胸腔镜手术治疗食管癌合并气管憩室9例报告

Video-assisted Thoracoscopic Surgery for Esophageal Cancer Coexistence With Tracheal Diverticulum:a Clinical Analysis of 9 Cases

目的 总结胸腔镜手术治疗食管癌合并气管憩室的经验。方法 2015年6月~2021年3月我们对7例食管癌合并气管憩室行腔镜颈胸腹三切口食管癌根治术,经右胸游离食管、腹游离胃及左颈部吻合;2例食管癌合并气管憩室行腔镜胸腹两切口食管癌根治术,经腹游离胃,右胸游离食管及胸内吻合。结果 9例顺利行单腔气管插管全麻,未发生因麻醉插管导致气管憩室的损伤。3例气管憩室在胸腔镜手术中探查诊断,其中1例在游离食管过程中发生憩室损伤,经缝合修补术后未发生与气管损伤相关的并发症。7例腔镜颈胸腹三切口手术时间(237.9±18.7)min,术中出血量(154.3±12.7)ml,清扫淋巴结(23.4±3.5)枚,术后住院时间(11.0±1.4)d;2例腔镜胸腹两切口手术时间分别为195、240 min,术中出血量160、150 ml,清扫淋巴结20、23枚,术后住院时间11、10 d。9例术后随访4~62个月,中位时间28个月,1例转移,1例因肿瘤复发死亡,余7例无复发和转移。结论 食管癌合并气管憩室罕见,术前应仔细阅片及术中精细操作,对安全实施食管癌手术具有临床指导意义。

Objective To summarize the clinical experience of video-assisted thoracoscopic esophagectomy for the treatment of esophageal cancer(EC)coexistence with tracheal diverticulum(TD).Methods From June 2015 to March 2021,thoracoscopic esophagectomy was performed in 9 cases of EC coexistence with TD,including 7 cases of MIE Mckeown esophagectomy(The esophagus was dissociated through the right chest and the stomach was dissociated through the abdomen,and the anastomosis was performed through the left neck)and 2 cases of Ivor-Lewis esophagectomy(The stomach was dissociated through the abdomen,and the esophagus was dissociated through the right chest,and the intrathoracic anastomosis was performed).Results All the 9 cases successfully underwent general anesthesia with single lumen endotracheal intubation,and there was no injury of TD caused by anesthesia intubation.Three cases of TD were explored and diagnosed during thoracoscopic surgery,of which one case developed diverticulum injury during the process of esophagus dissection,and no complications related to tracheal injury occurred after suture repair.For the 7 cases of MIE Mckeown esophagectomy,the operation time was(237.9±18.7)min,intraoperative blood loss was(154.3±12.7)ml,harvested lymph node number was 23.4±3.5,and hospital stay was(11.0±1.4)day.For the 2 cases of Ivor-Lewis esophagectomy,the operation time was 195 min and 240 min,intraoperative blood loss was 160 ml and 150 ml,harvested lymph node numbers were 20 and 23,and hospital stay was 11 d and 10 d,respectively.All the patients were followed up for 4-62 months(median,28 months).One case had metastasis,one case died of tumor recurrence,and the other 7 cases had no recurrence and metastasis.Conclusions EC coexistence with TD is rare.Careful preoperative evaluation of CT scanning and experienced operative skills are critical for safe performance of thoracoscopic esophagectomy .