手辅助胸腔镜行食管癌切除、胃食管颈部吻合术17例

目的探讨手辅助胸腔镜下食管癌切除术的适应证。方法2005年1月-2007年11月,我院在手辅助胸腔镜下行食管癌切除、胃食管颈部吻合术17例。胸腔镜下经右胸游离胸段食管及肿瘤,清扫胸腔内淋巴结,上腹部正中切口完成胃的游离及清扫腹腔内淋巴结,颈部切口完成食管癌切除胃食管颈部吻合术。结果1例因双腔气管插管失败,1例因胸腔粘连中转开胸,另15例经胸腔镜手术成功。手术时间250-360min,平均270min。术中出血量150-400ml,平均240ml。清扫淋巴结4-10枚,平均6.4枚。术后2-3d拔除胸腔引流管,引流量200-500ml,平均350ml。术后喉返神经损伤1例,术后3个月恢复。17例随访4-15个月,平均8个月,均健在,无肿瘤复发和转移。结论胸腔镜下食管癌切除术主要适用于食管癌临床Ⅰ期及Ⅱ期,肿瘤长度〈5cm,无外侵及纵隔明显肿大淋巴结的患者。

The hand-video assisted thoracoscopic esophagectiomy and gastroseophagostomy performed by way of the cervical incision for esophageal carcinoma 17 cases

Objective To investigate indications of hand-video assisted thoracoscopic surgery in the treatment of esophageal carcinoma. Methods Hand-video assisted thoracoscopic surgery was performed in 17 patients with esophageal carcinoma from January 2005 to Noveber 2007. Under thoracoscopy via thoracic and cen＇ical incisions ,the esophagus and tumor were disconnected and the intrathoracic lymph nodes were cleared through the right thorax. Then a median incision was made at the epigastrium. Through the incision the stomach was disconnected and intraabdominal lymph nodes were removed. Afterwards, esophagectomy and gastroesophagostomy were performed by way of the cervical incision. Results The operation time was 250 - 360min （ mean, 270min）. The operative blood loss was 150 -400ml （mean, 2dOml）. The number of removed lymph nodes was 4 - 10 （mean, 6.4）. The drainage tube was taken out at 2 - 3 days after operation, with a drainage volume of 200 - 250ml （mean, 350ml）. One patient developed a temporary left recurrent laryngeal nerve palsy that disappeared at 3 months after operation. Follow-up checkups for 4 - 15 months（mean,8 months）in the 17 patients showed no recurence or metastasis of tumor. Conclusion Hand-video assisted thoracoscopic surgery cab be adopted in patients with esophageal carcinoma at stage I or II ,〈5cm in diameter, and without outward infiltration and enlarged mediastinal lympy nodes.