微创手术治疗食管癌的现状

食管切除、系统淋巴结清扫仍然是可切除食管癌的有效治疗方式，但传统食管癌手术为开放性手术，术后具有较高的并发症发生率和死亡率。为达到降低食管癌术后并发症发生率及死亡率的目的，许多医学中心将各种术式的微创手术应用于食管癌手术，微创食管切除术（minimally invasive esophagectomy，MIE）在胸外科得到广泛发展。MIE已经被证实是一种安全、可行的食管癌治疗方式，与传统手术相比，MIE可减少手术失血量，做到完整规范的肿瘤切除及淋巴结清扫，获得与传统手术相当的长期生存结果。尽管如此，MIE治疗食管癌的优越性仍未得到明显体现，目前仍存在一些争议。本文就MIE治疗食管癌的手术技术、围术期结果、肿瘤切除的完整规范性、长期生存结果及应注意的问题等5个方面进行综述。

Minimally Invasive Esophagectomy for the Treatment of Esophageal Carcinoma

Esophagectomy and extensive lymphadenectomy still remain effective treatment strategies for patients with resectable esophageal carcinoma （EC）. However,traditional esophagectomy is performed via open approaches and associated with signi？cant postoperative morbidity and mortality. In order to reduce morbidity and mortality after esophag-ectomy,various minimally invasive techniques have been introduced to esophagectomy by many medical centers,and minimallyinvasive esophagectomy （MIE） has been widely developed in thoracic surgery. MIE has been proven to be a safe and feasible approach for the treatment of EC. Compared with open esophagectomy,MIE can reduce surgical blood loss,achieve complete and standardized tumor resection and lymph node dissection,and obtain equivalent long-term survival results. However,there are still controversies in some aspects of MIE for the treatment of EC,and the superiority of MIE has not been fully demons-trated. In this review,we focus on five aspects of MIE for the treatment of EC,including MIE techniques,perioperativeoutcomes,completeness and standard of tumor resection,long-term survival results and current problems.