电视胸腔镜与小切口开胸手术治疗食管良性疾病的比较

目的比较电视胸腔镜手术与小切口开胸手术治疗食管良性疾病的临床效果和适应证。方法1995年1月至2007年1月我院胸外科应用微创手术治疗食管良性疾病患者52例。其中贲门失弛缓17例,食管平滑肌瘤24例,食管憩室7例,食管脂肪瘤1例,食管囊肿1例,贲门失弛缓合并食管憩室1例,贲门失弛缓球囊扩张食管破裂1例。根据手术方式分为电视胸腔镜手术组25例,小切口开胸手术组27例。结果两组患者手术治疗效果均良好,无术后并发症,无手术死亡。电视胸腔镜手术组有2例因胸腔内广泛粘连和食管黏膜损伤中转开胸。两组患者手术时间、术后胸腔闭式引流时间、胃肠减压时间以及术后住院时间均无明显差异。结论电视胸腔镜手术和小切口开胸手术治疗食管良性疾病安全有效,术后恢复快。电视胸腔镜手术切口符合美观要求,可作为治疗食管良性疾病的常规术式。小切口开胸手术更适合于病情较复杂的患者。     

经胸小切口食管肌层切开术治疗贲门失弛缓症

目的总结经胸小切口食管肌层切开术治疗贲门失弛缓症的临床经验. 方法 25例贲门失弛缓症患者中中度9例,重度16例 ,均接受了手术治疗.手术经左胸腋后线第7或第8肋间进胸,切口6～8cm,行食管肌层切开.全组均未行抗反流手术. 结果全部患者顺利完成手术,无死亡,平均手术时间50分钟,术后平均住院天数10天.1例患者因损伤食管黏膜,于术中予以修补,其余患者术后无并发症.随访全部患者,吞咽困难消失,无胃食管反流症状.8例术后行24小时食管pH监测无病理性反流. 结论经胸小切口行食管黏膜外肌层切开术,创伤小,恢复快,并发症少,住院时间短.合理掌握胃食管连接部的肌层切开范围可有效防止术后胃食管反流发生.     

微创肌肉非损伤性开胸术353例

2001年开始我们为353例病人采用微创肌肉非损伤性开胸术完成手术，现总结报道如下。     

选择性手术病人术后近期体液变化初步探讨

为了探讨选择性手术病人术后近期的体液代谢变化,我们对107例因食管、贲门肿瘤而行开胸探查,食管胃切除吻合术和因胃部疾患行胃次全切除患者术后近期水的平衡过程进行了分析。材料及方法全组107例,胃及十二指肠溃疡、胃癌、萎缩性胃炎共84例,食管及贲门癌23例。在选择病例时将溃疡病伴急性上消化道大出血、溃疡病穿孔者除外;将术后近期内有并发症者,如梗阻、外瘘、出血、急性伪膜性肠炎及腹泻或术后出入量记录不全者除外。患者术前基本处于正常生理状态,体液基本处于平衡。     

胃食管交界区黏膜下肿瘤腹腔镜手术体会(附5例报告并文献复习)

目的:探讨腹腔镜胃局部切除术治疗胃食管交界区黏膜下肿瘤的可行性。方法:回顾性分析2005年3月至2008年3月5例行腹腔镜手术的胃食管交界区黏膜下肿瘤患者的手术方式设计,术后定期随访。结果:平均手术时间(108±19.5)min,术中平均出血(65±11.7)ml;5例手术均获成功,无病灶遗漏,无贲门狭窄、腹腔感染、脾脏损伤、胃漏等并发症和中转手术;术后随访均未见肿瘤复发。结论:腹腔镜胃局部切除术治疗胃食管交界区黏膜下肿瘤安全、有效。     

早期贲门腺癌的诊断和外科治疗的远期效果

目的 总结90例早期贲门腺癌外科切除治疗的经验和远期效果.方法 1972年至1997年间,对组织病理检查诊断为早期贲门腺癌的90例患者行外科手术切除治疗.手术经左侧开胸,行包括部分胃和食管的贲门切除术,食管胃主动脉弓下吻合术和胸腹腔局部淋巴结清扫术.结果 肿瘤切除率100%,术后死亡率1.1%(1/90),术后并发症发生率为4.4%(4/90).手术切除标本病理检查发现:黏膜内癌46例(51.1%),无淋巴结转移;黏膜下浸润癌44例(48.9%),淋巴结转移5例(11.4%).所有患者随访至2002年,其间失访7例,其总体5、10、15、20和25年生存率分别为91.9%、83.6%、69.6%、49.8%和16.6%.结论 为提高胃贲门癌生存率,早期诊断和早期治疗是最佳途径.早期贲门癌外科切除治疗可提供很好的长期生存效果.     

脾切除联合贲门周围血管离断术治疗TIPS术后食管胃底静脉曲张复发破裂出血17例体会

目的 探讨脾切除联合贲门周围血管离断术治疗经颈静脉肝内门体分流术（TIPS）术后食管胃底静脉曲张复发破裂出血的安全性及有效性。方法 回顾性分析2016年5月至2021年4月宁夏回族自治区人民医院TIPS术后食管胃底静脉曲张复发破裂出血行脾切除联合贲门周围血管离断术17例患者的临床资料。统计其手术时间、术中出血量、术后并发症及复发率，分析手术安全性及疗效。结果 全部患者完成了脾切除联合贲门周围血管离断术。行原位脾切除8例、传统法脾切除7例、包膜内脾切除2例；紧贴胃、食管下段选择性贲门周围血管离断术11例、保留自发性胃肾分流的选择性贲门周围血管离断术6例。平均手术时间186 min(145～518 min)，手术出血量348 mL(225～2 500 mL)，无手术死亡病例。术后门静脉血栓3例，肺部感染1例，肝性脑病1例。术后2年食管胃底静脉曲张消失6例，轻中度残留10例，重度静脉曲张1例。结论 脾切除联合贲门周围血管离断术是治疗TIPS术后食管胃底静脉曲张复发破裂出血的有效方法。     

腹腔镜联合胃镜治疗邻近贲门或幽门的胃间质瘤

目的探讨腹腔镜联合胃镜行胃楔形切除治疗邻近贲门或幽门的胃间质瘤的安全性和可行性。方法2006年9月～2008年11月对5例特殊部位的胃间质瘤（3例肿瘤距离贲门≤5cm,2例距离幽门≤5cm）采用腹腔镜联合胃镜进行胃楔形切除。切割闭合器切除肿瘤过程中,胃镜于胃腔内实时观察和调整切割缘位置,避免损伤贲门或者幽门,确保肿瘤完整切除且胃腔无狭窄。结果5例均成功完成腹腔镜联合胃镜胃楔形切除,肿瘤完整切除,无肿瘤破裂,无胃腔狭窄,无中转开腹。手术时间60～110min,平均84min;术中出血量10～50ml,平均30ml。术后中位排气时间3d,中位进流食时间术后3d。术后病理切缘均为阴性。1例术后出现粘连性肠梗阻（经保守治疗后缓解）,其余4例未出现手术相关并发症。术后3个月行胃镜以及钡餐造影,无胃腔狭窄。5例平均随访27.8月（8～34个月）,未发现肿瘤复发和转移。结论对于邻近贲门或幽门的胃间质瘤,腹腔镜联合胃镜行胃楔形切除是安全和可行的,符合胃肠道间质瘤的治疗原则,可以避免胃腔狭窄。     

胸腔镜下微创手术对纵隔肿瘤的治疗效果及对术后血栓形成的预防效果

目的 探讨胸腔镜下微创手术对纵隔肿瘤的治疗效果及对术后血栓形成的预防效果.方法 收集2017年1月至2020年6月新疆医科大学第一附属医院收治的纵隔肿瘤患者的临床资料,根据手术方式的不同将其分为开胸组和微创组,各95例.开胸组患者行传统开胸术,微创组患者行微创胸腔镜手术.比较两组患者的手术相关指标、术后恢复指标、手术前...     

经胸微创手术加食管内水囊扩张治疗贲门失弛症临床分析

目的观察经胸微创手术配合食管内水囊扩张治疗贲门失弛症的疗效。方法对8例贲门失弛症患者经胸微创手术配合食管内水囊扩张治疗,回顾性分析患者的病例资料。结果治愈8例,术后反流性食管炎0例(0%),无明显并发症。结论经胸微创手术加食管内水囊扩张术式治疗贲门失弛症疗效确切,手术简单,创伤小,恢复快,不良反应小,值得推荐,近期疗效较好,但远期疗效仍需随访观察。     

Radical operation for carcinoma of gastric cardia--lymph node dissection by laparosternophrenotomy approach

The adequate esophago-gastric resection and lymph node dissection can be performed without the necessity of a thoracotomy, by using the laparosternophrenotomy approach. For tumors restricted to lower esophagus of 4cm in localized tumors or 3cm in invaded tumors above the EG junction, the sternotomy approach is utilized. However, if the tumor extends to more than the above criteria, the thoracoabdominal approach must be utilized. For 14 years, 85 cases with tumor of gastric cardia were performed by sternotomy approach and 76 cases were performed by thoracotomy approach. The lymph node metastatic rate in the lower thoracic cavity was 26% in total. The lymph node metastatic rate of No. 110 was 22.6%, No. 111 was 17.4% and No. 112 was 12.5%. These results show the lymph node dissection in the lower thoracic cavity is very important in tumors of gastric cardia. The five year survival rate was 41% in patients who undergone curative operation by the sternotomy approach, and 45% in patients performed by the thoracotomy approach. According to our study of the lymph fluid stream in gastric cardia tumors using carbon, the lymph node dissection around the renal vein is important. This approach has less respiratory disturbance than the thoracotomy. This procedure is one of the best approaches for carcinoma of gastric cardia according to our criteria.     

Pulmonary metastasectomy in pediatric patients

This article describes the historical development of pediatric pulmonary metastasectomy but demonstrates that progress has been slow in understanding its proper applications. Because many pediatric metastatic tumors are rare, surgeons have grouped together patients of different histologies for the generation and analysis of case series. By examining tumor types individually, however, it is seen that certain histologies (adrenocortical carcinoma, alveolar soft part sarcoma, osteosarcoma) mandate surgical metastasectomy for patient survival. Other pediatric tumors (Wilms tumor, Ewing's sarcoma) are radiation sensitive, and the application of metastasectomy is controversial. In the case of still other types of tumor (neuroblastoma, differentiated thyroid cancer, rhabdomyosarcoma), metastasectomy is seldom performed except in highly unusual situations. Techniques for minimally invasive biopsy and for muscle-sparing thoracotomy are described for pediatric patients.     

Combined non-cardiac operations with minimally invasive direct coronary artery bypass grafting.

We report two cases in which Minimally invasive direct coronary artery bypass grafting was followed by other non-cardiac operations in the same operative setting. A left internal thoracic artery-to-left anterior descending artery anastomosis was constructed through a left anterior thoracotomy in both patients. Immediately after Minimally invasive direct coronary artery bypass grafting, one patient underwent a pancreatoduodenectomy for a biliary duct carcinoma and the other patient received a prosthetic graft replacement for an abdominal aortic aneurysm. Minimally invasive direct coronary artery bypass grafting is advantageous in patients with significant coronary artery disease who have to undergo other non-cardiac surgeries.     

Combined non-cardiac operations with minimally invasive direct coronary artery bypass grafting

We report two cases in which Minimally invasive direct coronary artery bypass grafting was followed by other non-cardiac operations in the same operative setting. A left internal thoracic artery-to-left anterior descending artery anastomosis was constructed through a left anterior thoracotomy in both patients. Immediately after Minimally invasive direct coronary artery bypass grafting, one patient underwent a pancreatoduodenectomy for a biliary duct carcinoma and the other patient received a prosthetic graft replacement for an abdominal aortic aneurysm. Minimally invasive direct coronary artery bypass grafting is advantageous in patients with significant coronary artery disease who have to undergo other non-cardiac surgeries.     

Minimally invasive therapy for benign tumors of the distal third of the esophagus--a single institute's experience

INTRODUCTION: Traditionally, the treatment of benign esophageal tumors is enucleation achieved via a thoracotomy. Since 1992, many reports of thoracoscopic and laparoscopic approaches have been published. In this paper, we present a retrospective study of 18 patients with benign distal esophageal tumors who underwent minimally invasive procedures. MATERIALS AND METHODS: A total of 18 patients were treated in our institute form 1994 to 2006. Tumors of the middle third were approached thoracoscopically, and laparoscopic transhiatal enucleation was performed for tumors of the lower third. One patient had associated achalasia cardia, for which a cardiomyotomy with Toupet fundoplication was also performed, and another patient underwent an esophagectomy for a large tumor. RESULTS: There were 12 males and 6 females and the average age was 59 years. The majority of the tumors were in the lower third, and the most common type of tumor was leiomyoma. Postoperative complications were recorded. DISCUSSION: Leiomyomas are the most common benign tumors and are located frequently in the middle and lower third. Based on our experience, we feel that lower esophageal tumors are best approached by a laparoscopic transhiatal route and midesophageal tumors by a right thoracoscopic approach. Conclusions: Minimally invasive surgery for benign esophageal tumors is ideal, reducing the morbidity of conventional methods.     

Clinicopathologic profiles and prognosis of gastric carcinomas from the cardia, fundus/body and antrum

Background/Aims: The putative influence of tumor location on the biologic behavior of gastric carcinomas remains controversial. The aim of this study was to investigate if carcinomas arising in the three types of gastric mucosa (cardia, fundus/body and antrum) have different clinical and pathologic profiles and carry a different prognosis. Methods: Three hundred and two patients with cardia or gastric carcinoma resected between 1984 and 1996 were retrospectively studied. Cases were divided in three groups according to tumor location: cardia (n = 80); fundus/body (n = 60); antrum (n = 162). The three groups were crosstabulated with clinic and pathologic parameters, such as age, sex, macroscopy, histology, desmoplasia, tumor size, depth of tumor wall penetration, nodal status, venous invasion and stage. Survival rates were calculated for the three locations according to the aforementioned parameters. Univariate survival analysis and Cox regression were performed for each location. Results: Cases from the cardia and fundus/body were similar and distinct from antrum cases according to macroscopy, tumor size, depth of wall penetration, venous invasion, nodal status and stage. Cases from fundus/body were similar to antrum cases and distinct from cardia cases according to gender and Laurén's classification. An overall difference in survival between the three locations was observed (p = 0.006). Cumulative survival was better for patients with carcinomas in the antrum than in the cardia (p = 0.04) and in the fundus/body (p = 0.003); no significant differences were observed in survival between cardia and fundus/body carcinoma cases. Cox regression identified stage and venous invasion as prognostic factors for patients with carcinomas in the three locations. In the group of cardia tumors, older patients had a worse outcome and in the group of fundus/body carcinomas, large tumors were associated with a poorer survival. Conclusions: Our results show that cardia carcinoma and antrum carcinoma are distinct gastric carcinoma entities whereas fundus/body carcinoma shares some characteristics from both entities.     

Transmanubrial approach with antero-lateral thoracotomy for apical chest tumor.

Transmanubrial osteomuscular sparing approach (TMA) has been recently proposed for the treatment of apical chest tumor to allow a safer subclavian artery control with a less invasive procedure for the patient. The present technique combines the antero-lateral muscle-sparing thoracotomy with TMA for lung cancer patients in whom extended resection of cervico-thoracic structures as well as anatomic lung resection and radical lymph nodes dissection are required.     

Laparoendoscopic removal of a benign gastric stromal tumor at the cardia.

OBJECTIVE: Gastrointestinal stromal tumors are the most common submucosal masses in the stomach and are mostly benign. Minimally invasive surgery is being increasingly used for their excision. Tumors close to the cardia often require a stapled resection of stomach. We report a technique for enucleating a 4-cm, well-circumscribed gastric submucosal tumor at the cardia, avoiding gastric transection. METHODS: A gastroscope was introduced to distend the stomach. A laparoscope was inserted through the umbilicus after pneumoperitoneum was created. Two 5-mm metal trocars were inserted into the stomach under vision. A 10-mm trocar was passed through the umbilical incision into the stomach for the camera. Dilute epinephrine was injected submucosally. The tumor was enucleated after incising the overlying mucosa. A gastroscope snare helped in grasping the tumor for retraction and final removal in a plastic bag. The submucosal defect and gastric port-site defects were sutured laparoscopically with Vicryl 3-0. RESULTS: Contrast studies showed no leakage. Final histology indicated a benign leiomyoma. The patient was discharged on the sixth day. No recurrence was noted at 6-month follow-up. CONCLUSION: Benign stromal tumors at the cardia can be safely enucleated by this method. This technique is cost-effective as it avoids expensive staplers or self-retaining gastric balloon ports.     

经胸腹联合小切口手术治疗贲门癌

目的探讨胸腹联合小切口在贲门癌手术中的应用效果。方法我科于2002年1月~2007年1月对60例贲门癌患者行贲门癌切除术,经胸腹联合小切口30例,经后外侧切口30例,回顾分析2组资料。结果手术均获成功,无手术死亡及严重并发症发生。与后外侧切口组相比,胸腹联合小切口组的切口长度短[(12.4±0.7)cm vs(19.2±2.0)cm,t=-17.577,P=0.000],手术时间短[(207.3±76.1)min vs(260.0±85.6)min,t=-2.519,P=0.015],开始下床活动早[(2.3±0.5)d vs(3.4±0.5)d,t=-8.521,P=0.000],胸腔引流量少[(276.7±58.7)ml vs(308.7±59.5)ml,t=-2.097,P=0.040],哌替啶用量少[(66.7±27.3)mg vs(113.3±45.4)mg,t=-4.818,P=0.000],吸氧时间短[(3.8±2.0)d vs(5.1±2.6)d,t=-2.171,P=0.034],动脉血氧饱和度高[(97.6±2.7)%vs(96.1±2.7)%,t=2.152,P=0.036]。2组清扫胸...     

New operative technique to resect of peripheral bronchogenic carcinoma with chest wall invasion using Kent's retractor]

We report the new operative technique for resection of peripheral bronchogenic carcinoma with chest wall invasion using Kent's retractor and hook suspender. Standard muscle sparing thoracotomy cannot obtain the adequate operative field in the posterior chest wall under the scapula because of sparing the latissimus dorsi muscle. To obtain a sufficient operative field at the operation for en bloc chest wall resection, especially with the area of the posterior chest wall under the scapula, resection of the trapezius muscle, rhomboideus major muscle, and latissimus dorsi muscle has been added to muscle-sparing thoracotomy. Through our new technique using Kent's retractor and hook suspender that has been used in the abdominal surgery, assistant surgeon can be eliminated in favor of hanging up the scapula, which is able to be performed much easier to obtain a good operative field. To use the Kent's retractor and hook suspender, the scapula is lifted upward and cranially. With these procedures, the proximal portion of the first, second and third ribs in the posterior chest wall covering by the scapula is able to resect from vertebrocostal junction with muscle-sparing thoracotomy. We examined the apparatus for a case of the right upper lung carcinoma with invasion to the posterior chest wall. We performed right upper lobectomy with chest wall in the area of the second, third and forth ribs with suspending the scapula by Kent's retractor after muscle-sparing thoracotomy.