电视胸腔镜下食管癌切除术的经验

目的总结电视胸腔镜(VATS)下食管癌切除术的经验.方法2003年10月至2004年12月行13例VATS食管癌切除术.其中男性11例,女性2例,平均年龄61(51～65)岁.病理类型均为鳞状细胞癌.胸中段6例,胸下段7例.pTNM分期:T1NoM0 1例,T1N1M02例,T2NoMo 3例,T2N1M0 5例,T3N1M02例.中段食管癌中,4例先在平卧位行全腔镜下胃游离,换为左侧卧位腔镜下游离食管,右侧小切口腔镜辅助下吻合;2例麻花位,腔镜下游离胃,右侧小切口腔镜下吻合.下段食管癌均右侧卧位,腔镜下游离胃和食管,左侧小切口腔镜辅助下吻合.结果本组无死亡和吻合口瘘;中转开胸3例:2例出血中转,1例腹腔粘连严重中转.1例二次开腹止血.平均手术时间4.8(3～6)h,术后平均10(8～11)d出院.结论VATS食管癌切除术是有应用前景的微创外科治疗手段,远期效果有待进一步临床观察.

Application of video assisted thoracoscopic surgery in the resection of esophageal carcinoma

Objective To summarize the clinical experience of esophagectomy with video assisted thoracoscopic surgery (VATS). Methods From October 2003 to December 2004, 13 patients with esophageal squamous cell carcinoma underwent thoracoscopic esophagectomy selectively. There were 11 male and 2 female, with mean age of 61 years (range 51 to 65). Among them middle segment esophageal carcinoma was in 6 cases and lower segment in 7. The pTNM classification of carcinoma included T_1N_0M_0 (n=1), T_1N_1M_0 (n=2), T_2N_0M_0 (n=3), T_2N_1M_0 (n=5), and T_3N_1M_0 (n=2). Three surgical techniques were utilized. For lower segment esophagectomy, patients were placed in a right lateral decubitus position, esophageal mobilization and gastric mobilization were done via a trocar hole and a mini-incision. In the four patients with middle segment carcinoma, laparoscopic gastric mobilization was done in a supine position, then thoracoscopic esophageal mobilization was done in a left lateral decubitus position. In the remaining two patients with middle segment carcinoma, all procedures were tried to complete in a supine position with right chest rising. Results All cases had no postoperative early death or anastomotic leakage. Three patients required conversion to thoracotomy because of haemorrhage (n=2) and dense adhesions (n=1). One re-operation was required for haemostasis with laparotomy. The operation time was 3-6 h with an average of 4.8 h. The median hospital stay was 10 d (range 8 to 11). Conclusion VATS is a safe and feasible minimally invasive approach for esophagectomy. A longer follow-up is needed to assess the impact of the procedure on long-term survival.