全腔镜Ivor-Lewis在食管癌外科治疗中的应用

目的 探讨联合全腔镜Ivor-Lewis手术治疗食管癌的安全、可行性及手术适应证.方法 行全腔镜Ivor-Lewis手术治疗食管癌5例,其中男性4例,女性1例,年龄56～72岁,平均63.6岁.先仰卧位,腹腔镜游离胃及管状胃成形,后取左侧半俯卧位,胸腔镜游离食管并清扫纵隔淋巴结,镜下完成食管荷包及胃食管机械吻合.结果 全组患者均顺利完成手术,无中转开胸或开腹,无围手术期死亡.手术时间280～330 min,平均302 min;其中腹腔镜操作时间110～130 min,平均118 min;胸腔镜操作时间140～170 min,平均156 min.手术出血量100～180 mL,平均130 mL.清扫淋巴结14～28枚,平均21.3枚;转移淋巴结0～5枚,平均1.6枚.术后消化道出血1例,保守治愈.术后病理分期：Ⅰb期2例,Ⅱ期2例,Ⅲa期1例.全组患者随访2～10个月,平均6.8个月,无复发.结论 全腔镜手术治疗食管癌是安全可行的.

Application of Ivor-Lewis esophagectomy with total thoracoscopy and laparoscopy for esophageal carcinoma

Objective To study the indication,safety and feasibility of Ivor-Lewis esophagectomy with total thoracoscopy and lapa- roscopy for esophageal cancer. Methods The patients included four men and one woman with a mean age of 63.6 years （ ranging from 56 to 72 years）. With the patients at a supine position, laparoscopy was performed to complete stomach mobilization and construct a tube-like stom- ach. Thoracoscopy was then carried out with the patients in half prone positon to mobilize the esophagus and dissect lymph nodes. Finally e- sophageal purse-string suture and mechanical gastro-esophageal anastomosis was completed. Results The procedure was completed success- fully in five patients without conversion to open surgery, with no death during perioperative period. The average operation time was 302min （ranging from 280 to 330 min）, average laparoscopy time was 118 min（ ranging from 110 to 130 min）and average thoracoscopy time was 156 rain（ ranging from 140 to 170 rain）. The average blood loss was 130mL（ranging from 100 to 180 mL） , average number of lymph nodes dissec- ted was 21.3 （ranging from 14 to 28）, and average number of lymph nodes metastases was 1.6（ ranging from 0 to 5）. The postoperative com- plications included one case of gastrointestinal bleeding, which was healed by symptomatic treatment. Postoperative pathological staging identi- fied stage Ⅰ b esophageal cancer in 2 cases, stage Ⅱesophageal cancer in 2 cases and stage Ⅲa esophageal cancer in 1 case. All patients were followed up with the mean time of 6.8 months （ ranging from 2 to 10 months） ,were alive without recurrence. Conclusion The total thoracos- copy and laparoscopy treatment of esophageal carcinoma is safe and feasible.