单操作孔胸腔镜联合腹腔镜食管癌根治术六例

Combination of single-port thoracoscopy and laparoscopy for the treatment of esophageal carcinoma： report of 6 cases

目的 探讨单操作孔胸腔镜联合腹腔镜食管癌根治术的可行性及近期疗效。方法2010年3-12月间解放军总医院应用经口置入钉砧头系统（OrVil）．行单操作孔胸腔镜联合腹腔镜食管癌根治术6例。患者先在平卧位下行腹腔镜游离胃并清扫腹腔淋巴结，然后取左侧卧位．在单操作孔胸腔镜下游离食管并清扫胸部淋巴结．最后将胃经膈肌裂孔上提到胸腔后制备管状胃．利用OrVil系统完成胃食管吻合。结果全组手术顺利。无中转开胸病例。手术时间200～320min：腹腔镜手术时间平均75（45～90）min，胸腔镜时间平均160（120～240）min。术中平均出血220（160～300）ml，平均清扫淋巴结12（9-18）枚。术后恢复顺利，未出现吻合口瘘、肺部感染、乳糜胸等严重并发症。结论单操作孔胸腔镜联合腹腔镜食管癌切除后，应用OrVil系统行胃食管胸顶吻合安全、可行。

Objective To study the feasibility and early results of radical resection of esophageal carcinoma using single-port thoracoscopy combined with laparoscopy. Methods From March 2010 to December 2010, 6 patients with esophageal carcinoma underwent radical resection by single-port thoracoscopy combined with laparoscopy in the General Hospital of People＇s Liberation Army. With the patients at a supine position, laparoscopy was performed to complete stomach mobilization and abdominal lymph node dissection. Thoracoscopy was then carried out with the patients lying on the left to mobilize the esophagus and dissect thoracic lymph nodes. Finally, the stomach was pulled into the thoracic cavity via the hiatus of the diaphragm to construct a tube-like stomach, which was then anastomosed to the esophagus using the OrVil system. Results No patient was converted to open surgery during the operation. The total operative time ranged from 200 to 320 min. The mean laparoscopic time was 75 （range, 45-90） min, and the mean thoracoscopic time 160（120-240） min. The mean intraoperative blood loss was 220（160-300） ml. The mean lymph node retrieval was 12（9-18）. No anastomotic fistula, chylothorax, lung infection were found postoperatively. Conclusion After esophageal resection using single-port thoracoscopic and laparoscopy, reconstruction using OrVil system is safe and feasible.