基于“单向式”胸腔镜技术体系的食管癌微创手术模式

The modified minimally invasive esophagectomy using the concept of "single-direction" thoracoscopic technique

目的探究基于"单向式"胸腔镜技术体系的食管癌微创手术模式的安全性和可行性。方法回顾性分析2018年6月至2019年4月,在我科施行基于"单向式"胸腔镜技术体系的65例食管癌微创手术患者的临床资料,其中男54例、女11例,平均年龄(62.5±7.8)岁。结果完成胸部操作平均时间(133.4±28.6)min,术中平均失血量(61.9±29.2)mL,无术中输血。手术中转开胸1例(因胸膜粘连闭锁严重)。主要并发症包括吻合口瘘、肺部感染、乳糜胸、切口感染、喉返神经麻痹和胃排空障碍,均经保守治疗治愈,无术后死亡病例。手术清扫淋巴结总数和总站数中位值分别为19枚和10站。术后中位住院时间为10 d。术后平均胸腔纵隔引流总量(1 117.3±543.4)mL。结论基于"单向式"胸腔镜技术体系的食管癌微创手术模式安全、可行,具有较好的术野清晰度和流畅简化的操作程序。

Objective To explore the safety and feasibility of the modified and improved thoracoscopic surgery for esophageal cancer using the concept of"single-direction"thoracoscopic technique.Methods The clinical data of 65 patients undergoing this modified minimally invasive esophagectomy based on"single-direction"thoracoscopic system between June 2018 and April 2019 were retrospectively analyzed,including 54 males and 11 females aged 62.5±7.8 years.Results The thoracoscopic operation time was 133.4±28.6 min,and intraoperative blood loss was 61.9±29.2 mL.No intraoperative blood transfusion was needed.One patient was transferred to open thoracotomy(due to severe pleural adhesion atresia).Major complications included anastomotic leak,pneumonia,chylothorax,incisional infection,recurrent laryngeal nerve paralysis and gastric emptying disorders,which were recovered by conservative treatment.No postoperative death occurred.The median number of lymph nodes and lymph node station harvested was 19 and 10,respectively.The median postoperative hospital stay was 10 days.The volume of chest drainage was 1117.3±543.4 mL.Conclusion The minimally invasive operation mode of esophageal cancer based on"single-direction"thoracoscopic system is safe and feasible,and has good field vision and smooth and simplified procedure.