改良全腹腔镜食管胃结合部肿瘤根治术

Modified total laparoscopic radical gastrectomy for carcinoma of the esophagogastric junction

食管胃结合部肿瘤可以经胸或经腹进行根治手术。经腹手术可以达到更为理想的腹腔淋巴结清扫效果，同时对呼吸功能损伤较小。因此，对于高龄、肺功能差的食管胃结合部肿瘤患者，经腹手术是一种较好的选择。目前经典的腹腔镜手术常常需要在腹上区做1个辅助小切口，在体外完成管状胃制作和放置吻合器机身。2011年11月首都医科大学附属北京朝阳医院对1例65岁男性低肺功能食管胃结合部肿瘤患者改良了腹部辅助小切口，采用经主操作孔施行全腹腔镜食管胃结合部肿瘤根治术。术中经食管裂孔向上游离胸段食管约5cm，牵拉至腹腔后横断。经口抵钉座置入系统（OrVil）后，在腹部经主操作孔放入食管吻合器将食管与残胃进行吻合。手术顺利，吻合方便快捷。患者术后恢复良好，随访16个月肿瘤无局部复发及转移征象。

Carcinoma of the esophagogastric junction can be radically resected through thorax or abdomen. Because abdominal operation can achieve more ideal abdominal lymph node dissection and less injury of respiratory function, it is ideal for the elderly patients and patients with poor pulmonary func tion. The classic laparoscopic radical gastrectomy needs a small abdominal incision for making tubular stomach and installation of stapling devices. All the procedures were completed via the main operating trocar. In November of 2011, a 65-year-old male pa tient with poor pulmonary function and carcinoma of the esopha gogastric junction underwent modified total laparoscopic esopha gogastric anastomosis. During the operation, the thorax esopha gus was mobilized about 5 cm above the esophageal hiatus, then it was pulled to the abdominal cavity and transected. After inser ting the OrVil via the mouth, the esophagogastric anastomosiswas done. The operation went through smoothly and the proce dure was completed conveniently and quickly. The patient recov ered well after operation with no local recurrence and metastasis.