经口输送钉砧系统(OrVil)在全腔镜Ivor Lewis食管癌根治术中的应用

Laparoscopic and thoracoscopic Ivor Lewis esophagectomy with transorally placed anvil(OrVil )

目的探讨利用OrVil经口输送钉砧系统行全腔镜Ivor Lewis食管癌根治术的可行性及近期疗效。方法 2012年1月至2014年12月,65例食管癌患者行全腔镜Ivor Lewis径路食管癌切除食管-胃胸腔内吻合术。手术步骤分为两部分,先采用腹腔镜游离胃和腹段食管,后采用胸腔镜游离胸段食管并切除食管癌病灶,术中经口输送钉砧(OrVil TM;Covidien,Mansfield,MA,USA)到食管残端,以环行吻合器(EEAXL25Covidien,Mansfield,MA,USA)行胸顶胃食管吻合。结果该组65例患者手术顺利,未发生术中并发症、中转开腹或开胸等情况。病变均位于食管下段,平均长度3.9cm。平均腹腔镜操作时间为99min,胸腔镜操作时间为160min;术中平均出血量300ml;术后平均5.8d后进食。术后病理诊断鳞状细胞癌56例,腺癌9例,切缘均阴性。每例患者胸部和腹部淋巴结平均清扫15.6和6.9枚。术后切口感染5例,乳糜胸1例,经保守治疗后好转;无吻合口痿。结论 OrVil经口输送钉砧系统行胸腹腔镜Ivor Lewis食管癌根治术是一种安全可行的手术方式,近期疗效满意。

Objective To investigate the feasiblity and short-term effect of laparoscopic and thoracoscopic Ivor Lewis esophagectomy with transorally placed anvil （OrVit）. Methods Methods Laparoseopic and thoracoscopic Ivor Lewis esophagectomy and esophagastric anastomosis were performed on 65 patients with esophageal cancer between January 2012 and December 2014. The anvil （OrVilTM; Covidien, Mansfield, MA, USA） was placed transorally and positioned at the esophageal stump. The esophagastric anastomosis was performed intracorporeally with a circular stapler （EEAXL25 Covidien, Mansfield, MA, USA）. Results All the operations were successfully performed, with no intra-operative complications or transfer to open surgery. All the lesions located in the lower portion of the esophagus, with the mean length of 3.9 cm. The mean time for laparoscopy and thoracoseopy was 99 min and 160 min, respectively, and the mean blood loss was 300 ml. The patients were able to take meal from 5.8 d after operation. Postoperative pathologcial examinations revealed that there were 56 cases of esophageal sqnamous cell cancer and 9 cases of adenocareinoma, and there was no positive findings on the incision margin. The mean number of harvested lymph nodes was 15. 6 from thorax and 6.9 from abdomen in each patient. There were 5 cases of incision infection and 1 case of chylothorax after operation, and all recovered by conservative therapy. Besides, there was no anastomotic leak after operation. Conclusions Laparoscopic and thoracoscopic Ivor Lewis esophageetomy with OrVil is mininally invasive with fast recovery, and is feasible and safe for the treatment of esophageal carcinoma to obtain a satisfactory short term effect.