摘要
目的总结开展腔镜辅助下McKeown术式切除食管癌的经验体会。方法回顾性分析1997年8月至2012年12月507例施行腔镜辅助下McKeowrt术式切除食管癌的患者临床资料。男348例，女159例；年龄（60．5±10．6）岁。其中，食管肿瘤位于上段39例（7．69％），中段312例（61．54％），下段156例（30．77％），术前放、化疗21例（4．14％）。TNM分期：0期55例（10．85％），瑚167例（32．94％），Ⅱ期203例（40．04％），Ⅲ期69例（13．61％），Ⅳ期13例（2．56％）；鳞癌463例（91．32％），腺癌及其他类型44例（8．68％）。手术采用腔镜辅助下经右胸、上腹、左颈人路，其中胸腔镜＋开腹281例（55．42％），胸腔镜＋腹腔镜179例（35．31％），开胸＋腹腔镜32例（6．31％），中转开胸／开腹15例（2．96％）。结果507例患者中腔镜辅助下完成McKeown食管癌切除手术492例（97．04％）。胸腔镜下食管游离及胸腔淋巴结清扫（81．5±34．7）min，腹腔镜下胃游离及腹区淋巴结清扫（60．3±17．5）min。胸腔镜手术出血（105．2±73．1）ml，腹腔镜手术出血（43．5±21．4）ml。清扫淋巴结总数（23．7±11．5）枚／例，其中胸腔淋巴结清扫（14．6±7．7）枚／例，腹腔淋巴结清扫（8．7±5．2）枚／例，颈区淋巴结清扫（1．3±1．1）枚／例。198例经食管床、309例经胸骨后径路重建食管。全组术中无死亡。术中因非病灶原因胸导管损伤13例、心房颤动9例、食管切缘阳性R1切除者3例、奇静脉／脾脏损伤出血3例、电凝钩／超声刀误伤气管3例。术后早期主要并发症为肺部感染54例（10．65％），颈部吻合瘘39例（7．69％），心律失常25例（4．93％），胸腔积液需要置管19例（3．75％），喉返神经损伤17例（3．35％），术后乳糜胸12例（2．37％）。术后早期死亡5例（0．99％）。241例（47．53％）接受术后放化疗。458例随访（41．5±35．9）个月，1、3、5年生存率分别为81．9％（324／396）、53．7％（148／276）、47．6％（63／132）。结论腔镜辅助下MeKeown术式切除食管肿瘤可行、有效，术后近、中期疗效可靠。
[ Abstract] Objective To assess our outcomes after McKeown minimally invasive esephagectomy（MMIE） for the treat- ment of esophageal cancer. Methods From August 1997 to December 2012, MMIE was performed in 507 patients. Esophage- al tumors located in the upper in 39（7.69% ）, middle in 312（61.54% ）, lower in 156（30.77% ）. Preoperative neoadjuvant chemomdiotherapy was used in 21 cases （4.14%）. Resection was performed for squamous cancer （463 cases, 91.32% ） , ad- enocareinoma and other histologic types （44 cases, 8.68% ） in patients with stages 0 （55, 10.85% ）, I （ 167, 32.94% ） , H （ 203, 40.04% ）, ]1I （69, 13.61% ）, and IV （ 13, 2.56% ） disease. Surgery were completed by thoracoscopic and lapa- mtomy （281 cases, 55.42% ）, total approach（ 179 cases, 35.31% ）, thoracotomy and laparescopic （32 cases, 6.31% ）, conversion to thoracotomy/laparotomy （ 15 cases, 2.96% ）. Results MMIE was successfully completed in 492（97.04% ） patients. The operative time of thoracoscopic the esophagus flee and pleural lymph node dissection was（81.5 ±34.7）min（60 - 180 min）, laparoseopic stomach free and abdominal area lymphadenectomy was 60.3 ± 17.5） rain（40 - 105 min）. The blood loss of thoracoseopic surgery was （ 105.2 ± 73.1 ） ml（ 55 - 1080 ml）, laparoscopie surgery （ 43.5 ± 21.4 ） ml （ 30 - 350ml）. The total number of lymph node dissection was 5 - 48 [ （ 23.7 ± 11.5 ）/case ], the number of thoracic lymph node dissection was 3 - 32 [ （ 14.6 ± 7.7 ）/case], abdominal lymph node dissection 2 - 29 E （ 8.7 ± 5.2 ）/ease）], and neck lymph node dissection 0 -7 [ （1.3 ± 1.1 ）/case]. 198 cases of esophageal reconstruction after esophageal bed, 309 cases through the sternum approach. The whole group were no deaths, intraoperative bleeding in 3 cases due to the azygos vein/spleen injury, the hook cautery/ultrasound surgery the knife accidentally injure trachea 3 cases, the non-focal cause 13 cases of thoracic duct injury, 9 cases of atrial llbrillation, esophageal resection margin-positive R1 resection in 3 cases. Major complications in the early postoperative period, lung infection rate was 10.65% （n =54）, the neck anasto- mosis leak rate was 7.69% （ n = 39）, arrhythmia rate was 4.93% （ n = 25 ）, pleural effusion catheter rate was 3.75% （ n = 19 ）, recurrent laryngeal nerve injury rate was 3.35% （ n = 17 ）, chylothorax rate was 2.37 % （ n = 12）. Mortality rate of early postoperative rate was O. 99% （ n = 5 ）. 241 patients（47.53% ） received postoperative radiotherapy and chemotherapy. The postoperative group average follow-up time was （41.5 ± 35.9） months（ 1 -96 months）, a successful follow-up of 458 eases, follow-up rate of 90.3%. The 1-year survival rate was 81.9% （ 324/396）, 3-year survival rate was 53.7% （ 148/276）, and 5-year survival rate was 47.6% （63/132）. Conclusion The surgical and oncologic outcomes of the MMIE procedure for esophageal cancer in our center were acceptable and comparable with those of reported the open-McKeown osophagectomy. The operation was shown to be feasible and safe, and these properties will be consolidated by experience.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2013年第6期334-338,共5页
Chinese Journal of Thoracic and Cardiovascular Surgery
基金
基金项目：浙江省重大科技专项和优先主题项目（2011C13039-2）
浙江省重点科技创新团队项目（2011R09040-03）
浙江省台州市科技局科研项目（091KY04）
关键词
食管肿瘤
腹腔镜
胸腔镜
外科手术
微创性
Esophageal neoplasms Laparoseopas Thoracoscopes Sugical pocedures, minimally invasive
