摘要
目的探讨半俯卧位人工气胸应用于电视胸腔镜食管癌根治术的安全性和有效性。方法回顾性分析59例行胸腔镜食管癌根治术的食管癌患者的临床资料，评价该手术方式的手术时间、淋巴结清扫和转移情况及术后并发症，比较患者手术前后的肿瘤TNM分期。结果本组59例患者中，51例患者在胸腔镜下完成手术，8例中转开胸手术。51例胸腔镜手术患者中，1例食管腺癌和1例食管小细胞癌患者分别在术前行新辅助化疗2个周期，术中发现食管床仅轻度粘连，并未增加手术难度。8例中转开胸手术的原因为奇静脉弓出血2例，下腔静脉出血1例，支气管动脉出血1例，超声刀致气管膜部穿孔1例和胸腔致密粘连3例。59例患者的住院时问为9-14d，平均住院时间为11．5d。电视胸腔镜食管癌根治术的手术时间为180-330min，平均手术时间为220．3min；其中胸部手术时间为80-120min，平均手术时间96．6min。术中估计出血量为100-300ml，平均出血量220．8ml；术后胸腔引流管放置时间为2-4d，平均放置时间为3．2d。术后发生心律失常1例，一过性声音嘶哑2例，肺部感染2例，全组患者并发症发生率占9．8％（5／51）。本组患者无围手术期死亡，无吻合口瘘和乳糜胸。术前分期和术后分期大体吻合，其中1例CT发现右喉返神经旁淋巴结肿大，临床分期为cT1N1M0期，术后病理报告为右喉返神经旁淋巴结反应性增生，术后降期为pT1NOM0期；1例食管胸上段鳞癌，术前根据CT和气管镜临床分期为T3N1M0期，术中发现肿瘤外侵及气管膜部，术后病理分期为T4NOM0期；其他患者的术前和术后的肿瘤TNM分期均吻合。结论采用半俯卧位人工气胸电视胸腔镜食管癌根治术治疗食管癌，安全可行，完全达到开胸手术的效果，是治疗早、中期食管癌较理想的手术方法。
Objective To explore the safety and effectiveness of artificial pneumothorax in semi- prone position applied to video-assisted thoracoscopic resection of esophageal cancer. Methods The clinical data of 59 patients with esophageal cancer, who underwent thoracoseopic resection of esophageal cancer during April 2010 to April 2011, were reviewed and analyzed retrospectively to evaluate the operation time, lymph node dissection and metastatic nodes, post-operative complications, and comparison of the pre- and post-operative TNM staging. There were 9 eases of the upper thoracic esophagus, 44 of the thoracic segment esophagus, and 6 of the lower thoracic segment esophagus. One case of esophageal adenocarcinoma and 1 case of esophageal small cell carcinoma were treated by 2 cycles of neoadjuvant chemotherapy. The patients were in semi-prone position, and an artificial pneunothorax was created with injection of CO2 （ at a pressure of 6-8 mmHg） via the trocar. The entire thoracic esophagus was dissociated, mediastinal lymph nodes dissected by thoracoscopy, stomach dissociated, abdominal lymph nodes were dissected through abdominal incision, and esophagogastric anastomosis was performed. Results Among the 59 patients, 51 patients completed the thoracoscopic surgery, and 8 were converted to thoracotomy, due to azygos arch bleeding in two cases, membranous tracheal perforation in one case, inferior vena cava bleeding in one case, bronchial artery bleeding in one case, and dense pleural adhesions in three cases. The average operation time of the thoracoscopic surgery was 220. 3 （180-330） min, and the average operation time for theoperation in the thoracic part was 96.6 （80-120） rain. The average blood loss was 220.8 （100-300） ml, the postoperative chest tube was placed for 2 to 4 days （average 3.2）, postoperative drainage volume was： 60- 300 ml （201.6 ml in average） in the 1st day, 30-280 ml in the 2nd day, and 0-160 ml in the 3rd day. The length of hospital stay was 11.5 days （9-14 d）. No mortality, anastomotie fistula, and ehylothorax occurred in our patient group. One ease of arrhythmia, two eases of transient hoarseness, and two eases of pulmonary infection were all improved under symptomatic treatment. The overall complication rate was 9.8% （5/51 ）. 714 lymph nodes were dissected in the 51 patient-group, with an average 14 lymph nodes per patient, including 512 chest lymph nodes （10 on average）. The pathology report showed fight recurrent laryngeal nerve lymph node metastasis in 6 cases, left recurrent laryngeal nerve lymph node metastasis in 3 eases, subcarinal lymph node metastasis in 2 eases, lesion lymph node metastasis in 1 case, and esophagogastrie junction lymph node metastasis in 1 case. Conclusions Video-assisted thoracoscopic surgery （ VATS ） conducted in semi-prone position combined with artificial pneumothorax for the treatment of esophageal cancer is technically feasible and safe, as effective as open thoracic surgery, not only to maintain the intact thorax, significantly lighter postoperative pain, and reduces perioperative complication, but also better wound appearance. The operation is welcomed by patients and meets the requirements of the development of esophageal surgery, and it is a quite ideal treatment of early and intermediate stage esophageal cancer.
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2012年第10期785-789,共5页
Chinese Journal of Oncology
关键词
食管肿瘤
电视辅助外科手术
胸腔镜
食管切除术
Esophageal neoplasms
Video-assisted thoracoscopic surgery
Thoracoscopy
Esophagectomy
