住院期间无一例患者死亡。术后并发症：肺部感染3例,颈部吻合口漏1例（术后第4天）,声音嘶哑3例,乳糜胸1例。结论胸、腹腔镜联合,颈部吻合的食管癌切除在技术上是可行的,并且是安全的。     

胸腹腔镜联合食管癌根治术在食管癌患者中的应用效果观察

目的:探讨胸腹腔镜联合食管癌根治术在食管癌患者中的应用效果。方法:将20例食管癌患者随机分为实验组和对照组各10例,对照组给予传统开胸食管癌根治术,实验组给予胸腔镜下游离食管+腹腔镜游离胃+胃食管左胸顶吻合术,两组均给予精心围术期护理,比较两组患者手术时间、术中出血量、术后肺膨胀不良发生率及住院时间。结果:两组患者术中出血量、术后肺膨胀不良发生率及住院时间比较差异有统计学意义(P0.05)。结论:胸腹腔镜联合食管癌根治术治疗食管癌患者,可减少术中出血量,降低术后肺膨胀不良发生率,缩短住院时间。     

胸腔镜、腹腔镜联合食管癌根治术11例体会

目的探讨胸腔镜、腹腔镜联合食管癌根治术的适应证及临床效果。方法 2011年3月该院应用胸腔镜、腹腔镜联合行食管癌根治术11例。胸腔镜下经右胸完成胸腔、纵膈的探查及食管周围的游离,腹腔镜下完成胃的游离及清扫腹腔内淋巴结,然后经颈部、腹部切口离断食管和胃食管吻合。结果手术时间200min,出血量230mL,术后疼痛轻,术后肺部无并发症。结论胸腔镜、腹腔镜联合食管癌根治术创伤小、恢复快,是一种较为安全可靠的食管癌手术方式,可作为部分患者的选择,值得临床推广。     

胸腹腔镜联合食管癌根治术治疗食管癌的疗效观察

目的探讨和评价胸腹腔镜联合食管癌根治术治疗食管癌的临床应用价值及其安全性。方法回顾性分析2010年4月—2012年4月由同一组医师完成的60例行胸腹腔镜联合食管癌根治术的食管癌患者,其中30例食管癌患者(A组)行胸腹腔镜联合食管癌根治术,另30例食管癌患者(B组)行传统的外科手术。比较2组患者的手术时间、术中出血量、淋巴结清扫数目、术后并发症情况、术后肛门排气时间以及住院时间指标。结果与传统的手术组相比,行胸腹腔镜联合食管癌根治术的患者的手术时间明显升高,但术中出血量、住院时间、术后肛门排气时间、术后并发症率下降明显,淋巴结清除数目无统计学差异。结论胸腹腔镜联合食管癌根治术治疗食管癌具有出血少、恢复快、手术安全、微创等优点,值得临床推广应用。     

胸腹腔镜联合食管癌根治术的围手术期护理

目的总结食管癌患者行胸腹腔镜联合食管癌根治术的围手术期护理体会。方法回顾性分析和总结67例食管癌患者行胸腹腔镜食管胃胸内吻合术围手术期的护理经验。结果 67例患者均顺利出院。其中吻合口瘘2例,经保守治疗后痊愈;肺部感染4例,经积极抗感染和护理后治愈;急性肾功能衰竭2例,经保守治疗症状消失。结论有效充分的围手术期护理,可以有效加快食管癌患者术后痊愈速度,提高食管癌患者痊愈率,减少并发症的发生。     

胸腔镜联合腹腔镜行食管癌根治术患者的观察及护理

目的 探讨全腔镜下(腹腔镜+胸腔镜)行食管癌根治术的优势及临床护理要点.方法 选取2010年10月至2011年4月的食管癌患者19例,按照不同手术方法分为行传统食管癌根治术的对照组(9例)和行腋下小切口辅助胸腔镜下游离食管+腹腔镜游离胃+胃食管右胸顶吻合的观察组(10例).比较2组手术结果.结果 2组术后排气时间比较无显著差异,而手术时间、术中出血量、术后胸腔引流量(胸引量)、术后住院时间等方面均有显著差异.结论 在全腔镜下(腹腔镜+胸腔镜)行食管癌根治术安全可行,小切口辅助胸腔镜下食管癌切除兼顾开放手术和纯胸腔镜手术的优点,值得在临床上推广应用.     

主动脉弓水平食管癌手术治疗20例疗效观察

目的总结主动脉弓水平食管癌颈、胸、腹常规三切口及电视胸腹腔镜辅助下完成肿瘤切除及消化道重建的外科治疗方法。方法 20例主动脉弓水平食管鳞癌患者,术前经内镜及组织病理检查确诊,并经胸部CT检查证实肿瘤与主动脉弓及奇静脉关系密切,选择经常规颈、胸、腹三切口或在电视胸腹腔镜辅助下完成食管癌根治及消化道重建。结果 17例常规颈、胸、腹三切口完成手术,3例在电视胸腹腔镜辅助下完成手术;无围手术期死亡病例;常规三切口手术患者发生颈部吻合口瘘4例,胃不全梗阻2例,胃瘫1例,均经对症治疗痊愈;胸腹腔镜辅助下手术患者术后恢复良好,无明确并发症发生。结论对主动脉弓水平食管癌,经颈、胸、腹三切口手术切除肿瘤及消化道重建术安全、疗效确切,电视胸腹腔镜辅助下完成该类手术具有创伤小、恢复快等优势。     

电视胸腔镜在食管癌诊断中的应用

目的：对近年应用电视胸腔镜手术（Video-THoracoscopic Surgery,VATS)诊治食管癌的价值进行研究。方法：1993－2000年,VATS诊治胸部疾病共307例,其中14例经VATS探查无严重食管周围粘连的食管癌患者,进行了VATS食管切除术,其结果与同期27例传统剖胸手术相比较,35例食管癌患者行VATS纵隔淋巴结活检及胸腔探查术,其诊断结果与术前CT检查相比较,结果：14例VATS食管切除的患者,胸部出血量明显少于剖胸术,平均分别为320ml(180-750ml),760ml(340-2700ml),VATS术后相应并发症为14％,剖胸术为26％,41例（VATS为14例,剖胸术为27例）患者术后平均随访期为18月（5－72月）两组术后生存期无明显判别。     

胸腹腔镜下行食管癌根治术围术期护理

目的探讨胸腹腔镜下行食管癌根治术围术期护理方法。方法对2010年2月~2011年2月完成的40例胸腹腔镜下行食管癌根治术患者与同期40例传统根治手术患者围术期护理进行比较分析,并对疗效进行比较。结果胸腹腔镜下行食管癌根治术患者术前心理护理、皮肤准备要求更高,术后有独特的并发症,护理有其复杂性,但微创手术患者疗效好。结论对胸腹腔镜下行食管癌根治术患者的护理,应重视术前心理护理,严格皮肤准备,加强术后并发症的观察与护理,使患者术后恢复快。     

Video‐assisted thoracoscopic esophagectomy in the left lateral decubitus position in an esophageal cancer patient with pectus excavatum

During thoracic cavity operations, it is difficult to obtain sufficient working space and good operative field visibility in patients with pectus excavatum because the space between the vertebral bodies and sternum is very narrow. Here, we report the successful treatment of esophageal cancer in a patient with pectus excavatum. A 77‐year‐old man with esophageal cancer was referred to our hospital for further treatment. He was diagnosed with multiple early esophageal squamous cell carcinomas. The patient had pectus excavatum, but because it was asymptomatic, a video‐assisted thoracoscopic radical esophagectomy in the left lateral decubitus position without pectus excavatum repair was selected. Despite the patient's unusual anatomy, video‐assisted thoracoscopic esophagectomy in the left decubitus position allowed for good operative field visibility, as the videoscope was inserted from the side of the diaphragm. This operative procedure is useful in patients with esophageal cancer who also have pectus excavatum. To the best of our knowledge, this is the second report of video‐assisted thoracoscopic esophagectomy in an esophageal cancer patient with pectus excavatum.     

Thoracoscopic enucleation of esophageal leiomyomas: a feasible and safe procedure

In recent years, minimally invasive approaches have been introduced, providing thoracoscopic/laparoscopic techniques in the treatment of esophageal leiomyomas. We determined the technical feasibility and patient safety of thoracoscopic enucleation of esophageal leiomyomas by evaluation of 10 consecutive patients undergoing this procedure. For the surgical approach, a four-trocar access via the right pleural cavity in single-lung ventilation was chosen. All minimally invasive procedures were successfully completed without conversion to open surgery. Every tumor was completely resected without opening of the mucosa. No relevant intra- or postoperative complications were detected. These data suggest that thoracoscopic enucleation is a feasible and safe procedure for esophageal leiomyomas.     

Right thoracoscopic resection in the supine position for recurrent pretracheal lymph nodes after esophagectomy

Mediastinal lymph node recurrence is often observed following esophageal cancer surgery; however, no treatment has been established for the same. Surgical resection is often considered for cases of recurrence in a single lymph node region, although the procedures and approaches vary depending on the recurrence site. Right thoracoscopic resection is rarely opted for owing to its high surgical difficulty. Herein, we report a successful case of right thoracoscopic resection in the supine position for recurrent pretracheal lymph nodes following esophagectomy. The intraoperative findings revealed few adhesions around the recurrent lymph nodes due to the initial surgery, and the recurrent lymph nodes were safely resected within a short period. The patient was discharged on postoperative day 4 without any complications, and there was no recurrence after 20 months. Thus, right thoracoscopic resection may be a promising treatment option for recurrent pretracheal lymph nodes after esophagectomy.     

食管癌、贲门癌术后膈疝的观察与护理

目的:探讨食管癌、贲门癌术后膈疝的观察与护理。方法:我科2008年1月～2009年6月发生食管癌、贲门癌术后膈疝8例,其中食管中段癌5例,贲门癌3例。膈疝发生最早时间为术后第3d,最晚发生在术后20年。结果:7例患者经胸片和CT明确诊断膈疝,1例因疑诊为肠梗阻,术中发现膈疝,均行膈疝修补术,术后恢复顺利,均痊愈出院。结论:食管癌、贲门癌术后膈疝是一种少见的并发症,手术前后呼吸道及消化道的管理、有效的生活护理、心理疏导有利于预防术后膈疝的发生,细致的临床观察有助于术后膈疝的发现和及时治疗。     

Thoracoscopic esophagectomy for stenosis of thoracic esophagus due to acute esophageal necrosis associated with alcoholic ketoacidosis

Acute esophageal necrosis (AEN) is a rare disease characterized by the appearance of diffuse black mucosa on upper gastrointestinal endoscopy; the condition often progresses to esophageal stenosis in the chronic phase. A 70-year-old man was admitted to a neighborhood hospital with the diagnosis of alcoholic ketoacidosis and an upper gastrointestinal endoscopy performed to investigate the symptom of esophageal tightness revealed AEN. The patient developed esophageal stenosis with scarring in the chronic phase and was referred to our hospital for surgery 6 months after the diagnosis of AEN. We performed thoracoscopic esophagectomy with the patient in the prone position. Although the esophagus was thickened and strong adhesions were present around the esophagus due to inflammation, we were able to complete the surgical procedure thoracoscopically. In patients presenting with benign esophageal stenosis developing after AEN, thoracoscopic esophagectomy may be a useful treatment option, even in the presence of severe fibrosis.     

安尔碘法胸膜固定治疗原发性自发性气胸的效果

背景：有学者认为对于易复发的原发性自发性气胸应积极行胸腔镜手术治疗,并且术中行胸膜固定能有效降低术后复发率。 目的：探讨安尔碘法胸腔镜治疗原发性自发性气胸的可靠性及有效性。 方法：纳入原发性自发性气胸患者64例,其中男46例,女18例,年龄15-30岁,随机均分为试验组与对照组,两组均进行胸腔镜手术治疗,其中试验组关闭切口前应用干纱布蘸取安尔碘涂抹整个胸腔,对照组未应用安尔碘。比较两组患者的手术时间、术中出血、术后引流量、术后漏气时间,术后拔管时间、术后并发症发病率及术后1年气胸的复发率。 结果与结论：两组手术时间、术中出血、术后漏气时间、术后拔除胸管时间及术后并发症的发生率比较差异均无显著性意义（P ＞0.05）;试验组术后引流量较对照组明显增加（P ＜0.05）,但未造成需医学干预的后果;试验组术后1年复发率低于对照组（P＜0.05）。结果表明胸腔镜手术过程中利用安尔碘涂擦壁层胸膜行胸膜固定,是一种预防原发性自发性气胸术后气胸复发的可靠且有效的治疗方式。     

Minimally invasive abdominal and left thoracic approach for esophagogastric junction adenocarcinoma with esophageal diverticulum: A case report

Controversy remains regarding the optimal resection approach for Siewert type II adenocarcinoma of the esophagogastric junction (EGJ). Furthermore, an esophageal diverticulum, although rare, can complicate surgical procedures. Herein, we report a case of EGJ adenocarcinoma with an esophageal diverticulum that was treated using the minimally invasive abdominal and left thoracic approach (MALTA). A 72‐year‐old man, with EGJ adenocarcinoma and an epiphrenic diverticulum on esophagogastroduodenoscopy underwent endoscopic submucosal dissection. The pathological diagnosis of the specimen revealed invasion to the lymphatic vessels. Therefore, laparoscopic proximal gastrectomy and thoracoscopic lower esophagectomy with D1 lymph node dissection and double‐tract reconstruction of the esophageal diverticulum were performed via MALTA. The patient was discharged without any postoperative morbidity. MALTA provides good visualization for the transection of the lower esophagus in cases of esophageal diverticulum. Moreover, MALTA for adenocarcinoma of the EGJ is technically feasible, even with the presence of a lower esophageal diverticulum.     

电视胸腔镜辅助食管癌切除术的围手术期护理

目的:总结电视胸腔镜辅助食管癌切除术患者围手术期的护理要点。方法:对我院实施的胸腔镜辅助下食管癌切除术42例患者术前给予的心理指导、消化道准备、呼吸道准备,术后给予的呼吸道护理、各引流管护理、止痛护理、饮食指导、早期活动及出院指导进行总结和评价。结果:42例患者均治愈出院,顺利康复。结论:加强经胸腔镜辅助行食管癌切除术患者的围手术期护理,术后并发症少,恢复快,平均住院时间缩短。     

Successful minimally invasive two‐stage operation for rare synchronous cancers of the esophagus and the pancreatic head: A case report

We report the case of a 70‐year‐old woman with synchronous advanced esophageal cancer and pancreatic head cancer. To reduce the surgical invasiveness, we performed a two‐stage operation that included percutaneous endoscopic gastrostomy and minimally invasive esophagectomy. In the first stage, we performed a percutaneous endoscopic gastrostomy, a thoracoscopic esophagectomy with cervical and mediastinal lymph node dissection, and an esophagostomy without a laparotomy. The second stage, which was performed 28 days after the first operation, consisted of a total gastrectomy, pancreaticoduodenectomy, colonic reconstruction, and jejunostomy. Fifty days after the second operation, the patient was discharged from the hospital. A two‐stage operation that includes minimally invasive esophagectomy seems to be useful for avoiding serious postoperative complications, even in patients with rare, synchronous advanced cancers of the esophagus and the pancreatic head.