Application of Thoracoscopy Combined with Laparoscopy in Esophagectomy for Esophageal Carcinoma_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

王友于 ,  曾富春 , 叢偉 , 薛洋 , 何彬 , 張琨

四川省醫學科學院·四川省人民醫院胸外科（成都 610072）;

Corresponding?author：

曾富春, Email: zfc624@sina.com.cn

Keywords：

胸腔鏡; 腹腔鏡; 食管癌切除術; 食管癌

DOI：

10.7507/1007-4848.20150153

Video：

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目的探討胸腹腔鏡在食管癌手術中應用的可行性及近期療效。方法 2012年6月至2013年10月四川省人民醫院胸外科90例食管癌患者行胸腹腔鏡聯合食管癌切除術，其中男54例、女36例，年齡47～83歲，平均（63.15±11.10）歲。手術先行胸腔鏡游離胸段食管并清掃淋巴結，再腹腔鏡游離胃行食管胃左頸部吻合術。記錄手術時間、術后胸腔引流管放置時間、平均住院時間、淋巴結清掃枚數、術后并發癥等。結果全部無圍術期死亡。手術時間260～450 min。術后4～11 d（平均5 d）拔除胸腔閉式引流管，胸腔總引流量為530～4 260 ml。全組共清掃縱隔淋巴結（氣管旁、右下肺韌帶、食管旁、隆凸下及左右喉返神經鏈旁）、腹腔淋巴結（賁門旁、胃左動脈旁）及頸部淋巴結1 395枚，平均每例15.5枚，15例（16.7%）發現淋巴結轉移。術后發生吻合口瘺7例（7.8%），聲音嘶啞5例（5.6%），肺部感染5例（5.6%），乳糜胸2例（2.2%），均經保守治療后痊愈。術后10～14 d出院。門診及電話隨訪82例，隨訪率91.1%，隨訪時間1～16個月，患者全部生存，無復發。結論胸腹腔鏡聯合行食管癌根治術在技術上是安全可行的，近期療效可靠。

Citation： 王友于, 曾富春, 叢偉, 薛洋, 何彬, 張琨. Application of Thoracoscopy Combined with Laparoscopy in Esophagectomy for Esophageal Carcinoma. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(6): 610-612. doi: 10.7507/1007-4848.20150153 Copy

1.	?Luketich JD, Schauer PR, Christie NA, et al. Minimally invasive esophagectomy. Ann Thorac Surg, 2000, 70(3): 906-912.
2.	Pellegrini C, Wetter LA, Patti M, et al. Thoracoscopic esophagomyo-tomy. Initial experience with a new approach for the treatment of achalasia. Ann Surg, 1992, 216 (3): 291-296.
3.	Westermaier T, Vince GH, Meinhardt M, et al. Arachnoid cysts of the fourth ventricle-short illustrated review. Acta Neurochir(Wien), 2010, 152(1): 119-124.
4.	李俊海, 魯鳴, 劉宏濤, 等. 電視胸腔鏡輔助下食管癌切除 (附33例報告). 現代腫瘤學, 2010, 18(6): 1139-1140.
5.	Nguyen NT, Roberts P, Follette DM, et al. Thoracoscopic and laparoscopic esophagectomy for benign and malignant disease: lessons learned from 46 consecutive procedures. J Am Coil Surg, 2003, 197(6): 902-913.
6.	Smithers BM, Gotley DC. Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg, 2007, 245(1): 232-240.
7.	杜銘, 陳煥文, 吳慶琛, 等. 胸腔鏡聯合腹腔鏡食管癌切除術治療40例食管癌的臨床分析. 第三軍醫大學學報, 2010, 10: 7.
8.	Higashino M, Takemura M. Indication and limitation of endoscopic surgical procedure for esophageal cancer. Gan To Kagaku Ryoho, 2004, 31(10): 1481-1484.
9.	Kernstine KH. Minimally invasive ivor-Lewis esophagectomy: use of the orvil device for the EEA intrathoracic anastomosis. Innovations, 2009, 4(6): 297-298.
10.	Bernadette UL, Kristi LH, Dawn EJ. Minimally invasive esophagec-tomy: esophagogastric anastomosis using the transoral orvil for the end-to-side ivor-Lewis technique. Innovations, 2009, 4(6): 319-325.
11.	邵龍龍, 相加慶. 食管癌腔鏡手術現狀. 中國癌癥雜志, 2011, 21(7): 528-532.
12.	陳煥文, 杜銘, 吳慶琛, 等. 人工氣胸在腔鏡食管癌切除術中的臨床分析. 第三軍醫大學學報, 2012, 34(8): 789-791.

1. ?Luketich JD, Schauer PR, Christie NA, et al. Minimally invasive esophagectomy. Ann Thorac Surg, 2000, 70(3): 906-912.
2. Pellegrini C, Wetter LA, Patti M, et al. Thoracoscopic esophagomyo-tomy. Initial experience with a new approach for the treatment of achalasia. Ann Surg, 1992, 216 (3): 291-296.
3. Westermaier T, Vince GH, Meinhardt M, et al. Arachnoid cysts of the fourth ventricle-short illustrated review. Acta Neurochir(Wien), 2010, 152(1): 119-124.
4. 李俊海, 魯鳴, 劉宏濤, 等. 電視胸腔鏡輔助下食管癌切除 (附33例報告). 現代腫瘤學, 2010, 18(6): 1139-1140.
5. Nguyen NT, Roberts P, Follette DM, et al. Thoracoscopic and laparoscopic esophagectomy for benign and malignant disease: lessons learned from 46 consecutive procedures. J Am Coil Surg, 2003, 197(6): 902-913.
6. Smithers BM, Gotley DC. Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg, 2007, 245(1): 232-240.
7. 杜銘, 陳煥文, 吳慶琛, 等. 胸腔鏡聯合腹腔鏡食管癌切除術治療40例食管癌的臨床分析. 第三軍醫大學學報, 2010, 10: 7.
8. Higashino M, Takemura M. Indication and limitation of endoscopic surgical procedure for esophageal cancer. Gan To Kagaku Ryoho, 2004, 31(10): 1481-1484.
9. Kernstine KH. Minimally invasive ivor-Lewis esophagectomy: use of the orvil device for the EEA intrathoracic anastomosis. Innovations, 2009, 4(6): 297-298.
10. Bernadette UL, Kristi LH, Dawn EJ. Minimally invasive esophagec-tomy: esophagogastric anastomosis using the transoral orvil for the end-to-side ivor-Lewis technique. Innovations, 2009, 4(6): 319-325.
11. 邵龍龍, 相加慶. 食管癌腔鏡手術現狀. 中國癌癥雜志, 2011, 21(7): 528-532.
12. 陳煥文, 杜銘, 吳慶琛, 等. 人工氣胸在腔鏡食管癌切除術中的臨床分析. 第三軍醫大學學報, 2012, 34(8): 789-791.

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Application of Thoracoscopy Combined with Laparoscopy in Esophagectomy for Esophageal Carcinoma

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