腹部无小切口腹腔镜联合右胸小切口Ivor-Lewis食管癌根治术30例近期疗效

Short-term outcomes of laparoscopy without abdominal incision combined with minimal thoracic incision esophagectomy in 30 cases

目的:评价腹部无小切口腹腔镜联合右胸小切口Ivor-Lewis食管癌根治术的安全性、可行性及短期疗效。方法:2012年至今我院行腹部无小切口腹腔镜联合右胸小切口Ivor-Lewis食管癌根治术30例,腹腔镜下游离胃并行D2淋巴结廓清,腹腔内制作部分管状胃,右腋下第5肋间10~12cm小切口进胸,游离食管并行胸内淋巴结廓清,将胃上提至胸腔,行食管胃胸膜顶吻合,镜下60闭合器完成剩余管状胃的制作。结果:手术经过顺利,其中中转开腹止血1例。手术平均时间160min,平均出血量25ml,所有病例无腹部并发症,无吻合口瘘,无肺内并发症,无胃排空延迟,均治愈出院。结论:腹部无小切口腹腔镜联合右胸微小切口IvorLewis食管癌根治术是安全可行的,近期效果满意。

Objective：To investigate the safety,feasibility and short - term outcomes of laparoscopy without ab-dominal incision combined with minimal thoracic incision esophagectomy. Methods：We conducted 30 cases of lapa-roscopy without abdominal incision combined with minimal thoracic incision esophagectomy since 2012. To remove the stomach and D2 lymph nodes dissection under laparoscopy,part of the gastric tube was made in the abdomen. The right thoracic incision was made 10 ~ 12cm in the right fifth intercostal space. After finishing the dissection of esopha-gus to the thoracic inlet and removing the thoracic lymph nodes,the stomach was pulled into the thoracic cavity and anastomosed to the esophagus. The whole gastric tube was made using Ethicon 60mm articulating Endoscopic Linear Cutter in the thoracic cavity. Results：All surgery were performed successfully except one converted to laparotomy to stanch bleeding. The median operation time was 160min and mean blood loss was 25ml. No cases of abdominal com-plication,anastomotic leakage,pulmonary complication or gastric retention was observed. All cases were cured. Con-clusion：Laparoscopy without abdominal incision combined with minimal thoracic incision esophagectomy can be safely performed to achieve favorable early outcomes.