胸腔镜食管切除术治疗食管癌

THORACOSCOPIC ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

电视胸腔镜食管切除术是治疗食管癌的一种新的手术方法 ,该方法在食管外科中的地位仍在争论之中。作者自 2 0 0 0年 5月至 2 0 0 2年 5月开展了 9例食管癌胸腔镜食管切除术。其中男 7例 ,女 2例 ;年龄 42～ 5 6岁 ,平均 5 1岁 ;颈段肿瘤 1例 ,上胸段 2例 ,中胸段 5例 ,下胸段 1例 ;病理均为鳞状细胞癌 ,分期为II期以下。 1例因肿瘤外侵粘连重 ,术中中转为开胸手术 ,8例顺利行胸腔镜食管切除及胃食管颈部吻合术。胸腔镜游离食管时间平均 70min(4 0～ 12 0min) ,总手术时间平均 2 5 2min(2 3 0～ 2 70min) ,术中平均出血量为 2 5 0ml(15 0～ 40 0ml) ,平均摘除胸部淋巴结 7个 (5～ 12个 )。术后并发喉返神经损伤 1例 ;颈部切口感染 1例 ,经保守治疗后痊愈。结果提示 ,胸腔镜食管切除术安全可行 ,近期结果与开胸术相当 ,远期结果及其在食管外科中的地位有待于进一步证实和探讨。

Thoracoscopic esophagectomy is an alternative to open thoracotomy in treatment of esophageal carcinoma, but its role in esophageal surgery is still controversial. Between May 2000 and May 2002, 9 patients affected by esophageal carcinoma underwent esophagectomy with thoracoscopic dissection of the esophagus. Seven patients were male, 2 were female,and the mean age was 51 (range, 42～56) years.One patient had the carcinoma at cervical segment, 2 at upper third thoracic segment, 5 at middle third, and 1 at lower third.All tumors were squamous cell type and were below stage II.Thoracoscopy and cervical esophagogastrostomy were successfully performed in 8 patients except in one case, in whom conversion to thoracotomy was necessary because of extensive tumor invasion.Thoracoscopic dissection took an average of 70 (range,40～120) minutes and the mean operative time was 252(range,230～270) minutes. the mean operative blood loss was 250ml (range,150～400ml) and the mean number of thoracic lymph nodes harvested was 7(range,5～12).One patient experienced a cervical infection,which healed with conservative treatment.One patient had a temporary left recurrent nerve palsy that disappeared during the following 6 months.These initial data indicate that thoracoscopic esophagectomy is safe and feasible. The short term result of thoracoscopy is comparable with that of open thoracotomy, and the long term result and its role in esophageal surgery deserve further investigation.