一种新的食管切除法——俯卧位胸腔镜食管切除术(附8例报告)

Minimal Invasive Esophagectomy in Prone Position-Experience of 8 Patients

目的:总结俯卧位胸腔镜食管切除术的临床经验。方法:2009年6月—2009年8月,对10例患者进行俯卧位胸腔镜食管切除术,其中男性8例,女性2例,年龄53～71岁(平均61.1岁)。病理检查结果鳞癌9例,小细胞癌1例。肿瘤部位食管上段癌2例,食管中段癌8例。2例患者行术前化疗。取俯卧位,采用全身麻醉,单腔管气管插管,胸腔镜下游离胸段食管,腹腔镜游离胃,胃食管颈部吻合。结果:无中转开胸病例,平均手术时间3.4h(3～4.5h),术中出血量平均100mL(50～150mL),术后胸腔引流管放置时间平均为4.0d(3～7d),住院时间为平均15.4d(7～37d)。3例患者术后出现并发症,其中颈部吻合口瘘1例,切口裂开1例,急性肾功能衰竭1例。结论:俯卧位胸腔镜食管切除术在技术上安全可行。

Objective： To summarize the clinical experience of minimal invasive esophagemomy （MIE） in prone position for treatment of esophageal carcinoma, Methods：From June 2009 to August 2009, 10 patients underwent MIE in prone position. Median age was 61.1 years. The tumor located at upper segment in 2 cases, middle segment in 8 cases. Nine patients were di- agnosed as esophageal squamous cell carcinoma and 1 patients was diagnosed as esophageal small cell carcinoma. Two patients received chemotherapy before operation. Results： Average operative time was 3.4h, average blood loss during operation was 100 ml. Perioperative complication occurred in 3 patients, including 1 cases of cervical anastomotic leak, wound infection in 1 case and acute renal failure in 1 case. The median chest tube duration was 4 d and median hospital stay was 15.4 d. Conclusion：Thoracic esophagectomy in prone position was technique feasible and safe.