单孔充气式纵隔镜联合腹腔镜治疗食管癌疗效分析

Effect Analysis on Single-hole Inflatable Mediastinoscopic and Laparoscopic Esophagectomy for Esophageal Cancer

目的探讨单孔充气式纵隔镜联合腹腔镜治疗食管癌的效果。方法回顾性分析2017年1月至2019年12月我院收治的13例食管癌患者的临床资料,其中胸上段2例,胸中段11例。术前分期:0期1例,Ⅰ期4例,ⅡA期2例,ⅡB期3例,ⅢA期3例。所有患者均行单孔充气式纵隔镜联合腹腔镜食管癌根治术。结果全组患者均顺利完成手术,手术时间平均(291.00±43.94)min,术中出血量平均(153.08±59.78)ml,剥除淋巴结平均(19.77±2.20)枚,住院时间平均(19.62±3.33)d。术后并发食管胃吻合口漏2例,无喉返神经损伤、乳糜漏、肺部并发症。13例患者均获得随访,随访至2020年6月,其中1例术后6个月肺部转移致呼吸衰竭死亡,1例纵隔淋巴结广泛转移,其余11例无肿瘤复发及转移,无吞咽困难。结论单孔充气式纵隔镜联合腹腔镜治疗食管癌,术后并发症少,恢复快,是一种安全、可行的微创手术方式。

Objective To investigate the effect of single-hole inflatable mediastinoscopic and laparoscopic esophagectomy for esophageal cancer.Methods A total of 13 patients with esophageal cancer from January 2017 to December 2019 were enrolled and analyzed retrospectively,including 2 of upper thoracic segment and 11 of thoracic middle segment esophagus.All the patients performed esophagectomy by single-hole inflatable mediastinoscopy and laparoscopy.Results All cases completed the surgery without perioperative deaths.The average operation time was(291.00±43.94)min,the intraoperative blood loss was(153.08±59.78)ml,the numbers of lymph nodes removed was(19.77±2.20),and the average hospital stays were(19.62±3.33)days.Postoperative esophageal and gastric anastomotic leakage occurred in 2 patients,and there was no recurrent laryngeal nerve injury,chylous fistula or pulmonary complications.13 cases were followed up to June 2020,one patient died of respiratory failure due to pulmonary metastasis 6 months after operation,one patient was found extensive mediastinal lymph node metastasis,and other 11 patients survived without dysphagia symptoms,cancer metastasis and recurrence.Conclusion The single-hole inflatable mediastinoscopy combined with laparoscopy of esophagectomy is safe,effective for esophagectomy of esophageal cancer patients with less post-operative complications and faster recovery.