扶镜手在胸腔镜下食管癌纵隔淋巴结清扫中的配合技巧

Coordination skills of the hand mirror in thoracoscopic esophagectomy for mediastinal lymph node dissection

目的探讨扶镜手在胸腔镜下食管癌纵隔淋巴结清扫中的配合技巧。方法2012年9月至2016年9月,莆田学院附属医院胸心外科共完成胸腹腔镜联合下三野食管癌根治术438例。回顾性分析不同区域纵隔淋巴结清扫中手术实施情况,总结扶镜手的注意事项。结果所有患者手术均获得成功,34例中转开胸,中转开胸率为7.8%(34/438)。23例中转开腹,中转开腹率为5.2%(23/438)。手术时间(245.5±62.2)min,范围186.0~358.0 min;术中出血量(100±10)ml,范围50.0~1 350.0 ml;术后胸腔闭式引流管拔除时间(12.4±3.5)d,范围8.0~46.0 d;术后住院时间(17.9±2.6)d,范围14.0~52.0 d。结论胸腔镜下食管癌纵隔淋巴结清扫术中,扶镜手需要系统了解胸腔镜各部件的结构、性能及操作方法,全面掌握食管癌手术的手术步骤及相应的解剖结构,充分了解操作者的手术习惯,动态适时调节镜头的角度与焦距,配合顺利完成手术。

Objective To explore the coordination skills of the assistant hand mirror in thoracoscopic esophagectomy for mediastinal lymph node dissection.Methods From September 2012 to September 2016,four hundred and thirty-eight cases were treated with thoracoscopic and laparoscopic esophagectomy for esophageal cancer in the Department of Cardiothoracic Surgery,Affiliated Hospital of Putian University.Retrospective analysis was made to summarize the matters needing attention in the mediastinal lymph node dissection of different regions.Results All the operations were successfull thirtyfour cases were transferred to thoracotomy,and the conversion rate was 7.8%(34/438).Twenty-three cases were converted to open surgery,and the conversion rate was 5.2%(23/438).The operation time ranged from 186 to 358 min,with an average of(245.5±62.2)min;the intraoperative bleeding volume ranged from 50 to 1350 ml,with an average of(100±10)ml;the removal time of closed thoracic drainage tube ranged from 8 to 46 d,with an average of(12.4±3.5)d;and the hospitalization time ranged from 14 to 52 d,with an average of(17.9±2.6)d.Conclusion In thoracoscopic mediastinal lymphadenectomy for esophageal cancer,the arm-rest needs to systematically understand the structure,performance and operation method of each component of thoracoscopy,fully grasp the operation procedure and corresponding anatomical structure of esophageal cancer,fully understand the operation habits of the operator,dynamically and timely adjust the angle and focal length of the lens,and match them.The operation was successfully completed.