利用OrVil经口输送钉砧系统行胸腹腔镜Ivor Lewis食管癌根治术

Laparoscopic and thoracoscopic Ivor Lewis esophagectomy with thrasorally placed anvil(OrVil)

背景与目的:全腔镜下食管癌根治术手术创伤小,但手术难度大,本文旨在探讨一项新技术:利用OrVil经口输送钉砧系统行胸腹腔镜Ivor Lewis食管癌根治术的可行性及近期疗效。方法:2009年8月13日对1例中段食管癌患者行胸腹腔镜联合Ivor Lewis食管癌根治术,术中经口输送钉砧(OrVilTM;Covidien,Mansfield,MA,USA)到食管残端,以环行吻合器(EEAXL25Covidien,Mansfield,MA,USA)行胸顶胃食管吻合。结果:手术历时280min,术中出血200mL,未输血,未行胸腹部辅助切口,围术期无手术相关并发症,无吻合口瘘,患者于术后12d出院。随访3个月,无复发。结论:利用OrVil经口输送钉砧系统行胸腹腔镜Ivor Lewis食管癌根治术可行,近期疗效满意。

Background and purpose： Combined usage of the laparoscopic and thoracoscopic lvor Lewis esophagectomy is a mini-invasive procedure with high demands of skill level. In this study, we explored a novel technique for esophagastric anastomosis with minimally invasive Ivor Lewis esophagogastrectomy. Methods： We performed a minimally invasive Ivor Lewis esophagogastrectomy on a patient with midthoracic esophageal cancer on August 13^th, 2009. The anvil （OrVilTM; Covidien, Mansfield, MA, USA） was placed thrasorally and positioned at the esophageal stump. The esophagastric anastomosis was performed intracorporeally with a circular stapler （EEAXL25 Covidien, Mansfield, MA, USA）. Results： The operation time lasted for 280 minutes with a blood loss of 200 mL without transfusing blood. We performed the procedure entirely through laparoscopy and thoracoscopy. There were no complications post-operation, and no anastomic leak. The patient＇s hospital stay lasted a total of 12 days. Follow up was conducted for 3 months and no recurrence was found. Quality of life was satisfying. Conclusion： Laparoscopic and tboracoscopic lvor Lewis esophagectomy with thrasorally placed anvil for the treatment of esophageal carcinoma ensures the feasibility and safety of esophagectomy.