机器人辅助食管癌根治手术的应用

Application of robot-assisted minimally invasive esophagectomy for patients with esophageal cancer

目的总结机器人辅助食管癌根治手术的初步应用经验及分析短期治疗效果。方法纳入2016年2月至2017年12月148例在四川大学华西医院胸外科行机器人辅助食管癌切除和胸腹二野淋巴结清扫的食管癌患者,其中男126例、女22例,年龄(62.0±8.0)岁。收集患者的一般资料和围手术期指标,回顾性分析患者的术后短期治疗效果。结果 McKeown食管癌切除手术106例,Ivor-Lewis食管癌切除手术42例,所有患者平均手术时间为(336.0±76.0)min,术中平均出血量(130.0±89.0)ml,平均淋巴结清扫(21.0±8.0)个,术后平均住院时间(12.0±7.2)d,术后并发症包括吻合口瘘8例(5.4%),声音嘶哑23例(15.5%),食管气管瘘1例(0.7%),肺部感染13例(8.7%),乳糜胸4例(2.7%)和伤口感染2例(1.4%),无术中大出血病例及死亡病例。结论机器人辅助McKeown和Ivor-Lewis食管癌根治手术均安全可行,短期治疗效果良好。

Objective To present the initial clinical experience of robot-assisted thoracoscopic esophagectomy for patients with esophageal cancer and to analyze the short-term outcomes of these patients.Methods Between February 2016 and December 2017,148 patients with esophageal carcinoma underwent robotic esophagectomy and twofields lymph node dissection.There were 126 males and 22 females at average age of 62.0±8.0 years.Demographic data,intraoperative characteristics and short-term surgical outcomes were collected and analyzed.Results 106 patients underwent McKeown esophagectomy and 42 patients underwent Ivor-Lewis esophagectomy.The mean operation time was 336.0±76.0 min,the mean intraoperative blood loss was 130.0±89.0 ml,the mean number of lymph nodes removed was 21.0±8.0 and the mean length of postoperative hospital-stay was 12.0±7.2 days.Postoperative complications included anastomotic fistula(n=8,5.4%),pulmonary infection(n=13,8.7%),hoarseness(n=23,15.5%),tracheoesophageal fistula(n=1,0.7%),chylothorax(n=4,2.7%)and incision infection(n=2,1.4%).There was no intra-operational massive hemorrhage or in-hospital mortality.Conclusion Both robot-assisted McKeown and Ivor-Lewis esophagectomy are safe and feasible with good early outcomes.