侧俯卧位胸腔镜食管癌根治术31例临床分析

目的：总结侧俯卧位胸腔镜食管癌根治术的临床经验。方法：回顾性分析2013年9月至2015年6月，我院全胸腔镜治疗的食管癌患者31例。采用全身麻醉，双腔管气管插管，由同一组医师行侧俯卧位胸腔镜游离胸段食管并清扫纵隔淋巴结，开腹游离胃，直线切割缝合器制作管状胃，通过胸骨后路径上提管胃，食管胃左颈部吻合。结果：中转开胸4例，手术时间（4．5±1．8）h，术中出血量（150±60）ml，术后胸腔引流管放置时间（5±3）d，术后住院时间（11±5）d。5例患者术后出现并发症，其中颈部吻合口瘘2例，颈部吻合口狭窄1例，胸腔积液1例，声音嘶哑1例。结论：侧俯卧位胸腔镜食管切除术在技术上是安全、微创、可行的。

Experience of 31 patients treated by thoracscopic esophagectomy in left lateral and for-ward inclination position

Objective:To summarize the clinical experience of thoracscopic esophagectomy in left lateral and for-ward inclination position.Methods:From September 2013 to June 2015,31 patients underwent thoracoscopic esoph-agectomy in left lateral and forward inclination position.Patients had a left lateral position and 45°forward inclination after anesthesia.Thoracic esophagus dissociation and lymph nodes dissection were finished with totally thoracoscopic surgery.After thoracic surgery was done,supine position was needed to dissociate stomach and dissect lymph nodes through laparotomy surgery.Stomach tube was pulled through after the sternum path and was coincided with cervical esophagus at neck.Results:Average operative time was(4.5 ±1.8)h,average blood loss during operation was(150 ± 60)ml.The chest tube duration was(5 ±3)d and postoperative hospital stay was(11 ±5)d.Perioperative complication occurred in 5 patients,including 2 cases of cervical anastomotic leak,anastomotic stenosis in 1 case,pleural effusion in 1 case and voice hoarse in 1 case.Conclusion:Thoracoscopic esophagectomy in left lateral and forward inclination position is technically safe,minimally invasive,feasible.