微创食管癌切除术150例分析

目的：探讨微创食管癌切除术治疗食管癌的可行性及应用价值。方法回顾性分析我科2009年5月～2014年2月150例微创食管癌切除术（minimally invasive esophagectomy ，MIE）的资料，男87例，女63例，年龄（57．3±9．2）岁。胸上段食管癌35例，胸中段74例，胸下段41例。胸、腹腔镜联合30例，全胸腔镜＋腹部开放115例，胸部开放＋腹腔镜5例，均行食管胃左颈吻合术。结果150例手术均获成功，手术时间（352．2±95．3）min，术中估计失血量（223．2±190．5）ml，术后区域淋巴结清扫数量（30．5±6．2）枚，阳性转移率28．7％（43／150）。术后病理分期ⅠA期18例，ⅠB期35例，ⅡA期39例，ⅡB期24例，ⅢA期19例，ⅢB期15例。术后住院时间（12．8±3．7）d。无围手术期死亡，术后并发症发生率28．7％（43／150），包括肺部感染11例（7．3％），呼吸衰竭2例（1．3％），乳糜胸2例（1．3％），活动性出血二次手术1例（0．7％），吻合口漏16例（10．7％），声音嘶哑7例（4．7％），气管损伤1例（0．7％），胸胃排空障碍3例（2．0％）。结论 MIE手术治疗食管癌创伤小，恢复快，技术可行，手术安全合理，值得临床应用推广。

Minimally Invasive Esophagectomy in 150 Patients with Esophageal Carcinoma

Objective To explore the feasibility and safety of minimally invasive esophagectomy （ MIE） for the treatment of esophageal carcinoma. Methods Clinical data of 150 patients with esophageal carcinoma who underwent MIE in our department from May 2009 to February 2014 were analyzed retrospectively. There were 87 males and 63 females, with their age of 57.3 ±9.2 years old.The tumors were located at upper thoracic segment in 35 cases, middle segment in 74 cases, and lower segment in 41 cases. A total of 30 patients were scheduled for thoracoscopy combined with laparoscopy operations , 115 patients for thoracoscopy and laparotomy operations , and 5 patients for thoracotomy and laparoscopy operations. Results No patient died postoperatively. The mean operation time was 352.2 ±95.3 min.The mean intraoperative blood loss was 223.2 ±190.5 ml.The average number of dissected lymph nodes was 30.5 ±6.2 for each patient, with a positive metastatic rate of 28.7%（43/150）.Postoperative pathological staging found stage ⅠA in 18 cases, stageⅠB in 35 cases, stageⅡA in 39 cases, stageⅡB in 24 cases, stageⅢA in 19 cases, and stage ⅢB in 15 cases.The length of postoperative hospital stay was 12.8 ±3.7 days.Postoperative complications occurred in 28.7%of patients （43/150）, including lung infection in 11 patients （7.3%）, respiratory failure in 2 patients （1.3%）, chylothorax in 2 patient （1.3%）, active hemorrhage leading to a re-operation in 1 patieat（0.7%）,anastomotic leakage in 16 patients （10.7%）, gastric dynamic disorders in 3 patient （2%）, tracheal injury in 1 patient （0.7%）, and hoarseness in 7 patients （4.7%）, respectively. Conclusion MIE is a minimally invasive, feasible, and safe surgical procedure for the treatment of esophageal carcinoma, bearing advantages of quick postoperative recovery and being worthy of further clinical application.