胸腹腔镜联合应用治疗食管癌的临床分析

Clinical Application of Combined Thoracoscopic and Laparoscopic Esophagectomy for Esophageal Cancer

目的探讨食管癌根治术中联合应用胸腔镜、腹腔镜技术的手术指征可行性、及安全性。方法回顾分析我院自2008年9月至2011年4月31例食管癌患者联合使用腔镜行食管癌切除术的临床资料。食管癌病变位于上段者3例,中段15例,下段者13例。手术方法为先行胸腔镜右胸入路行食管游离并纵隔淋巴结清扫,再行腹腔镜游离胃,后行颈部胃食管吻合。术后病理分期:Ⅰ期18例,Ⅱ期9例,Ⅲ期4例。结果3例中转开胸,其余均腔镜顺利完成手术。术后并发症出现吻合口瘘3例,乳糜胸2例,顽固心律失常1例,均经积极保守治疗后痊愈。术后声音嘶哑3例。术后随访1—20个月,死亡3例,均为癌转移恶液质。结论胸腹腔镜技术联合应用手术治疗早中期食管癌是安全可行的。创伤小,治疗效果满意。

Objective To discuss the indication, feasibility and safty of combined thoracoscopic and laparoscopic esophagectomy for esophageal cancer. Methods Retrospective medical records analysis was conducted for 31 esophageal cancer patients who underwent combined thoracoscopic and laparoscopic esophagectomy from September 2008 to April 2011.The tumors were located in upper esophagus in 3 cases, middle esophagus in 15 cases, and lower esophagus in ,13 cases. The surgery started with the thoracoscopic mobilization of thoracic esophagus and lymph nodes dissection, which were followed by the laparoscopic stomach mobilization and gastroesophageal anastomosis in left neck. Postoperation pathological staging identifided stage I esophageal cancer in 18 cases, stage II in 9 cases, stage III in 4 cases. Results Except for open conversion in 3 cases, all patients were completed smoothly. Postoperative anastomotic leak was found in 3 cases, chylothorax in 2 case, arrhythmia in 1 cases, the positive cured after conservative treatment. Postoperative hoarseness in 3 cases. All patients were successfully followed up with durations ranged from 1 to 20 months. 3 patients died of cancer metastasis and cancer cachexia. Conclusion Combined thoracoscopic and laparoscopic esophagectomy is safe and feasible treatment for esophageal cancer.