右侧剖胸经膈肌裂孔“骨骼化”食管癌根治手术的临床应用

目的探讨右侧剖胸经膈肌裂孔“骨骼化”食管癌根治手术及其在胸中上段食管癌临床应用的可行性和优越性。方法右侧剖胸一或二切口，应用“电凝锐性解剖”将食管周围组织（包括局部区域淋巴结和结缔组织）连同食管整块切除，使食管周围不能切除的解剖结构“骨骼化”，经膈肌裂孔游离胃，使用吻合器作食管胃胸顶或颈部吻合。结果共有26例胸中上段食管癌采用本项技术完成手术治疗，无手术死亡，术后并发症2例（7．7％）。结论该术式切口少，保留膈肌的完整性，既达到减创的目的，同时应用“电凝锐性解剖”，强调食管周围不能切除的解剖结构的“骨骼化”，遵循无瘤原则，以提高术后长期存活率。

Clinical Application of Right-Sided Thoracotomy with Trans-Diaphragm-Hiatus ＂Skeletonized＂ for Thoracic Esophageal Carcinoma

Objective To explore the feasibility and superiority of the clinical application of right-sided thoracotomy with trans-diaphragm-hiatus ＂skeletonized＂ for thoracic esophageal carcinoma. Method With one or two incision of right-sided thoracotomy, the irremovable Para esophagus structure was ＂skeletonized＂ by electricity solidified keen-dissection and the esophagus was removed completely. The stomach was separated through the diaphragm hiatus and the esophagus and stomach were anatomized at the top of thorax or at the neck by a stapler. Result There were 26 cases of thoracic esophageal carcinoma received this type of surgical treatment from Mar. 2006 to Feb. 2008. There was no cases of surgical death, and there were 2 cases with postoperative complication （7.7%）. Conclusion This surgical procedure can preserve the integrity of diaphragm with less incision and reduce the damage. The way of electricity solidified keen-dissection can ＂skeletonized＂ the irremovable Para esophagus structure. This type of operation follows the no-carcinoma principle and can lead to an improved postoperative survival rate.