电视胸腔镜食管癌切除术

Thoracoscopic resection of esophageal cancer

目的:探讨电视胸腔镜(VATS)食管癌切除术及手辅助电视胸腔镜(HVATS)食管癌切除术的方法及效果。方法:对51例食管中段癌患者予以VATS食管癌切除术,均行食管胃颈部吻合。其中15例在全胸腔镜下经右胸游离食管,经腹游离胃并制成管状胃,提至颈部与食管吻合;36例先经腹游离胃并制成管状胃,辅助手经腹部切口右肋弓下腹膜外进入右胸托肺及协助VATS游离食管,将胃提至颈部吻合。结果:VATS手术时间平均为200 min,HVATS手术时间平均为160 min。手术和术后恢复均顺利,无吻合口狭窄。1例HVAST手术者术后发生颈部吻合口瘘,颈部伤口敞开换药后痊愈。无围手术期死亡。结论:VATS食管癌切除术能达到常规开胸手术相同的手术效果,特别是HVATS食管癌切除术具有手术时间短、创伤小、并发症少、恢复快等优点。

Objective：To explore the method and effect of video-assisted thoracoscopy and hand-assisted video-thoracoscopy for resection of esophageal cancer .Method：Fifty-one patients with mid-esophageal cancer underwent video-thoracoscopic esophagectomy through cervical esophagogastric anastomosis . Fifteen patients from them received thoracoscopy surgery to dissect esophagus , then gastric tube was made by laparotomy , and anastomosis was made in the neck .The other 36 patients received hand-assisted video-thoracoscopy , first of all the gastric tube was made by laparotomy , the dissection of esophagus was performed with the assiatance of hand to press down the lung , and the anastomosis was made in the neck .Results：The mean operative time of video-thoracoscopic esophagectomy was 200 min, and of hand-assisted video-thoracoscopy was 160 min.All patients′surgery and postoperative recovery were successfully with no anastomotic stricture .One patient who received hand-assisted video-thoracoscopy had cervical anastomotic fistula, which healed by dressing change through the neck incision .There was no perioperative mortality . Conclusion：It is suggeste that the outcome of video-assisted thoracoscopic resection of esophageal cancer is same as routine thoracic operation , with the advancements of shorter operative time , minimal invasion , less complications and quick recovery .