胸腹腔镜联合治疗食管癌的临床价值

Clinical value of combined thoracoscopic and laparoscopic esophagectomy for the treatment of esophageal carcinoma

目的 探讨胸腹腔镜联合治疗食管癌的临床价值.方法 回顾性分析2013年5月至2014年8月扬州市江都人民医院收治的50例行胸腹腔镜联合治疗食管癌患者的临床资料.患者先左侧卧位,胸腔镜下游离食管并清扫胸部淋巴结;然后平卧位,腹腔镜下游离胃并清扫腹腔淋巴结,制作管状胃行左颈部机械吻合术.收集患者手术时间、术中出血量、淋巴结清扫数目、术后胸腔引流量、术后进食时间、住院时间和病理学检查结果.通过电话和门诊随访,了解患者恢复情况和生存情况,随访时间截至2014年9月.正态分布的计量资料以x^-±s表示或均数（范围）表示.结果 50例患者无中转开胸和开腹患者.胸腔镜手术时间为（85 ± 30） min,腹腔镜手术时间为（55±22） min,总手术时间为（210±40） min.术中胸腔平均出血量为115 mL（50-210 mL）,术中腹腔平均出血量为65 mL（30- 100 mL）;胸腔平均清扫淋巴结数目为11.3枚（8.0-15.0枚）,腹腔平均清扫淋巴结数目为8.5枚（6.0-12.0枚）.术后胸腔平均引流量为340mL（200-650 mL）;术后平均进食时间为7 d（6 -8 d）;术后平均住院时间为12 d（11 -14 d）.术后病理学检查结果均为鳞癌,术后分期为T1 -3N0-1M0期,上下切缘阴性.术后发生吻合口瘘1例,肺部感染3例,经对症支持治疗痊愈出院;喉返神经损伤3例,随访6个月后恢复.50例患者随访1 -16个月,术后3个月出现吻合口狭窄2例,予以内镜下扩张治疗3次后痊愈.无复发转移及死亡患者.结论 胸腹腔镜联合治疗食管癌安全、有效.

Objective To investigate the clinical value of combined thoracoscopic and laparoscopic esophagectomy for the treatment of esophageal carcinoma.Methods The clinical data of 50 patients who underwent combined thoracoscopic and laparoscopic for the treatment of esophageal carcinoma at the Jiangdu People＇s Hospital of Yangzhou from May 2013 to August 2014 were retrospectively analyzed.The patients underwent the thoracoscopic mobilization of the intrathoracic esophagus and lymph node dissection in the left lateral decubitus position, and then the patients underwent laparoscopic mobilization of the stomach and lymph node dissection in the horizontal position, finally the gastric tube was pulled out to have stapled anastomosis through left neck.The operation time, volume of intraoperative blood loss, number of lymph node dissected, amount of postoperative thoracic drainage, time to resume diet after surgery, postoperative hospital stay and results of pathological examination were collected.Patients were followed up via telephone interview and out-patient examination till September 2014.The recovery condition and survival of patients were collected.The measurement data with normal distribution were presented as x^- ± s or mean value （range）.Results There was no patient transferred to open thoracic surgery or abdominal surgery.The operation time of thoracoscopic and laparoscopic procedures were （85 ±30）minutes and （55 ± 22） minutes, respectively.The total operation time was （210 ± 40） minutes.The mean volume of intraoperative blood loss was 115 mL （range, 50-210 mL） in the thoracic cavity and 65 mL （range, 30-100 mL） in the abdomen.The mean number of lymph nodes dissected was 11.3 （range, 8.0-15.0） in the thoracic cavity and 8.5 （range, 6.0-12.0） in the abdomen.The mean volume of postoperative thoracic drainage, mean time to resume diet and postoperative hospital stay were 340 mL （range, 200-650 mL） , 7 days （range, 6-8 days） and 12 days （range, 11-14 days）.The 50 cases were diagnosed as esophageal squamous cell cancer and staged as T1-3N0-1M0 by postoperative pathological examination, with negative upper and lower margin.There was 1 case of anastomotic leak, 3 cases of lung infection who were cured by symptomatic treatment and 3 cases of recurrent laryngeal nerve injury after operation who recovered after 6-month follow-up.All patients were successfully followed up without recurrence and death.During the follow-up of 1-16 months, 2 patients were found anastomotic stricture at postoperative 3 months, and were cured by endoscopic dilation for 3 times.Conclusion Combined thoracoscopic and laparoscopic esophagectomy is safe and effective for the treatment of esophageal carcinoma.