胸腹腔镜微创手术治疗食管癌的临床分析

Clinical analysis of minimally invasive surgery under thoracoscopy and laparoscopy in the treatment of esophageal cancer

目的 分析胸腹腔镜微创手术治疗食管癌的可行性及临床效果. 方法 回顾分析2014年8月至2016年2月衡阳市中心医院心胸外科86例食管癌患者行胸腹腔镜食管癌切除微创手术.记录手术时间、术中出血量、胸腔引流管留置时间、住院时间、淋巴结清扫枚数、术后并发症等. 结果 86例患者均顺利完成手术,无术中死亡及术中大出血.手术时间270-380 min,术中出血量50-550 ml,术后3-10 d拔除胸腔引流管,术中清扫淋巴结10-19枚,其中13例发现淋巴结转移.术后发生颈部吻合口瘘6例（7.0%）,声音嘶哑8例（9.3%）,肺部感染7例（8.1%）,乳糜胸1例（1.2%）,均经保守治疗后痊愈.术后住院时间9-20 d.术后随访3-21个月,1例于术后10个月颈部淋巴结转移,其余患者均未出现复发、转移或死亡. 结论 胸腹腔镜微创手术治疗食管癌在技术上是安全可行的,临床效果满意,值得临床推广应用.

Objective To analyze the feasibility and clinical effect of thoracoscopy and laparoscopy minimally invasive surgery in the treatment of esophageal cancer.Methods Eighty-six cases patients with esophageal cancer who were underwent the minimally invasive surgery under thoracoscopy and laparoscopy for esophageal cancer in the Central Hospital of Hengyang from August 2014 to February 2016 were retrospectively analyzed.Operation time,bleeding volume,indwelling time of thoracic drainage tube,length of stay,number of lymph node dissection,postoperative complications and so on were recorded.Results All patients were successfully completed surgery,no intraoperative death and intraoperative massive hemorrhage.Operation time was 270-380 min,the amount of bleeding during the operation was 50-550 ml.Chest drainage tube was removed from 3 to 10 d after operation.The number of lymph node dissected was 10-19.Lymph node metastasis was found in 13 cases.Postoperative cervical anastomotic fistula in 6（7.0%） cases,hoarseness in 8（9.3%） cases,7（8.1%） cases of pulmonary infection,and 1（1.2%） case of chylothorax,all were cured after conservative treatment.Postoperative hospital stay was 9-20 d.The patients were followed up for 3 to 21 months,1 case had lymph node metastasis in 10 months after surgery,and the other patients had no recurrence,metastasis or death.Conclusion Minimally invasive surgery under thoracoscopy and laparoscopy for esophageal cancer is safe and feasible,clinical effect is satisfied,it is worthy of further clinical application.