微创食管癌切除术进展

Development of Minimally Invasive Esophagectomy

随着食管手术技术的不断发展,很多国外的肿瘤中心相继开展了旨在减少食管癌手术并发症和死亡率的食管微创手术技术。本文综述了微创食管癌手术的概念、手术方式、淋巴结清扫状况、并发症和死亡率,以及术后的生存质量的情况。目前怎样界定小创伤或微创仍然是一个非常困难的事情,也就是说食管微创手术目前还没有一个统一的标准,但是很多的资料表明食管微创外科有着很多的优势。在手术入路方面,越来越多的进行食管微创手术的医生采取了与当前开放Ivor-Lewis手术相似的方式,并获得了与开放手术相当甚至更好的淋巴结清扫。食管微创手术的术后生存质量的评价好于开放手术。在手术的并发症与死亡率方面与目前的开放手术相同。考虑到食管微创手术目前仍处于起步阶段,随着技术的不断完善,微创手术将获得更好的效果。当今的食管外科正在向着微创、彻底清扫的方向发展,可以预见在不远的将来,食管外科必将加入微创外科行列。

With the development of the surgical technique, the minimally invasive esophagectomy, aiming to decrease the morbidity and mortality rates due to esophageal cancer, has been performed in more and more medical centers in China and worldwide. In this paper, the concept, technique, lymphadenectomy, complications and mortality, as well as the postoperative quality of life of the minimally invasive esophagectomy, are reviewed. Even though it is still difficult to define the minor wound or micro-trauma because there is not yet a unified standard for the minimally invasive esophagectomy, various clinical data have shown this surgical procedure enjoys a lot of advantages. In the operative approach of esophagectomy, more and more surgeons engaging in micro-traumatic surgery are adopting an operation mode similar to that of Ivor-Lewis operation mode, and have obtained as good or better results in lymphodenectomy as in open surgery. The post-operative quality of life of the patients undergoing this micro-traumatic surgery is better compared to those with open surgery. As for the morbidity and mortality rates, the minimally invasive esophagectomy showed satisfactory results as well, like the open surgery. As it is just in the beginning stages, the technique of minimally invasive esophagectomy will continue to be improved in the future.