胸、腹腔镜联合食管癌手术的临床分析

目的:探讨胸腹腔镜联合手术治疗食管癌的可行性和疗效,并总结相关临床经验。方法:2010年3月至2010年8月采用胸腔镜联合腹腔镜施行7例食管癌切除术,肿瘤均位于食管中上段,行胃体游离并经食管床上提胃体(管状胃)行食管胃颈部吻合术。结果:所有患者均顺利完成腔镜手术,无中转开胸病例,手术时间平均260min,术中平均出血200ml。平均清扫淋巴结12.8枚。术后下床活动时间平均3d,术后平均住院12d。术后1例发生吻合口漏,无其他并发症发生。患者均康复出院,术后随访2～8个月,均恢复良好。结论:胸、腹腔镜联合食管切除术较常规食管癌手术患者创伤小,术后康复快,且淋巴结清扫彻底,值得临床推广。

Clinical analysis of combined thoracoscopic and laparoscopic operation for esophageal carcinoma

Objective:To investigate the feasibility and therapeutic effect of combined thoracoscopic and laparoscopic operation for esophageal carcinoma,and summarize the clinical experience.Methods:From Mar.2010 to Aug.2010,seven patients with esophageal carcinoma were performed with combined thoracoscopic and laparoscopic surgery.They were all the carcinoma of the upper and middle esophagus.Video-assisted thoracoscopic surgical approach was used to free the esophagus and resect lymph node,and laparoscopic surgical approach was to free the stomach,which was raised through the esophageal bed to the neck for esophagogastric anastomosis.Results:All the gastric and esophageal mobilizations were successfully performed by endoscopic surgery,without conversion to open surgery.The mean operative time was 260min.Mean intraoperative blood loss was 200ml.The average number of removed lymph nodes was 12.8.The mean time of off-bed activity was 3d.The average postoperative hospital stay was 12d.Postoperative complications included only one case of anastomotic fistula.Patients were all healed and discharged.The follow-up was 2-8 months,all patients well recovered.Conclusions:Combined thoracoscopic and laparoscopic resection of esophageal carcinoma is mini-invasive,with quick recovery and radical remove of lymph node compared with conventional esophageal carcinoma operation,and should be popularized in clinic.