全胸腔镜下食管胃胸内吻合术治疗中下段食管癌的技术探讨

目的探讨全胸腔镜下食管胃胸内吻合术治疗中下段食管癌的可行性。方法我科单医疗组2012年3～8月在20例食管中下段癌根治术中行全胸腔镜下食管胃胸内吻合,运用普通胃肠吻合器（强生管型吻合器）行食管胃右胸内吻合以重建消化道,并腔镜下行吻合口减张缝合及大网膜包埋。结果 20例均获成功,无中转开胸。手术时间270～350min,平均310 min,其中胸腔镜胸部操作时间150～220 min,平均200 min,术中出血250～480 ml,平均350 ml。每例清除淋巴结11～27枚,平均19.9枚,阳性4例6枚（阳性率1.5%,6/398）。无围手术期死亡,术后2天即可下床活动。1例吻合口漏（1/20,5%）,保守治愈。其余19例术后住院时间10～16 d,平均12 d。随访1～6个月,无死亡,无复发,进普食。结论全胸腔镜下食管胃胸内吻合术微创治疗中下段食管癌可行。

Total Thoracoscopic Anastomosis of Tube-like Stomach and Esophagus in Chest Cavity for the Treatment of EsophagealCarcinoma

Objective To explore the feasibility of total thoracoscopic anastomosis of tube-like stomach and esophagus in chest cavity in minimally invasive esophagectomy of middle-lower part of esophageal cancer. Methods Twenty patients with middle- lower esophageal cancer underwent total thoracoscopic anastomosis of tube-like stomach and esophagus in chest cavity between March 2012 and August 2012. Common gastrointestinal anastomat was used in digestive tract reconstruction. The surgical skills and short-term results were analyzed. Results No case was converted to open csophagectomy. The total operation time ranged from 270 to 350 min with a mean time of 310 min, and the VATS time was from 150 to 220 min with a mean time of 200 min. The operative blood loss was from 250 to 480 ml with a mean blood loss of 350 ml. 11 to 27 lymphnodes were removed in each patient（ 19.9 per patient in average） , and the total 6 lymphnodes in 4 cases turned out to be positive （ positive rate was 1. 5% , 6/398 ）. No patient died during hospitalization. The postoperative pain diminished significantly, and the patients could leave bed 2 days after operation. One case suffered anastomotic leak（ 1/20,5% ） , which was cured by conservative therapy. The postoperative hospital stay of the other 19 cases was from 10 to 16 days with a mean of 12 days. All of the patients received a follow-up from 1 to 6 months,during which, no death and recurrence were observed, and the patients reeoverd normal diet. Conclusions Total thoraeoscopic anastomosis of tube-like stomach and esophagus in chest cavity is feasible in minimally invasive esophagectomy of middle-lower esophageal cancer. It has less trauma and is worthy of wide clinical practice.