右侧支气管封堵、左侧半俯卧位及气胸条件下胸腹腔镜联合食管次全切除及选择性三野淋巴结清扫手术的临床分析

Thoracoscopic-laparoscopic Subtotal Esophagectomy and Selected Three-field Lymphadenectomy with the Right Bronchial Occlusion in Left Semiprone Position under Artificial Pneumothorax for Esophageal Carcinoma

目的初步总结右侧支气管封堵、左侧半俯卧位及气胸条件下胸腹腔镜联合食管次全切除及选择性三野淋巴结清扫手术的临床经验。方法食管癌患者120例,均采用右侧支气管封堵、左侧半俯卧位及气胸条件下胸腹腔镜联合食管次全切除及选择性三野淋巴结清扫手术。结果 120例均采用右侧支气管封堵、左侧半俯卧位及气胸条件同时应用胸腹腔镜联合食管次全切除,73例(60.8%)行二野淋巴结清扫,47例(39.2%)行三野淋巴结清扫。平均手术时间(210.5±23.2)min,其中胸腔镜游离时间平均(105.4±16.5)min,术中平均出血量(46.7±7.3)ml,均无术中输血,平均每例清扫淋巴结(27.3±8.6)个,住院时间平均12.6(7～95)d。术后并发症39例(32.5%):吻合口瘘9例(7.5%),喉返神经损伤12例(10.0%),心血管并发症10例(8.3%),肺部并发症8例(6.7%)。死亡2例(1.7%),死因为肺部感染。术后病理分期TNM分期:T1N0M013例,T2N0M019例,T2N1～3M026例,T3N1～3M062例。结论采用右侧支气管封堵、左侧半俯卧位及气胸条件下胸腹腔镜联合食管次全切除及选择性三野淋巴结清扫治疗食管癌在技术上是安全可行、值得推广的手术方式。

Objective To assess the safety and teasibility of thoracoseopic-laparoscopic subtotal esophagectomy and selected three-field lymphadenectomy with the right bronchial occlusion in left semiprone position under artificial pneumothorax for esophageal carcinoma. Method 120 esophageal carcinoma patients were performed thoracoscopic and laparoscopic subtotal esophagectomy and selected three-field lymphadenectomy with the right bronchial occlusion in left semiprone position under artificial pueumothorax. Results All the patients underwent thoraeoscopic and laparoscopic subtotal esophagectomy successfully in leftward semiprone position under artificial pneumothorax condition. Among them, 73 patients received two-field lymphadeneetomy and 47 received three-field lymphadenectomy. The average operative time was 210.5 ± 23.2 min, the average thoracoscopic operative time was 105.4 ± 16.5 min, and the blood loss was 46.7 ±7.3ml, and no blood transfusion during the surgery. Mean lymph node harvest was 27.3 ± 8.6 nodes. Hospital stay ranged from 7 to 95 days and the average was 12.6 days. The postoperative complication rate was 32.5%, including 9 （7.5%） of anastomotic leakage, 12 （ 10.0% ） of recurrent laryngeal nerve injury, 10 （8.3%） of cardiovascular complication and 8 （6.7%） of pulmonary complications. Two patients died of the pulmonary infection, and the mortality rate was l. 7%. The postoperative TNM staging revealed 13 of T1N0M0, 19 of T2N0M0, 26 of T2N1.3M0 and 62 of T3N1-3M0. 95 cases were followed up for one month to two years. Out of them, 5 cases died of neoplasm metastasis, and the others were achieved normal eating and good life quality. Conclusion It is a feasible and safe method of thoracoscopic-laparoscopic subtotal esophagectomy and selected three-field lymphadenectomy with the right bronchial occlusion in left semiprone position under artificial pneumothorax for esophageal carcinoma, and deserves to be popularize.