电视胸腔镜在食管外科的应用12例分析

THE APPLICATION OF VIDEO-ASSISTED THORACOSCOPIC SURGERY (VATS) IN THE TREATMENT OF ESOPHAGEAL DISEASES

目的 总结电视胸腔镜外科 (VATS )在食管外科中的应用体会。方法 回顾性分析 1992年 10月～ 2 0 0 1年 9月 12例VATS食管手术。 12例病人中男性 10例 ,女性 2例 ,年龄 34～ 6 3岁。恶性病变 10例 ,其中鳞状细胞癌 9例 ,腺样囊性癌 1例 ;TNM分期1期 5例 ,2期 5例。良性病变 2例 ,分别为食管平滑肌瘤及食管囊肿。对 7例食管恶性肿瘤在VATS下行右胸食管游离切除、食管胃颈部吻合 ,3例经右胸食管大部切除、食管胃右胸内吻合 ;对 2例食管良性疾病经左胸行平滑肌瘤及囊肿摘除术。其中 3例中转开胸。结果 本组没有死亡 ;胸腔镜下游离食管时间平均 70min,总手术时间平均 2 5 2min。共摘除纵隔淋巴结 7枚。术后引流量平均 180ml/2 4h。拔管时间平均 2天。分别于术后 9～ 13天出院。术后并发喉返神经损伤、颈部切口感染各 1例。结论 VATS作为一种微创手术治疗食管疾病是有效、可行的 ;VATS手术胸部以外的并发症与常规开胸手术相近 ;VATS对食管癌的治疗效果尚有争议 。

Objective With the development in optics and video systems, video assisted thoracoscopic surgery (VATS) in the diagnosis and treatment of esophageal lesions has come to clinical use. The experience with the method in 12 patients admitted to the surgical department of the General Hospital of PLA from Oct.1993 to Sept.2001 was summarized. Methods Of the 12 patients (male 10, female 2) with the age ranging from 34 to 63, 10 were suffering from malignant tumors (9 squamous carcinoma, 1 adenoid cysticcarcinoma) with 5 in TNM stage 1, and 5 in stage 2, and 2 were having benign tumors (1 esophageal leiomyoma, 1 esophageal cyst). In 7 patients with malignant tumors, esophagectomy was performed through the right thorasic cavity followed by asophagogastrostomy in the neck, and in 3 patients the anastomosis was done in the right thoracic cavity. A left thoracoscopic extirpation of esophageal leiomyoma and esophageal cyst was performed in patients with benign tumors. Thoracotomy was necessary in 3 patients. All patients were ventilated with a double lumen endotracheal tube, so that only the ipsilateral lung collapsed. Results There was no operative mortality in the group. Mean time for freeing the esophagus through thoracoscope was 70 minutes, and mean overall operation time was 252 minutes. 7 enlarged mediastinal lympha nodes were excised. The mean postoperative drainage volume was 180ml/24h and the mean duration of drainage tube was 2 days. The patients were discharged from the hospitals 9～13 days after the operation. Two postoperative complications occurred, one presented as left recurrent laryngeal nerve injury and the other as incision infection. Conservative therapy was given and recovery was uneventful. Conclusions As a minimally invasive surgical technique, VATS was a feasible and effective option in the treatment of esophageal lesions. Complications of VATS were similar to that of conventional open chest surgery. There is still controversy with regard to esophageal resection with VATS for malignant tumors, therefore further investigation is necessary.