单一颈部切口微创食管切除术的初步应用

Application of Minimally Invasive Esophagectomy With a Single Cervical Incision

目的探讨单一颈部切口微创食管切除术治疗食管癌的可行性和安全性。方法2019年3月~2020年6月我科采用单一颈部切口微创食管切除术治疗食管癌18例,胸腔镜下游离食管和清扫淋巴结,全腹腔镜游离胃、清扫淋巴结并制作管状胃,经单一颈部切口取出标本,吻合食管与管胃。结果18例均顺利完成手术,手术时间252~391 min,平均301 min。术中出血量90~280 ml,平均160 ml。淋巴清扫(27.2±6.3)枚。术后肛门排气时间2~10 d,平均4 d。术后住院时间8~21 d,平均12.5 d。术后第1、2、3天疼痛视觉模拟评分(Visual Analogue Scale,VAS)分别为(2.6±0.3),(3.8±0.7),(3.1±1.1)分。术后3例吻合口漏,其中2例经介入治疗恢复,1例经延长胃管拔除保守治疗恢复。18例术后随访9~20个月,平均12个月,1例术后18个月复发,余17例无疾病进展。结论单一颈部切口微创食管切除术可行,安全。

Objective To investigate the feasibility and safety of minimally invasive esophagectomy(MIE)with a single cervical incision in the treatment of esophageal carcinoma.Methods From March 2019 to June 2020,18 cases of esophageal carcinoma were treated by MIE with a single cervical incision.We mobilized the esophagus and dissected lymph nodes via thoracoscopy.Total laparoscopic dissociation of the stomach,dissection of lymph nodes and production of tubular stomach were performed.The specimens were taken out through a single neck incision and the esophagus and tube stomach were anastomosed.Results All the 18 cases of operations were successfully performed.The operative time ranged 252-391 min,with a mean of 301 min.The intraoperative blood loss ranged 90-280 ml,with a mean of 160 ml.The number of lymph nodes dissection was 27.2±6.3.The first flatus after operation was 2-10 d,with a mean of 4 d.The postoperative hospital stay was 8-21 d,with a mean of 12.5 d.The Visual Analogue Scale(VAS)scores on postoperative day 1,day 2,day 3 were(2.6±0.3),(3.8±0.7),and(3.1±1.1)points,respectively.Anastomotic leakage occurred in 3 cases.Two cases recovered after interventional treatment while 1 case recovered by conservative treatment.Follow-ups were conducted in the 18 patients for 9-20 months(mean,12 months).One case recurred 18 months after operation with remaining 17 cases being progression-free.Conclusion MIE with a single cervical incision is feasible and effective.