胸、腹腔镜联合切除食管癌40例临床分析

Thoracoscopic and laparoscopic esophagectomy for esophageal carcinoma:a report of 40 cases

目的:探讨胸、腹腔镜联合切除食管癌的疗效及安全性。方法:对2011年5月至2012年3月40例食管癌患者采用胸、腹腔镜联合切除术,先侧卧位、胸腔镜下游离切除食管并清扫胸部淋巴结;然后平卧位,腹腔镜下游离胃并清扫腹部淋巴结,将胃制成管状于左颈部吻合。结果:全组无中转开胸腹病例,手术时间平均为320min,术中失血量平均280ml,淋巴结清扫共计392枚。术后住院时间平均10.2天,术后36h胸部切口疼痛VAS法评分平均为3.26分,术后胸腔引流平均为200ml,胃肠减压引流量平均为150ml,术后并发症总发生率为15.0%(6/40),其中肺部感染5例,颈部吻合口瘘2例(术后第5、8天)。随访40例,随访时间为1-9个月,均无复发、转移、死亡。结论:胸、腹腔镜联合食管癌切除术安全、疗效可靠。

Objective：To explore the efficacy and safety of thoracoscopic and laparoscopic esophagectomy for esophageal carcinoma.Methods：From May 2011 to March 2012,40 cases of esophageal carcinoma were treated in our department by this way.Being placed at a left lateral decubitus position,the patients received the thoracoscopic surgical approach to free the intrathoracic esophagus as well as lymph node dissection,then with horizontal position,laparoscopic mobilization of the stomach and lymph node dissection were carried out,and then the tube-like stomach was created.Finally,the tube-like stomach was anastomosed to the cervical part of esophagus.Results：Among 40 cases,no one was converted to open thoracic and abdominal surgery.The total operation time was with an average of 320 minutes.Intraoperative blood loss mean was 280ml.Totally 392 lymph nods were removed.The average hospitalization time was 10.2 days.The postoperative 36h chest pain incision VAS method average score was 3.26 pionts.The average volume of postoperative thoracic drainage was 200ml.The average of gastrointestinal decompression was 150ml.The morbidity of postoperative complication was fifteen percent and included pulmonary infection（5 cases）,cervical anastomotic leak（2 cases,separately occurred in 5 and 8 days after the surgery）.Of the patient,40 received an follow-up for 1 to 9 months,there were no recurrence,metastasis and death.Conclusion：Thoracoscopic and laparoscopic esophagectomy for esophageal carcinoma is safe and efficient.