电视胸腔镜食管癌切除术

Video-assisted thoracoscopic resection of esophageal carcinomas

目的探讨胸腔镜食管癌切除术适应证. 方法 1997年7月～2003年7月,对75例食管癌胸腔镜下经右胸游离食管、肿瘤,清扫淋巴结,经上腹切口游离胃,并经胸骨后上提,行左颈食管胃吻合. 结果中转开胸3例,2例因肿瘤侵及肺门及心血后壁无法分离而中转开胸,1例因奇静脉出血而中转开胸.手术时间160～220 min,胸部操作时间60～90 min ,术后出血300～400 ml,无手术死亡.术后出现胃扭转1例,吻合口漏2例,吻合口狭窄1例,乳糜胸1例.60例随访3个月～7年,平均4年,2例锁骨上淋巴结转移,1例腹腔淋巴结转移,1年生存率85.0%(51/60),3年生存率40.0%(31/60),5年生存率40.0%(24/60). 结论胸腔镜食管癌切除可行,适用于Ⅰ、Ⅱ期非外侵患者.

Objective To investigate indications of thoracoscopic resection of esophageal carcinomas. Methods A total of 75 patients with esophageal carcinomas underwent video - assisted thoracoscoplc surgery （VATS） from July 1997 to July 2003. The dissection of the esophagus and radical resection of lymph nodes were performed using a right - sided VATS approach. Then the stomach was dissociated through an upper - abdominal incision and was pulled up for esophago - gastric anastomosis in the left neck.Results A conversion to open surgery was required in 3 patients, in 2 of whom the tumors had enroded into the hilum and the posterior wall of the heart, and in 1 of whom the azygous vein was ruptured. The operation time was 160 -220 min, with the intrathoracic operation time accounting for 60-90 min. The postoperative blood loss was 300- 400 ml. No surgery - related deaths were noted. Postoperative complications included 1 case of volvulus of stomach, 2 cases of anastomotic leakage, 1 case of anastomotic stenosis, and 1 case of chylothorax. Follow - up checkups in 60 patients for 3 months - 7 years （ mean, 4 years） found 2 cases of supraclavicular lymph node metastasis and 1 case of abdominal lymph node metastasis. The 1 - , 3 - and 5 - year survival rates were 85.0% （51/60）, 51.7% （31/60） and 40.0% （24/60） , respectively. Conclusions Video - assisted thoracoscopic resection of esophageal carcinomas is feasibly suited to patients with localized lesions at phase Ⅰ or Ⅱ.