达芬奇机器人手术系统辅助下食管切除手术方式及研究现状

Procedures and research status of Da Vinci robot-assisted minimally invasive esophagectomy

食管癌是消化道常见恶性肿瘤,严重威胁人类生命和健康.食管切除、系统淋巴结清扫仍然是早期可切除食管癌最有效的治疗方式.然而,由于食管周围解剖结构复杂,食管及肿瘤在术中暴露、分离以及淋巴结清扫成为传统开放手术和微创食管切除术（MIE）中的难点.达芬奇机器人手术系统具有三维成像、操作精确稳定等优点.目前,包括我国在内的多个国家已开展达芬奇机器人手术系统辅助下食管切除术（RAMIE）.笔者将对经右胸-腹-颈部路径食管切除术、经右胸和上腹路径切除胸腔内食管胃吻合术、经裂孔食管切除术这3种手术方式的方法、应用情况以及RAMIE的研究现状进行深入探讨.

Esophageal cancer is one kind of the common gastrointestinal cancers, which is a serious threat to health and life of human beings.Esophagectomy with systematic lymphadenectomy is still the most effective treatment method for early and resectable esophageal cancer.However, due to the complex paraesophageal anatomy, there are some great difficulties need to be overcome in traditional open surgery and minimally invasive esophagectomy（MIE）, such as the exposure and separation of esophagus together with tumor, lymph node dissection, etc.Da Vinci Surgical System （Intuitive Surgical, USA） with the advantages like 3-dimensional view, accuracy and stability, has been used to perform robot-assisted minimally invasive esophagectomy （RAMIE） in many countries including China.Frequently-used procedures of RAMIE include McKeown procedure, Ivor-Lewis procedure and transhiatal esophagectomy （THE）.This review makes an introduction to the methods and applications of these 3 procedures, and the research status of RAMIE.