胸腔镜食管癌切除术临床经验总结

Clinical experience of esophagectomy with video-assisted thoracoscopic surgery

目的:总结胸腔镜辅助(video-assisted thoracoscopic surgery,VATS)食管癌切除的临床经验,评价VATS食管癌切除术的近期效果。方法:回顾性分析河南安阳市肿瘤医院胸二科2010年7月至2012年2月行VATS食管癌切除的76例临床资料。男41例,女35例;年龄48～78(平均62)岁。肿瘤平均长度3.6 cm。鳞状细胞癌72例,癌肉瘤2例,小细胞内分泌癌1例,贲门腺癌合并食管胸上段黏膜重度不典型增生1例。胸上段癌10例,胸中段癌55例,胸下段癌10例,贲门癌合并食管胸上段黏膜重度不典型增生1例;其中8例行术前化学治疗(化疗)2周期,1例化疗3周期,1例行术前放射治疗(放疗),2例为放疗后复发。TNM分期:T1N0M0 15例;T1N1M0 2例,T1N2M0 2例,T2N0M0 9例,T2N1M0 8例,T2N2M0 1例,T3N0M0 19例,T3N1M0 10例,T3N2M0 5例,T3N3M0 2例,T4aN1M0 3例。手术操作分3步:1)经右胸VATS游离食管肿瘤,清扫胸腔淋巴结;2)经上腹部切口游离胃并制作管状胃:3)行食管胃颈部端侧器械吻合。结果:76例中70例成功经VATS切除食管病变,6例术中辅助MSI(muscle sparing incision)切口。平均手术时间4.4 h,平均出血量210 mL,平均清扫淋巴结14枚/例(其中胸部淋巴结平均8.97枚/例),平均住院时间23 d。术后发生肺部感染11例,治疗后痊愈。发生喉返神经损伤7例,无围手术期死亡,无吻合口瘘。结论:采用VATS对TNM分期中T3以内的食管癌切除可行,近期手术效果较好。

Objective： To summarize the clinical experience of video-assisted thoracoscopic surgery （VATS） in esophagectomy and to evaluate the short-term effect of VATS esophageal resection. Methods： A retrospective analysis of 76 cases of clinical data from July 2010 to February 2012 in Anyang Tumor Hospital was carried out. All patients underwent VATS esophageal age of 62 （from 48 to 78） years old. The resection. Forty-one males and 35 females were included with an average mean tumor length was 3.6 cm. There were 72 patients with squamous cell carcinoma, 2 patients with carcinosarcoma, 1 patient with small cell endocrine carcinoma, and 1 patient with cardia adenocarcinoma coupled with severe atypical hyperplasia of upper thoracic esophageal middle, and lower chest segment esophageal cancer accounted for 10, 55, and 10 patients mucosa. The upper, respectively with 1gastric cardia adenocarcinoma. Eight patients were given 2 cycles＇ chemotherapy before surgery3 1 given 3 cycles, 1 given pre-operative radiotherapy3 and 2 relapsed after radiotherapy. The tumor-lymph node-metastasis （TNM） staging indicated： T1NOM0 in 15 patients, T1N1M0 in 2 patients, T1N2M0 in 2 patients, T2NOM0 in 9 patients; T2NIM0 in 8 patients, T2N2M0 in 1 patient, T3NOM0 in 19 patients, T3N1M0 in 10 patients, T3N2M0 in 5 patients, T3N3M0 in 2 patients, and T4aN1M0 in 3 patients. The operation contained 3 steps： Resection of esophagus with right-chest VATS and cleaning of thoracic lymph node, the separation of the stomach by upper- middle abdominal incision and the application of tubular stomach, and esophagogastrostomy by end-side with stapling at the neck. Results： Of the 76 cases of VATS esophageal resection, 70 were completed successfully, while 6 required an intra-operative assisted muscle sparing incision （MSI）. The mean surgical procedure lasted 264 min with the mean volume ofintra-operative bleeding standing at 210 mL and 14 lympho-nodes resected averagely of which, 8.97 was located in chest. The mean length of hospital stay was 23 d. Post-operative pulmonary infection was found in 11 patients but cured after the treatment. Recurrent laryngeal nerve was injured in 7 patients. Neither peri-operative death nor anastomotic leakage was seen. Condusion： Esophageal resection with VATS is applicable to the patients with esophageal cancer before T3 stage in TNM staging.