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 , 丛伟 , 薛洋 , 何彬 , 张琨

四川省医学科学院·四川省人民医院胸外科（成都 610072）;

Corresponding author：

曾富春, Email: zfc624@sina.com.cn

Keywords：

胸腔镜; 腹腔镜; 食管癌切除术; 食管癌

DOI：

10.7507/1007-4848.20150153

Video：

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Abstract Full text Figures/Tables Video References Cited by

目的探讨胸腹腔镜在食管癌手术中应用的可行性及近期疗效。方法 2012年6月至2013年10月四川省人民医院胸外科90例食管癌患者行胸腹腔镜联合食管癌切除术，其中男54例、女36例，年龄47～83岁，平均（63.15±11.10）岁。手术先行胸腔镜游离胸段食管并清扫淋巴结，再腹腔镜游离胃行食管胃左颈部吻合术。记录手术时间、术后胸腔引流管放置时间、平均住院时间、淋巴结清扫枚数、术后并发症等。结果全部无围术期死亡。手术时间260～450 min。术后4～11 d（平均5 d）拔除胸腔闭式引流管，胸腔总引流量为530～4 260 ml。全组共清扫纵隔淋巴结（气管旁、右下肺韧带、食管旁、隆凸下及左右喉返神经链旁）、腹腔淋巴结（贲门旁、胃左动脉旁）及颈部淋巴结1 395枚，平均每例15.5枚，15例（16.7%）发现淋巴结转移。术后发生吻合口瘘7例（7.8%），声音嘶哑5例（5.6%），肺部感染5例（5.6%），乳糜胸2例（2.2%），均经保守治疗后痊愈。术后10～14 d出院。门诊及电话随访82例，随访率91.1%，随访时间1～16个月，患者全部生存，无复发。结论胸腹腔镜联合行食管癌根治术在技术上是安全可行的，近期疗效可靠。

Citation： 王友于, 曾富春, 丛伟, 薛洋, 何彬, 张琨. 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, 鲁鸣, 刘宏涛, 等. 电视胸腔镜辅助下食管癌切除 (附33例报告). 现代肿瘤学, 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.	杜铭, 陈焕文, 吴庆琛, 等. 胸腔镜联合腹腔镜食管癌切除术治疗40例食管癌的临床分析. 第三军医大学学报, 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.	邵龙龙, 相加庆. 食管癌腔镜手术现状. 中国癌症杂志, 2011, 21(7): 528-532.
12.	陈焕文, 杜铭, 吴庆琛, 等. 人工气胸在腔镜食管癌切除术中的临床分析. 第三军医大学学报, 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, 鲁鸣, 刘宏涛, 等. 电视胸腔镜辅助下食管癌切除 (附33例报告). 现代肿瘤学, 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. 杜铭, 陈焕文, 吴庆琛, 等. 胸腔镜联合腹腔镜食管癌切除术治疗40例食管癌的临床分析. 第三军医大学学报, 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. 邵龙龙, 相加庆. 食管癌腔镜手术现状. 中国癌症杂志, 2011, 21(7): 528-532.
12. 陈焕文, 杜铭, 吴庆琛, 等. 人工气胸在腔镜食管癌切除术中的临床分析. 第三军医大学学报, 2012, 34(8): 789-791.

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Application of Thoracoscopy Combined with Laparoscopy in Esophagectomy for Esophageal Carcinoma

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