微创食管切除术

Minimally invasive esophagectomy

背景与目的：剖胸食管切除术常能引起严重并发症，并延长患者恢复正常活动的时间。微创手术能减少并发症，目前国内鲜有报道。本文探讨胸腔镜结合腹腔镜治疗食管疾病的可行性，并介绍手术具体操作方法。方法：自2001年11月至2005年10月，本科为20位患者行胸腔镜下食管切除术。男性16例，女性4例，48～70岁，食管中下段癌，病理学诊断为鳞状细胞癌。5例由胸腔镜结合腹腔镜，颈部切口完成。其余15例均为胸腔镜下切除食管，开腹和颈部切口完成。结果：手术时间为6～14．5小时，在ICU监护时间为1天，手术及院内死亡率为0，无并发症。结论：在有着丰富的微创手术及剖胸术的经验的医院开展胸腔镜下食管切除是安全可行的。

Background and purpose： Open esophagectomy can be associated with significant morbidity and negatively impact on recovery of the patients to routine activities. Minimally invasive surgery may has the advantage in lowering the morbidity of esophagectomy compared to open esophagectomy So far, only a few of papers have been published in our country. Our study is to evaluate the feasibility of video-assisted thoracoscopic surgery（VATS） and laparoscopic surgery for the treatment of esophageal diseases. Methods： From November 2001 to October 2005, 20 male patients underwent minireally invasive esophagectomy with the age ranging from 48 to 70 years. All of the patients have been pathologically proved to be squamous cell carcinoma within mid-lower proportion of the esophagusl . Minimally invasive esophagectomy was performed by video-assisted thoracoscopic and laparoscopie surgery with mini-necktomy in 5 cases; by videu-assisted thoracoscopic and laparotomy with mini-necktumy in 15 cases. Results： The operation time was 6-14.5 hours, the median period in intensive care, unit was 1 day with no operative related or hospitalized mortalities. Conclusions： Minimally invasive esophagectomy is technically feasiMe and safe in selected patients. The benefit in terms of and efficacy and survival needs to be clarified by clinical trial at larger scale.