改良Ivor-Lewis术在食管癌根治术中的应用

The application of modified Ivor-Lewis operation for esophageal cancer

回顾性分析28例食管癌患者行改良Ivor-Lewis术临床资料。手术先用腹腔镜游离胃并清扫腹腔淋巴结,部分患者腹腔镜下制作管状胃;再经胸腔镜辅助右胸8～12 cm小切口游离食管并清扫纵隔淋巴结,行食管胃右胸内吻合。结果显示所有患者均顺利完成手术,无中转手术及术中大出血。手术总时间为195～474 min,平均时间284 min;腹腔镜时间为30～210 min,平均时间76 min。术中总出血量50～1 800 ml,平均198 ml;平均清扫淋巴结15枚,转移率为60.7%(17/28)。术后病理分期:Ⅰ期2例、Ⅱ期13例、Ⅲ期12例、Ⅳ期1例。无吻合口瘘及死亡病例,3例肺部感染,1例乳糜胸;所有患者均治愈出院。

Clinical data of 28 patients with esophageal cancer who have accepted modified Ivor-Lewis surgery from December 2010 to December 2011 were retrospectively analyzed. Dissociation of stomach and resection of celiac lymph nodes and the making of gastric tube in some cases were carried out by laparoscopic surgery. Dissection of e- sophageal cancer and mediastinal lymph nodes were conducted through a 8 - 12 cm video-assisted right anterior minithoracotomy. Then esophago-gastric anastomosis was performed in right thoracic cavity. All of the operations were performed successfully without hemorrhage or conversion. The whole operative time were 195 -474 min （the average： 284 min） ; the time of laparoscopic surgery was 30 -210 min（the average： 76 min） ; the blood loss was 50 ~ 1 800 ml （the average： 198 ml）. The average number of lymph nodes was 15 and metastatic rate was 60. 7%. Postoperative staging： 2 cases were stage I; 13 csaes were stage II ;12 csaes were stageIII; 1 csae was stage IV. Postoperative complications： pulmonary infection was found in 3 cases and chylothorax in one case. No case of anastomotic leakage or death occurred.