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1.
目的 评价模块化胸腔镜食管癌切除在微创食管癌切除术中的应用价值.方法 回顾性分析2011年12月至2012年12月第三军医大学大坪医院收治的45例胸段食管癌患者的临床资料,采用模块化手术流程行胸腔镜食管癌切除+胃食管颈部吻合术.患者按食管癌术前准备,行电视胸腔镜联合腹腔镜食管癌切除术或电视胸腔镜食管癌切除+开腹游离胃手术.胸腔镜食管游离及纵隔淋巴结清扫按照模块化流程(针对患者情况进行灵活排列组合)进行:(1)下肺韧带游离及下段食管旁、下肺韧带(第8L、9组)淋巴结清扫.(2)奇静脉弓下食管的游离.(3)游离奇静脉弓上食管.(4)奇静脉弓的离断.(5)胸段食管的完全游离.(6)结扎胸导管.(7)清扫下气管旁、主肺动脉窗、隆凸下、双侧肺门以及左侧喉返神经旁(第4、5、7、10、2L组)淋巴结.采用电话或信件联系方式对患者术后进行随访.术后1年内每3个月门诊复查胸腹部CT及纤维胃镜了解有无肿瘤复发及转移,超过1年后每半年检查1次.随访时间截至2013年2月.结果 45患者中,行电视胸腔镜联合腹腔镜食管癌切除术29例,电视胸腔镜食管癌切除+开腹游离胃手术16例.肿瘤长度为(4.2 ±2.5)cm,AJCC分期T1、T2、T3、T4期患者分别为7、14、15、9例,NO、N1、N2、N3期患者分别为23、13、7、2例.45例患者胸腔内操作时间为(72±13) min,总手术时间为(249 ± 39) min,术中出血量为(183±62) ml,术中清扫淋巴结数目为(27±7)枚,术后住院时间为(18 ±7)d.2例患者中转开胸手术.45例患者均无术后死亡发生,术后发生并发症11例次(2例患者出现两种并发症),6例发生颈部吻合口瘘,4例出现吻合口狭窄,3例出现声音嘶哑.45例患者均获得随访,随访时间为1.5 ~14.0个月,平均随访时间为8个月.1例患者于术后12个月因上消化道大出血死亡,1例患者于术后8个月因肝转移引发MODS死亡,其余43例均生存.结论 电视胸腔镜食管癌切除术中采用模块化手术流程安全、可行,具有良好的近期效果. 相似文献
2.
Background
Minimally invasive esophagectomy (MIE) is a feasible technique that has been shown to be safe for the treatment of esophageal cancer. Chylothorax remains a challenging and potentially life-threatening postoperative complication of MIE. In this retrospective series, we evaluated the results of preventive intraoperative thoracic duct ligation in patients who underwent video-assisted thoracoscopic esophagectomy for cancer. 相似文献3.
Radical thoracoscopic esophagectomy for cancer 总被引:12,自引:2,他引:12
Background: Much of the morbidity of conventional esophagectomy for cancer is thought to relate to the thoracotomy wound and while transhiatal esophagectomy removes the need for a thoracotomy, it is not oncologically sound. Videothoracoscopy could potentially provide an oncologically sound means for resecting the thoracic esophagus without the need for a thorcotomy.
Methods: Between June 1991 and June 1994, thoracoscopic mobilization of the thoracic esophagus combined with radical lymphadenectomy was attempted in 24 patients as part of three-stage esophagectomy for cancer (5 squamous and 19 adenocarcinomas). Mean age was 59 years (range 43–76). Eight patients were ASA grade I, 10 were ASA II, and 6 ASA III. Two patients had early lesions (T1N0) but all other cancers were T2 (3) or T3 (19). Dissection of the thoracic esophagus was attempted via a right-sided approach, followed by a laparotomy and a cervical incision.
Results: The thoracoscopic procedure was successful in 22 patients; it was abandoned in one patient with dense pleural adhesions and in another with inoperable tumor. Mean duration of the thoracic component was 184 min (120–330). There were three post-operative deaths. Ten further patients had major complications. Median post-operative stay was 18 days (9–129). Mean node harvest was 13 nodes (6–28). Two-year survival (cancer specific) was 33%.
Conclusions: Radical thoracoscopic mobilization of the esophagus is feasible, but the potential for complications remains high and requires further study. 相似文献
4.
目的探讨胸腔镜食管癌根治术的安全性。方法回顾性分析2005年1月至2012年3月间复旦大学附属中山医院胸外科收治的胸腔镜食管癌根治术(260例)和常规开胸三切口食管癌根治术(322例)患者的临床资料。比较两组手术相关指标、围手术期并发症、再次手术、再人ICU及其转归。结果与开胸组相比.胸腔镜组患者胸部手术时间更短[(105±30)min比(112±41)min,P=0.000],胸部出血量更少[(95±48)ml比(107±44)ml,P=0.002],术后住院时间更短[(14.3±7.5)d比(16,9±9.5)d,P=O.000],胸部淋巴结清扫数量更多[(13.5±5.0)d比(11.6±4.7)d,P=0.000],围手术期并发症发生率更低[34.6%(90/260)比45.0%(145/322),P=0.011),围手术期死亡率更低[0.8%(2/260)比3.4%(11/322),P=0.032)。两组患者术后再次手术的比例相当[1.5%(4/260)比2.5%(8/322),P=0.425),但胸腔镜组术后需要再人ICU者明显更少[5.4%(14/260)比10.6%(34/322).P=0.024)。结论与开胸手术相比。胸腔镜食管癌根治术在安全性方面具有一定的优势。 相似文献
5.
Makoto Iwahashi Mikihito Nakamori Masaki Nakamura Toshiyasu Ojima Masahiro Katsuda Takeshi Iida Keiji Hayata Hiroki Yamaue 《Surgery today》2014,44(9):1708-1715
Purposes
The clinical benefits of thoracoscopic radical esophagectomy in the prone position compared to conventional open esophagectomy have not been fully documented.Methods
Forty-six patients with esophageal cancer who underwent MIE in the prone position (MIE-P group) were enrolled, and 46 case-matched controls that underwent open esophagectomy (OE group) were identified using propensity score methods to achieve a valid comparison of outcomes between MIE and open esophagectomy.Results
The duration of systemic inflammatory response syndrome was shorter in the MIE-P group than in OE group (P = 0.005). The time to first walking was earlier in the MIE-P group (P < 0.001). Although the vital capacity ratio (%VC) declined after the operation in both groups, the change ratio of the %VC was 85.3 % in the MIE-P group and 69.6 % in the OE group (P < 0.001). No mortality occurred in either group. The postoperative morbidity rate was lower in the MIE-P group (13 %) than in the OE group (30.4 %) (P = 0.020). Two patients (4.3 %) in the OE group and one patient in the MIE-P group (2.2 %) had pneumonia.Conclusions
MIE in the prone position was associated with less impairment of the pulmonary function, earlier recovery of activity and lower subsequent morbidity compared to open esophagectomy. Further investigation of the long-term outcomes is, therefore, needed. 相似文献6.
Video-assisted thoracoscopic esophagectomy for esophageal cancer 总被引:13,自引:3,他引:10
Kawahara K Maekawa T Okabayashi K Hideshima T Shiraishi T Yoshinaga Y Shirakusa T 《Surgical endoscopy》1999,13(3):218-223
BACKGROUND: The Ivor-Lewis procedure is a radical, invasive, and effective procedure for the resection of most esophageal cancers. To minimize invasiveness, we performed thoracoscopic and video-assisted esophagectomy and mediastinal dissection for esophageal cancer. METHODS: From November 1995 to June 1997, 23 patients with intrathoracic esophageal cancer, excluding T4 cancers, underwent thoracoscopic and video-assisted esophagectomy. Bilateral cervical dissections were performed as well as preparation of the gastric tube and transhiatal dissection of the lower esophagus. The cervical esophagus was cut using a stapler knife, and esophageal reconstruction was performed through the retrosternal route or anterior chest wall. Next, thoracoscopic mediastinal dissection and esophagectomy were performed. RESULTS: The mean volume of blood loss was 163 +/- 122 ml; mean thoracoscopic surgery duration, 111 +/- 24 min; mean postoperative day for patients to start eating, 8 +/- 3 days; and mean hospital stay, 26 +/- 8 days. No patient developed systemic inflammatory response syndrome postoperatively. Tracheal injury occurred and was repaired during the thoracoscopic approach in one patient. No patients died within 30 days after surgery. Postoperative complications included transient recurrent nerve palsy in five patients, pulmonary secretion retention requiring tracheotomy in two, and chylothorax in one. Five patients died of cancer recurrence within 1 year of surgery. CONCLUSIONS: Our surgical experience with thoracoscopic and video-assisted esophagectomy indicate that it is a feasible and useful procedure. 相似文献
7.
For more safety: no-knife stapling for vascular division during video-assisted thoracoscopic surgery
Staple cutters facilitate video-assisted thoracoscopic surgery, but their potential malfunction at vascular division can threaten
the patient's life. We have used no-knife staplers and have divided between the staple lines without event. We show this technique
to be a risk management alternative. 相似文献
8.
Background
Compared with the lung isolation using double-lumen endobronchial tube intubation, the artificial capnothorax using single-lumen endotracheal tube intubation has shown to be a safe, more convenient, and cost-effective procedure for thoracoscopic esophagectomy. However, the impact of capnothorax on coagulation is not well defined. Herein, we evaluate the impact of a capnothorax on coagulation and fibrinolysis in patients who undergoing thoracoscopic esophagectomy.Methods
Between March 2014 and August 2014, 24 patients underwent thoracoscopic esophagectomies for esophageal cancer with the procedure of artificial capnothorax (group P); we also performed 24 thoracoscopic esophagectomy cases without using capnothorax (group N). The demographics and arterial blood gas, as well as the parameters of coagulation and fibrinolysis, of the two groups were analyzed.Results
The pH value of group P after CO2 insufflation was significantly lower than in group N (P < 0.05), and the partial pressure of carbon dioxide (PaCO2) was significantly increased compared with group N (P < 0.05). The R and K values after CO2 insufflation were significantly longer than before anesthesia (P < 0.05), and both α angle and MA value after CO2 insufflation were significantly lower than those before anesthesia (P < 0.05). No significant differences in R value, K value, α angle, or MA value were observed between pre-anesthesia and termination of capnothorax. No significant difference in LY30 data was found between different groups (P > 0.05).Conclusion
Artificial capnothorax in patients receiving endoscopic resection of esophageal carcinoma had a significant impact on coagulation. These patients showed significant impairments in coagulation not observed in patients without artificial capnothorax.9.
10.
Ninomiya I Osugi H Fujimura T Kayahara M Takamura H Takemura M Lee S Nakagawara H Nishimura G Ohta T 《General thoracic and cardiovascular surgery》2008,56(3):119-125
Objective The attainment of proficiency in thoracoscopic radical esophagectomy for thoracic esophageal cancer requires much experience.
We aimed to master this procedure safely with our regular surgical team members under the direction of an experienced surgeon.
We evaluated the efficacy of instruction during the induction period and the significance of our results.
Methods We compared the results of 12 thoracic esophageal cancer patients who underwent thoracoscopic radical esophagectomy in our
institution (group A) to those of the initial 17 patients who underwent the same operation at the director’s institution (group
B).
Results We were able to perform complete thoracoscopic radical esophagectomies without any direction after experiencing 10 cases that
were performed under adequate direction. The number of dissected lymph nodes and the duration of the procedure were similar
in the two groups: 34 (22–53) vs. 26 (9–55) nodes, P = 0.23; and 327.5 (230–455) vs. 315 (190–515) min, P = 0.947, respectively. The amount of thoracic blood loss was significantly less in group A than in group B: 185 (110–380)
g vs. 440 (110–2360) g, P = 0.0035. Postoperative pneumonia and atelectasis were observed in 25.0% of group A patients and in 17.6% of group B patients.
The incidence of recurrent nerve palsy was 30.7% in group A and 11.7% in group B, but there was no statistically significant
difference (P = 0.19). The morbidity rates in group A and group B were 41.6% and 29.4%, respectively (P = 0.694).
Conclusion Thoracoscopic radical esophagectomy can be mastered relatively quickly and safely under the direction of an experienced surgeon
and a regular surgical team.
This article is based on a study first reported in Nihon Naishikyougeka Gakkaizasshi (J Jpn Soc Endosc Surg) 2006;11:155–161 (in Japanse with English abstract). 相似文献
11.
电视胸腔镜手术在肺癌治疗中的应用 总被引:1,自引:0,他引:1
电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)是一种微创、安全、可行的技术。随着手术器械和技巧的日趋改进,电视胸腔镜在临床的应用越来越广泛。本文就电视胸腔镜手术在肺癌治疗中的应用作一综述。 相似文献
12.
Osugi H Takemura M Higashino M Takada N Lee S Ueno M Tanaka Y Fukuhara K Hashimoto Y Fujiwara Y Kinoshita H 《Surgical endoscopy》2003,17(3):515-519
Background: The efficacy of thoracoscopic radical esophagectomy for cancer of the thoracic esophagus and the learning curve
required have yet to be clearly established. Methods: Eighty treatment-naive patients with esophageal cancer without contiguous
spread underwent esophageal mobilization and extensive mediastinal lymphadenectomy through a 5-cm minithoracotomy and four
trocar ports. The outcomes in the first 34 patients (group 1) and the last 46 patients (group 2) were compared. Results: There
were no differences in background or clinicopathologic factors between the two groups. The duration of the thoracoscopic procedure
and blood loss were less (p <0.0001), the incidence of postoperative pulmonary infection was less (p = 0.0127), and the number
of mediastinal nodes retrieved was greater (p = 0.0076) in group 2. Multivariate analysis demonstrated that surgical experience
(number of cases performed) predicted the risk of pulmonary infection (p = 0.0331). Conclusion: Video-assisted thoracoscopic
radical esophagectomy can be performed with safety and efficacy comparable to those of open esophagectomy. Morbidity decreases
with the surgeon's experience. 相似文献
13.
Petri R Zuccolo M Brizzolari M Rossit L Rosignoli A Durastante V Petrin G De Cecchis L Sorrentino M 《Surgical endoscopy》2012,26(4):1102-1107
Background
Surgical resection is the mainstay treatment for resectable esophageal cancer. Minimally invasive esophagectomy is performed with increasing frequency and proves to be a safe and effective surgical alternative to the open technique. Minimally invasive esophagectomy using thoracoscopic esophageal mobilization with the patient in prone position seems to offer some advantages with regard to surgeon ergonomics and clinical outcome. 相似文献14.
小切口电视胸腔镜辅助与传统开胸肺癌根治术的比较 总被引:11,自引:2,他引:9
目的探讨小切口电视胸腔镜辅助肺癌根治术的临床价值。方法2005年1月~2006年6月收治49例I、Ⅱ期非小细胞肺癌,22例在小切口(腋前线肋间6~8cm)辅助电视胸腔镜下行肺叶切除术及肺门纵隔淋巴结清扫(VATS组),27例在常规开胸手术下完成肺叶切除术及淋巴结清扫(传统开胸组),比较2种术式肺功能和C反应蛋白(C reactiveprotein,CRP)的变化。结果胸腔镜组2例为方便安全地处理肺门血管将小切口扩大至12~15cm。2组患者术后血清CRP浓度明显升高,第1天达到峰值,胸腔镜组CRP术后1d(56.1±10.9)mg/L,显著低于传统开胸组(73.8±15.1)mg/L(t=-4.603,P=0.000)。2组术后肺功能每分钟通气量相对值(minute ventilation volume,MV)、1秒用力呼气容积相对值(forced expiratory volume in one second,FEV1)下降,术后1周时胸腔镜组MV为(95.6±16.4)L,显著高于传统开胸组(81.9±12.7)L(t=3.296,P=0.002),胸腔镜组FEV1为(57.1±5.7)%,显著高于传统开胸组(51.4±6.9)%(t=3.105,P=0.003)。结论与常规开胸肺癌根治术相比,小切口电视胸腔镜辅助肺叶切除术适合于早中期肺癌,疗效确切,可明显减少病人的手术创伤,可以作为非小细胞型肺癌的一种常规的治疗手段。 相似文献
15.
目的:比较胸腔镜食管癌根治术与开放手术的纵隔淋巴结清扫情况,探讨胸腔镜手术的根治性及安全性。方法回顾性分析2009年6月至2011年6月间四川省肿瘤医院胸外科经左颈右胸上腹食管癌根治术治疗304例患者的临床资料。其中199例行传统开放三切口食管癌根治术(开放组),105例行胸腹腔镜三切口食管癌根治术(腔镜组),比较两组患者术中淋巴结清扫情况及围手术期并发症发生情况。结果腔镜组清扫纵隔淋巴结数目为(10.1±5.5)枚,明显少于开放组的(13.3±7.5)枚(P<0.01);但匹配术后病理分期后,各期腔镜组和开放组的胸内淋巴结清扫数目差异并无统计学意义(均P>0.05)。开放组和腔镜组左喉返神经旁淋巴结平均清扫数分别为(2.7±0.2)枚和(1.4±0.2)枚,下段食管旁分别为(1.0±0.1)枚和(0.6±0.1)枚,病灶旁分别为(1.7±0.2)枚和(0.7±0.1)枚,差异均有统计学意义(均P<0.01);其他区域两组淋巴结清扫数目差异均无统计学意义(均P>0.05)。腔镜组围手术期并发症发生率为28.6%(30/105),低于开放组的41.2%(82/199)(P<0.05),但喉返神经麻痹发生率[12.4%(13/105)]明显高于开放组[2.5%(5/199),P<0.01)。结论胸腔镜食管癌根治术安全可行。但在行胸腔镜纵隔淋巴结清扫时,应加强对喉返神经旁、下段食管旁和病灶旁淋巴结的清扫,并注意喉返神经的保护。 相似文献
16.
Background The most critical parameter in the evaluation of the feasibility of video-assisted thoracoscopic surgery (VATS) lobectomy for lung cancer is long-term outcome. In this study, patients in whom more than 5 years had elapsed since
they had undergone VATS lobectomy for lung cancer were identified, and the 5-year survival rate and frequency of recurrence
were evaluated as the long-term outcomes; in addition, the frequency of perioperative complications were also evaluated as
the short-term outcomes.
Methods The stage, histology, perioperative complications, recurrence, and survival data were carefully reviewed in 198 patients who
underwent VATS lobectomy for lung cancer between 1998 and 2002.
Results Median postoperative follow-up period was 72.1 months. Of the 198 patients, 138 and 30 were diagnosed as having p-stage IA and IB disease, respectively, while the remaining 30 patients had more advanced disease. Perioperative complications
were observed in 20 patients (10.1%), however, there were no perioperative mortalities. Recurrence was observed in 26 patients
(13.1%): of these, 11 patients showed local recurrence, including malignant pleural effusion and mediastinal lymph node recurrence,
and 16 patients showed distant metastasis, the lung being the commonest site of metastasis; six patients had both local recurrence
and distant metastasis. During the study period, there were 26 deaths (13.1%), of which 17 were due to lung cancer and 9 were
due to other causes. The 5-year overall survival rates of the patients with p-stage IA and IB disease were 93.5% and 81.6%, respectively.
Conclusion VATS lobectomy for the treatment of lung cancer is as feasible and safe as open lobectomy in terms of both very long- and
short-term outcomes. 相似文献
17.
胸腔镜肺叶切除术治疗早期肺癌的学习曲线 总被引:2,自引:1,他引:2
目的 通过评估胸腔镜肺叶切除术治疗早期肺癌不同阶段的手术效果,探讨胸腔镜肺叶切除术的学习曲线.方法 回顾性分析2006年9月至2008年6月由同一手术组连续完成的60例全胸腔镜下肺叶切除加纵隔淋巴结清扫术治疗早期肺癌的病例资料.按手术先后依次分为4组(A、B、C、D),每组15例,比较各组手术时间、术中出血量、纵隔淋巴结清扫站数及个数、中转开胸率、术后并发症、术后胸管引流时间以及术后住院天数,分析不同阶段的手术效果.结果 各组病例在年龄、性别、肿瘤大小、病理分期以及手术方式等方面差异无统计学意义(P>0.05).A组手术时间(228.0±55.6)min明显长于C组(155.0±33.6)min或D组(152.7±27.4)min(P<0.001),B组手术时间(200.3±67.1)min亦明显长于C组或D组(P<0.05),而C、D两组之间差异无统计学意义(P=0.896);在术中出血量方面,A组(283.3±111.2)ml明显多于C组(156.7±86.3)ml或D组(143.3±67.8)ml(P<0.01),B组(286.7±188.4)ml亦明显多于C组或D组(P<0.01),C、D两组之间差异无统计学意义(P=0.767);各组淋巴结清扫数量、中转开胸率、术后并发症、术后胸管引流时间以及术后住院天数比较,差异均无统计学意义(P>0.05).结论 胸腔镜肺叶切除术的学习曲线大约为30例. 相似文献
18.
19.
Maruyama R Miyake T Suzuki Y Shoji F Okamoto T Ichinose Y 《Surgical laparoscopy, endoscopy & percutaneous techniques》2006,16(2):117-118
We performed video-assisted thoracoscopic surgery for pulmonary metastasis with the patient in the prone position because the use of the full lateral decubitus position was not possible owing to a deformity of the upper extremity, which existed because of a previous operation for osteosarcoma. In cases where the lateral decubitus position cannot be used, the prone position is both safe and effective for treating dorsal lesions of the lung by means of video-assisted thoracoscopic surgery. 相似文献
20.
Sonographic evaluation for peripheral pulmonary nodules during video-assisted thoracoscopic surgery 总被引:1,自引:1,他引:0
Background: The clinical value of sonographic guidance during video-assisted thoracoscopic surgery (VATS) was studied in 26 patients with peripheral pulmonary nodules. Methods: Twenty-six patients underwent VATS between June 2000 and March 2001 for primary lung cancer (n = 15), pulmonary metastasis (n = 6), and various benign tumors (n = 5). Results: Sonographic guidance successfully visualized peripheral pulmonary tumors in 21 of the 26 patients (81%). Among them, rich intratumoral blood flow signal was identified in 8 of the 15 primary lung cancers by using color Doppler sonography. The peak velocity was 26 ± 12.8 cm/s in primary lung cancer and 9.4 ± 1.7 cm/s in pulmonary metastasis, respectively (p < 0.01). Conclusion: Sonographic guidance during VATS is helpful for locating lesions and determining the extent of surgical resection. The color Doppler method was also useful for evaluating intratumoral blood flow, which yielded significant information for differentiating primary lung cancer, metastatic tumors, and various benign tumors. 相似文献