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目的探讨胸、腹腔镜联合手术在食管癌治疗中的安全性、手术方法及临床效果。方法对40例食管癌患者行电视胸腔镜联合腹腔镜下食管癌根治术。于左侧卧位行胸腔镜下胸段食管的游离及淋巴结清扫,胸部手术完成后改平卧位行腹腔镜下胃游离及淋巴结清扫,胃游离后剑突下小切口完成管状胃的制作,再将管状胃从食管床拉至颈部与颈段食管吻合。结果 2例因单肺通气不成功中转开胸。总手术时间215～400 min,平均280 min;术中无大出血,总出血量100～800 ml,平均227 ml。共清扫淋巴结413枚,平均每例10.3枚;术后住院8～30 d,平均13.6 d。住院期间无一例患者死亡。术后并发症:肺部感染3例,颈部吻合口漏1例(术后第4天),声音嘶哑3例,乳糜胸1例。结论胸、腹腔镜联合,颈部吻合的食管癌切除在技术上是可行的,并且是安全的。
Objective To investigate the safety, operative methods and clinical effects of thoracic and laparoscopic combined surgery in the treatment of esophageal cancer. Methods 40 cases of esophageal cancer patients underwent video-assisted thoracoscopic laparoscopic esophagectomy. In the left lateral position thoracoscopic thoracic esophageal esophageal free and lymph node dissection after thoracic surgery to change the supine laparoscopic gastric free and lymph node dissection after gastric free small xiphoid incision to complete the production of tubular stomach, Tubular stomach is then pulled from the esophageal bed to the neck and esophageal anastomosis. Results of 2 cases due to unsuccessful one-lung ventilation transfer thoracotomy. The total operation time was 215-400 min with an average of 280 min. No major bleeding occurred during operation. The total amount of bleeding was 100-800 ml with an average of 227 ml. A total of 413 lymph nodes, an average of 10.3 per case; postoperative hospital stay 8 to 30 days, an average of 13.6 d. None of the patients died during hospitalization. Postoperative complications included 3 cases of lung infection, 1 case of anastomotic leakage of the neck (4 days after operation), 3 cases of hoarseness, and 1 case of chylothorax. Conclusions Thoracic and laparoscopic resection of cervical esophagectomy is technically feasible and safe.