半右侧卧位腹腔镜联合左胸小切口食管胃结合部癌根治的临床应用

Clinical Application of Laparoscope Combined with Left Chest Small Incision for Radical Resection for Esophagogastric Junction Carcinoma in the Semi-right Lateral Supine Position

目的探讨半右侧卧位腹腔镜联合左胸小切口在食管胃结合部癌手术治疗中的可行性。方法分析2016年2月-2019年5月12例食管胃结合部癌根治术中应用半右侧卧位腹腔镜联合左胸小切口的手术结果。结果12例患者全部在半右侧卧位下顺利完成腹腔镜联合左胸小切口食管胃结合部癌根治术。平均手术时间(190.09±40.41)min,平均失血量(122.50±60.07)ml。无中转开放手术;术后无吻合口瘘、吻合口狭窄、切口感染及手术死亡,无上切缘癌残留。结论应用半右侧卧位行腹腔镜联合左胸小切口食管胃结合部癌根治术,便于在腹腔镜下完成近端胃切除及淋巴结清扫,同时便于经胸部切口完成食管下段切除及纵隔淋巴结清扫,能够顺利完成食管胃胸腔内吻合及包埋,术中不用变换体位,避免传统左侧胸腹联合切口肋弓切断及膈肌切开对患者的损伤,在需要中转开放手术时可经胸腹联合切口完成手术,增加了手术安全性。

Objective To evaluate the feasibility of the esophagogastric carcinoma treatment under laparoscopy combined with small incision of left chest in semi-right lateral supine position.Methods Retrospective analysis the results of 12 cases of esophagogastric junction carcinoma radical resection in our hospital from February 2016 to May 2019 using laparoscope combined with small incision of left chest in semi-right lateral supine position.Results All the 12 patients were successfully completed radical resection of carcinoma.The average operation time(190.09±40.41)min,average blood loss(122.50±60.07)ml.No patient was transited to troditional open surgery,and no anastomotic fistula、postoperative anastomotic stenosis、incision infection、operation death and residual margin positive happened.Conclusions Application of semi-right lateral position can make the proximal stomach resection and lymph node cleaning more easily.At the same time it can make esophageal resection under the chest incision and stomach esophagus anastomosis more conveniently.It can avoid the damage of rib arch and diaphragmatic muscle.There is no need to change the operative position.This position can make the operation more safely.