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。

Combined laparoscopy and thoracoscopy esophagectomy for esophageal carcinoma

Objective To evaluate the clinical application and safety of combination of thoracoscopy and laparoscopy for the treatment of esophageal carcinoma.Methods Combined thoracoscopy and laparoscopy esophagectomy was carried out in 40 patients with esophageal cancer.Being placed at a left lateral decubitus position,the patients received right thoracoscopy mobilization of the intrathoracic esophagus as well as lymph node dissection;then with supine position,laparoscopy mobilization of the stomach and lymph node dissection were carried out;followed by creation of a gastric tube through a small incision under the xiphoid;finally we pulled out the gastric tube from the esophageal bed to the neck and made an intermittent gastroesophageal anastomosis.Results The cases had to coverse to open esophagectomy for unsuccess of intubate with double-lumen tube.The total operation time ranged from 215 to 400 minutes with a mean of 280 minutes.No massive hemorrhage occurred during the operation,the total blood loss ranged from 100 to 800 ml(mean,227 ml).Totally 413 lymphnods were removed(10.3 per patient in average).The mean hospital stay in this series was 13.6 days(range:8-30 days).During the hospitalization,no patient died;postoperative complications included pulmonary infection(3 cases),cervical anastomotic leak(1 case,occurred in 4 days after the surgery),hoarseness(3 cases) and chylothorax(1 case).Conclusion Combination of thoracoscopy and laparoscopy with cervical anastomosis is feasible and safe for the treatment of esophageal carcinoma.