胸腹腔镜联合Mckeown手术在食管癌中的应用

The application of thoracoscopy and laparoscopy combined with Mckeown in esophageal cancer operation

目的：探讨胸腹腔镜联合Mckeown手术治疗食管癌的可行性。方法：胸腹腔镜联合Mckeown手术治疗食管癌8例，其中食管癌位于上段者1例，中段5例，下段2例。先左侧半俯卧位，胸腔镜游离胸段食管并清扫纵隔淋巴结；再取仰卧位，腹腔镜游离胃，并行胃食管左颈部吻合。结果：8例患者均顺利完成手术，无中转开胸或开腹手术，无围手术期死亡。手术时间240～400min，术中出血120～420ml，清扫淋巴结4～22枚，术后住院14—19d。术后出现呼吸衰竭1例，经呼吸机辅助治疗后痊愈；声音嘶哑1例。随访2—11个月，均健康存活。结论：胸腹腔镜联合Mckeown手术治疗食管癌在技术上安全可行，值得临床推广。

Objective： To explore the feasibility of thoracoscopy and laparoscopy combined with Mckeown in esophageal cancer operation. Methods： Eight cases with esophageal cancer（ including superior segment in 1 case, middle segment in 5 cases and inferior segment in 2 cases） were treated with thoracoscopy and laparoscopy combined with Mckeown. Mediastinal lymph nodes of all cases were dissected in thoracic segment of the esophagus using thoracoscopy in prone position of left half. Gastroesophageal anastomosis in left neck of all cases were implemented using laparoscopy in supine postion. Results：All operations were successful, no conversion to open surgery and death during perioperative period were found. The operation time, blood loss, number of dissected lymph nodes and postoperative hospital stay were 240 to 400 minutes, 120 to 420 ml,4 to 22 and 14 to 19 days, respectively. One case with respiratory failure was found, who cured after the breathing machine auxiliary treatment. One case with hoarseness was found. All patients were followed up for 2 to 11 months and survival. Conclusions：The thoracoscopy and laparoscopy combined with Mckeown for treating esophageal cancer is safe and feasible ,which is worthy of being widely applied in clinic.