电视胸腔镜食管癌切除术

Video-assisted thoracoscopic esophagectomy for esophageal carcinoma

目的探讨电视胸腔镜食管切除术的临床经验。方法 2009年8月～2010年12月该院采用电视胸腔镜食管癌切除术治疗食管癌患者22例。其中,男性14例,女性8例,年龄47～73岁,平均64.8岁;病变部位:胸上段食管癌1例,胸中段食管癌14例,胸下段食管癌7例。术前病理确诊均为鳞癌。手术采用胸腔镜游离胸段食管并清扫淋巴结,开腹游离胃行食管胃颈部吻合。结果 1例因胸腔严重粘连、1例因肿瘤明显外侵而中转辅助小切口完成手术,手术时间200～330min,平均280min。其中胸部手术时间平均为85min(45～120min),术中出血150～350mL,平均220mL。术后住院10～15d,平均12d。共清扫淋巴结246枚,平均每例清除12.3枚。术后并发症发生率25%(4/20):颈部吻合口瘘2例(术后第7天和第8天),心律失常1例,声音嘶哑1例。结论电视胸腔镜食管癌切除术在技术上是安全、可行的,但要把握好手术适应证。

[Objective] To explore the clinical experience of video-assisted thoracoscopic and esophagectomy for esophageal carcinoma.[Methods] From August 2009 to December 2010,22 cases of esophageal carcinoma were performed in our department by this way.Forty patients were 14 males and 8 females,and aged from 47 to 73（average 64.8）.There was 1 case of carcinoma of the upper esophagus,14 cases of carcinoma of the middle esophagus,and 7 cases of carcinoma of the next segment.The pathological types were squamous cell carcinoma entirely.VATS approach was used to mobilize the intrathoracic esophageal,stomach was mobilized by open approach,esophago-gastric anastomosis was performed in the left side of the neck.[Results] Among the 22 cases,because of 2 cases of pleural severe adhesion and 1 case of clearly outside the tumor invasion,we had to converse to transit-assisted small incision in the chest.All operative time was 200 to 330 min,with an average of 280 min,thoracoscopic time 45 to 120 min with an average of 85 min.Intraoperative blood loss was 150 to 350 mL with an average of 220 mL.All patients were hospitalized from 10 to 15 d,with an average of 12d.There were 246 pieces of lymphnodes removed,with an average of 12.3.Operative morbidity is 50%（anastomotic leak 2 cases in the neck after the first 7 and 8d,atrial fibrillation 1case,voice hoarseness 1case）.[Conclusions] Video-assisted thoracoscopic esophagectomy is technically feasible and safe,but we should pay special attention to the operation indication.