OrViL经口钉砧输送系统在全腔镜食管癌根治术中的应用

目的 探讨OrViL经口钉砧输送系统在全腔镜食管癌根治术中的安全性、可行性及疗效。方法 收集2009 年9月至2012年3月6例食管中下段癌患者，实施全腔镜下食管癌根治术，使用OrViL钉砧输送系统经口腔送入钉砧，置入25mm圆形吻合器，行食管胃胸膜顶机械吻合。结果 6例患者均在全胸腹腔镜下顺利完成手术，平均手术时间为260min（210～340min），出血量为120ml（100～250ml），术后胸管留置时间为4d（3～6d），住院时间为14.2d（11～26d）。术后发生肺部感染3例，单侧喉返神经损伤1例，无乳糜胸、吻合口瘘及狭窄等其他并发症。随访6～24个月，除1例失访外均无远处转移、复发和严重返流症状。结论 使用OrViL经口钉砧输送系统进行全腔镜食管癌根治及食管胃胸内吻合术安全、可行，近期临床治疗效果较好。

The application of the circular-stapled anastomosis with the trans-orally inserted anvil system OrViL in total thoracoscopic and laparoscopic radical esophagectomy of esophageal cancer

Objective To investigate the application of trans-orally inserted anvil system OrViLTM in total thoracoscopic and laparoscopic radical esophageetomy, and to evaluate its feasibility, safety and efficacy. Methods Five patients of lower and middle thoracic esophageal cancer and 1 of cardia cancer were enrolled to receive total thoracoscopic and laparoseopie radical esophagectomy. The esophagogastlic anastomosis was completed by using trans-orally inserted anvil system OrViL （Covident, CT, USA） and 25ram cir- cular stapler on upper thoracic cavity under the vision of thoracoscope. Results The operation of the 6 patients was successful and un- eventful. The average operative time was 260min（210-340min）and blood loss was 120ml （100-250ml）. The average time of thoracic drainage was 4 days （3-6 days） and discharge time was 14. 2 days （11-26 days）. After the operation, pulmonary infections occurred in 3 patients, and 1 in unilateral recurrent laryngeal nerve injury. No complications like chylothorax, anastomotic leakage or stenosis and other severe complications occurred. With a 6 to 24 months follow-up, no recurrence, distant metastasis or severe reflux observed. Conclusion The technique of total thoracoscopic and laparoscopic Ivor Lewis esophagectomy with trans-orally placed anvil system Or- ViL for the esophagogastric anastomosis in thoracic cavity is feasibility and safety, showing a good short-term clinical outcome.