胸腔镜联合腹腔镜行食管癌根治术的临床研究

目的探讨胸腔镜联合腹腔镜治疗食管癌的临床效果。方法对25例食管癌患者行电视胸腔镜联合腹腔镜下食管癌根治术。左侧卧位行胸腔镜下胸段食管的游离及周围淋巴结的清扫,然后改平卧位,腹腔镜下胃游离及淋巴结清扫,剑突下小切口完成管状胃的制作,再将管状胃从食管床拉至颈部与颈段食管吻合。结果总手术时间270～400 min,平均338 min;术中无大出血,总出血量100～600 mL,平均270 mL。共清扫淋巴结185枚,平均每例7.4枚;术后住院8～20 d,平均10.3 d。1例因奇静脉破裂中转开胸。术后并发症:1例因吻合口漏伴胸腔感染死亡,胃排空障碍1例,乳糜胸1例,声音嘶哑2例。结论胸腔镜联合腹腔镜手术治疗食管癌在技术上是可行的。

Clinical study on combined laparoscopy and thoracoscopy esophagectomy

Objective To evaluate the clinical application of combination of thoracoscopy and laparoscopy in the treatment of esophageal carcinoma.Methods Combined thoracoscopy and laparoscopy esophagectomy was carried out in 25 patients with esophageal cancer.Being placed at a left lateral decubitus position,the patients received right thoracoscopy mobilization of the intrathoracic esophagus as well as lymph node dissection;then with supine position,laparoscopy mobilization of the stomach and lymph node dissection were carried out;followed by creation of a gastric tube through a small incision under the xiphoid;finally we pulled out the gastric tube from the esophageal bed to the neck and made an intermittent gastroesophageal anastomosis.Results The total operation time ranged from 270 to 400 minutes with a mean of 338 minutes.No massive hemorrhage occurred during the operation,and the total blood loss ranged from 100 to 600 ml(with a mean of 227 ml).Totally 185 lymphnods were removed(7.4 per patient on average).The hospital stay in this series ranged from 8 to 20 days(with a mean of 10.3 days).One case had to be converted to open esophagectomy for azygos vein rupture.One patient died for pulmonary infection combined with cervical anastomotic leak,other postoperative complications included 1 case of delayed gastric emptying,1 case of chylothorax,and 2 cases of hoarseness.Conclusion Combination of thoracoscopy and laparoscopy esophagectomy is feasible for the treatment of esophageal carcinoma.