经腹手助胸腔镜术式在高龄病人食管癌手术中的应用

Clinical application of hand-video assisted thoracoscopic surgery in radical operation for the aged patients with esophageal carcinoma

目的探讨经腹膈肌径路手助胸腔镜手术方式(HVATS)在高龄病人食管癌根治术中的临床应用价值及其优势。方法麻醉采用双腔气管插管全身麻醉,手术通过上腹切口游离胃,应用胸腔镜技术,结合单手(左手)经膈肌切口径路(膈肌中路)进入右胸腔辅助操作,游离全胸段食管,清扫纵隔淋巴结,经右颈部胸锁乳突肌内缘切口行食管胃吻合。结果完成食管癌切除根治手术共18例,其中70岁以上食管癌患者占10例。全组均在HVATS下顺利完成了手术治疗,食管癌彻底切除,食管旁、贲门旁、胃左动脉周围及肺门、隆突下等处淋巴结完全清扫。结论应用经腹膈肌径路HVATS技术行食管癌根治术符合食管癌外科治疗原则。该方法缩短了手术时间,简化了手术操作程序,提高了手术安全性,拓宽了手术适应证,为老年食管癌患者的微创外科治疗手段提供了一种新的选择,具有极大的临床应用价值。

[Objective] To search for the clinical value and advantages of hand-video assisted thoracoscopic surgery（HVATS） in radical operation for the aged patients with esophageal carcinoma. [Methods] 18 patients with esophageal carcinoma （male： 11, female： 7, age range： 52-83 years old, average： 67 years old） underwent radical esophagectomy and esophagogastrostomy by using HVATS and assisted incision of diaphragm from April 2004 to May 2005. Of those there were 10 cases aged patients above 70-year-old. [Results] The operations were successfully performed with good exposure. There was no mortality, the thoracic operating trauma and time and blood loss, the post-operative pain, the intraoperative or post-operative complications, and the post-operative convalescence was shortened. [Conclusion] HVATS assisted incision of diaphragm reduces bleeding and trauma to thoracic surgery so that the post-operative pain is much reduced; the post-operative complication reduced and the convalescence is smooth, so it is a safer, more effective, less traumatic, time-saving and minimally invasive procedure, and it can be done with excellent results in the treatment of radical operation for the aged patients with esophageal carcinoma. It will be of great clinical value and advantages to the aged patients with esophageal carcinoma.