胸腹腔镜联合食管癌切除二野淋巴结清扫150例报告

Thoracolaparoscopic esophagectomy with two-field lymph node dissection for esophageal carcinoma： report of 150 cases

目的总结开展胸腔镜联合腹腔镜食管癌切除二野淋巴结清扫的早期经验。方法回顾性分析150例胸腹腔镜食管癌切除二野淋巴结清扫的临床资料。结果150例食管癌患者中．食管上段癌14例，中段癌95例。下段癌41例；其中鳞癌142例。其他类型癌8例。全组无术中死亡者，中转开胸6例，中转开腹2例。手术时间（258±45）min，其中胸腔操作（140±33）min。腹腔和颈部操作（119±28）min。平均术中出血（207±130）ml，切除淋巴结（23．3±8．2）枚／例。肿瘤分期为Ⅰ期39例，Ⅱ期58例，Ⅲ期53例。围手术期并发症发生率为32％（48／150），其中肺部感染17例．喉返神经麻痹13例，颈部吻合口瘘和心律失常各9例，乳糜胸5例，暂时性胸胃排空障碍5例．肠梗阻2例，肠扭转1例，血小板减少1例。围手术期死亡2例．均死于肺部感染致呼吸衰竭。结论胸腹腔镜联合食管癌切除二野淋巴结清扫是一种技术上可行的微创食管癌术式。

Objective To summarize early experience in combined thoracolaparoscopic esophagectomy with two-field lymph node dissection for esophageal carcinoma. Methods A total of 150 patients with thoracic esophageal cancer who underwent combined thoracoscopic and laparoscopic esophagectomy in Uninon Hospital, Fujan Medical University, were enrolled in this study. Results Locations of the tumors included upper esophagus （n =14）, middle esophagus （n =95）, and lower esophagus （n=41）. Pathological type showed squamous cell cancer （n=142） and other types of cancer （n=8）. There was no intraoperative death. Conversion to open thoracotomy was required in 6 patients and conversion to open laparotomy in 2 patients. The average total operative time was （258±45） min. The average operative thoracoscopie time was （140±33） min. The average time for gastric mobilization and neck esophagogastric anastomosis was （119±28） min. The average blood loss during the procedure was （207±130） ml. The average number of harvested lymph node with the specimen was 23.3±8.2. The tumor staging included stage Ⅰ （n=39）, Ⅱ （n=58） and Ⅲ （n.=53）. Postoperative complications occurred in 48 （32%） patients including pneumonia （n=17）, recurrent laryngeal injury （n=13）, anastomotic leak （n=9）, arrhythmias （n=9）, chyle chest （n=5）, delayed gastric emptying （n=5）, ileus （n=2）, volulus （n=l）, and thromboeytopenia （n=1）. Two patients died postoperatively due to respiratory failure resulting from pneumonia. Conclusion Thoracolaparoscopie two-field lymph node dissection of esophageal cancer is a feasible minimally invasive appraoch.