LigaSure腹腔镜胃微创游离术在食管癌根治术中的应用(附15例报告)

Laparoscopic gastric mobilization using LigaSure Vessel Sealing System in esophagectomy:a report of 15 cases

目的评价LigaSure腹腔镜胃微创游离术在食管癌根治术中的应用价值。方法2007年1月～2008年1月，应用LigaSure腹腔镜胃微创游离术联合右侧开胸行食管癌根治术15例．其中食管中段癌8例。食管下段癌7例，TNM分期为T1-3N0-1M0．腹腔镜手术方法：以脐孔，左、右锁骨中线肋缘下，脐与剑突连线上、中1／3交界点为手术操作孔，术中采用LigaSure分离、处理血管。结果15例LigaSure腹腔镜胃微创游离术均获成功，无中转开腹，手术时间110～200min．术中出血量20-50m1．腹腔淋巴结清扫数量12枚，无术中、术后严重并发症发生，术后胃肠功能恢复时间3～4d。15例随访1-20个月，无腹腔肿瘤复发转移，无死产。结论在食管癌根治术中采用LigaSure腹腔镜胃微创游离术是安全可行的，可以缩短手术时间，减少出血量．减轻手术创伤．是值得推广的手术方式。

Objective To evaluate the clinical value of laparoscopic gastric mobilization using LigaSure Vessel Sealing System in esophagectomy.Methods From January 2007 to January 2008, Esophageetomy were performed by laparoscopic gastric mobilization using LigaSure Vessel Sealing System and thoracotomy, involving 15 patients with esophageal carcinoma （8 in middle segment, 7 in lower segment）.The TNM staging was T1-3N0-1M0.Laparoscopy was employed during the operations, Four trocars were inserted through the umbilicus,below the costal arch at both the midclavicular lines,or at the junction of the upper one third and lower two third of the line between the umbilicus and the xiphoid process.All the vessels were separated , cut and coagulated by using the LigaSure. Results Laparoscopic gastric mobilization using LigaSure Vessel Sealing System were performed successfully in all patients, without conversion to open surgery,the operation time was 110- 200 minutes, the blood loss was 20- 50ml,the number of lymph nodes resected was12,no severe intra-and post-operative complications occurred,the reeovery time of gastrointestinal function was 3- 4 days. All patients were followed up from 1 to 20 months, no postoperative death and tumor recurrence were found.Conclusion Laparoscopic gastric mobilization using LigaSure Vessel Sealing System is a safe and feasible technique, shorten the surgical operation time, reduce blood loss and lessen tissue injury, it have the extensively applied value.