电视胸腔镜食管良性病变手术20例

Video-assisted Thoracoscopic Surgery for Benign Esophageal Diseases:Report of 20 Cases

目的探讨电视胸腔镜(video-assisted thoracoscopic surgery,VATS)在食管良性病变手术中的临床应用价值。方法 2005年3月～2011年3月,行胸腔镜手术治疗食管良性病变20例,采用3个1.0 cm切口,一个为进镜口,另外两个为操作孔,必要时将一个操作孔延长至5 cm。行良性肿瘤摘除术10例,贲门失弛缓症肌层切开术(Heller术)6例,膈肌食管裂孔疝修补术3例,外伤致膈肌损伤行膈肌修补术1例。结果 20例手术均获成功,1例贲门失弛缓症因术中损伤食管黏膜将一个操作口延长为5 cm的小切口,1例多发食管平滑肌瘤将操作口延长至3 cm。10例良性肿瘤术后病理证实为食管平滑肌瘤。20例手术时间50～152 min,住院时间4～9 d,平均6 d。无手术死亡及严重并发症发生。全组随访2～62个月,平均31个月,无明显进食哽噎等症状出现或复发。结论 VATS治疗食管良性病变安全、有效、可行,关键是选择好适应证和手术入路,可作为经选择的食管良性病变的首选治疗方法。

Objective To evaluate video-assisted thoracoscopic surgery （VATS） in the treatment of benign esophageal diseases. Methods From March 2005 to March 2011, totally 20 patients with benign esophageal diseases underwent VATS in our hospital. With three 1. O-cm incisions as one observation and two operating holes （ one of the operating holes could be enlarged to 5 cm when necessary）, we removed benign tumors in 10 patients, performed esophagomyotomy （Heller＇ s operation） in 6 cases, hiatal hernia repair in 3, and diaphragmatic repair in 1. Results VATS was completed in all the 20 patients within 50 - 152 minutes. In two of the patients, one of the operating hole was enlarged to 5 and 3 cm respectively because of injury to the esophageal membrane during esophagomyotomy or multiple esophageal leiomyoma. Postoperative pathological examination revealed esophageal leiomyoma in all the 10 patients with benign tumors. The mean hospital stay was 6 days （ranged from 4 to 9 days）. No patients died or developed severe complications. The patients were followed up for a mean of 31 months （ranged from 2 to 62 months）, during which none of them ever choked or had recurrence. Conclusions VATS is feasible, safe, and effective for benign esophageal diseases. With proper choices of surgical approaches and indications, it can be the first choice for benign esophageal diseases.