食管癌腔镜手术方式探讨(附80例分析)

Thoracoscopic and laparoscopic esophagectomy for esophageal cancer:lessons learned from 80 consecutive cases

目的 总结食管癌腔镜手术经验,并对我科各种腔镜方式进行梳理归纳.方法 选取河北医科大学第四医院2009年3月至2012年6月胸外科单治疗组腔镜食管癌切除术共80例,其中男52例,女28例,年龄为35 ～ 80岁,平均年龄为60.5岁.其中食管上段癌27例,中段癌31例,下段癌22例.全部患者行腹腔镜游离胃,右侧开胸食管胃胸内吻合术10例,胸腔镜游离食管,食管胃颈部吻合术44例,右侧胸腔镜食管胃胸内吻合术2例,右侧胸腔镜辅助小切口食管胃胸内吻合术24例.结果 1例患者因右侧胸腔广泛粘连且单肺通气无法耐受而改为开式,1例患者因游离气管时气管套囊处气管膜部撕裂而改为开式;其余69例均完成腔镜手术.3例患者术后因肺部感染呼吸衰竭而转入ICU治疗后痊愈;8例患者出现颈部吻合口瘘,经换药痊愈出院;2例患者因出现小切口感染经换药后痊愈出院;1例患者术后出现胃排空障碍,经胃肠减压,针灸后痊愈;9例患者出现声音嘶哑;1例患者术后吻合口狭窄反复行5次扩张术后痊愈;1例患者胃壁坏死行空肠造瘘进食.其余患者均恢复顺利,痊愈出院.结论 食管癌腔镜手术可以减小创伤,术后并发症减少,技术操作已经成熟,可以广泛应用于食管癌患者.

Objective To summarize and evaluate the experiences of the minimally invasive esophagectomy for esophageal cancer.Methods Data were collected from 80 patients,52 men and 28 women with a mean age of 60.5 years and a range of 35-80 years,in the Fourth Hospital of Hebei Medical University from March,2009 to June,2012.There were 27 patients with the upper third esophageal cancer,31 with the middle third and 22 with the lower third.All the cases were undergone with laparoscopic gastric mobilization.Of all the patients,there were 10 patients with right thoracotomy,44 with thoracoscopic esophageal mobilization and cervical esophagogastric anastomosis,2 with thoracoscopic esophagectomy,and 24 with video-assisted minithoractomy.Results Minimally invasive esophagectomy were successful in all patienls except for 2 patients converted to open thoracotomy.The incidence of complications was 25/80(31.3%),including 3 cases with pneumonia,8 with cervical fistula,2 with wound infection,1 with delayed gastric emptying,9 with hoarse voice,1 with anastomotic stenosis and 1 with gastric wall necrosis.Conclusion Minimally invasive esophagectomy is feasible and can reduce trauma and syndromes in the patients with esophagectomy.