摘要
目的探讨非充气式纵隔镜联合腹腔镜食管癌根治术在食管癌合并心肺疾病患者中的临床应用价值。方法回顾性分析2021年1月~2024年10月我院采用非充气式纵隔镜联合腹腔镜食管癌根治术治疗20例合并心肺疾病的食管癌患者的临床资料。颈、腹部2组手术人员同时进行,取左颈部切口,游离出颈段食管,置入纵隔镜后应用超声刀自上而下游离胸段食管并清扫食管旁淋巴结,与腹腔镜组(自下而上游离胃及食管)于纵隔内会师完成食管游离,制作成管状胃后于颈部完成吻合。结果20例手术均顺利完成,无中转开胸。手术时间(130.5±25.5)min,术中出血量(60.5±32.5)ml,纵隔淋巴结清扫3~11枚,腹腔淋巴结清扫1~5枚,术后住院时间(20.0±6.0)d。术后吻合口漏2例,吻合口狭窄2例,胸腔积液2例,肺部感染2例,乳糜胸1例,喉返神经损伤1例,均经保守治疗后痊愈。术后病理:鳞癌18例,腺癌2例;术后TNM分期:Ⅰ期6例,Ⅱ期10例,Ⅲ期4例,与术前评估一致。20例随访1~24个月,中位随访时间12个月,复查CT无复发及死亡病例。结论非充气式纵隔镜联合腹腔镜食管癌根治术治疗合并心肺疾病的食管癌安全、可行。
Objective To explore the clinical application value of non-inflatable mediastinoscopy combined with laparoscopic radical resection for esophageal cancer patients complicated with cardiovascular and pulmonary diseases.Methods A retrospective analysis was made on clinical data of 20 patients with esophageal cancer complicated with cardiovascular and pulmonary diseases treated with non-inflatable mediastinoscopy combined with laparoscopic radical resection in our hospital from January 2021 to October 2024.The cervical and abdominal surgical teams worked simultaneously.During the operation,a left neck incision was made to free the cervical esophagus.After inserting a mediastinoscope,an ultrasonic knife was used to free the thoracic esophagus from top to bottom and clean the lymph nodes adjacent to the esophagus.The laparoscopic procedure(freeing the stomach and esophagus from bottom to top)was connected in the mediastinum to complete the esophageal freedom,and a tubular stomach was made and anastomosed at the neck.Results All the 20 operations were successfully completed without conversion to thoracotomy.The operation time was(130.5±25.5)min,the intraoperative blood loss was(60.5±32.5)ml,a total of 3-11 mediastinal lymph nodes and 1-5 abdominal lymph nodes were cleared,and the postoperative hospital stay was(20.0±6.0)d.There were 2 cases of anastomotic leakage,2 cases of anastomotic stenosis,2 cases of pleural effusion,2 cases of pulmonary infection,1 case of chylothorax,and 1 case of recurrent laryngeal nerve injury.After conservative treatment,all of which were cured.Postoperative pathology showed 18 cases of squamous cell carcinoma and 2 cases of adenocarcinoma.Postoperative TNM staging was 6 cases in stageⅠ,10 cases in stageⅡ,and 4 cases in stageⅢ,consistent with preoperative evaluation.All the 20 cases were followed up for 1-24 months,with a median follow-up time of 12 months.CT re-examinations showed no recurrence,and no death case was recorded.Conclusion Non-inflatable mediastinoscopy combined with laparoscopic radical resection is safe and feasible for esophageal cancer patients complicated with cardiovascular and pulmonary diseases.
作者
惠云生
张彬彬
江南
钱如林
Hui Yunsheng;Zhang Binbin;Jiang Nan(Department of Thoracic Surgery,Henan Provincial Chest Hospital,Chest Hospital of Zhengzhou University,Zhengzhou 450000,China)
出处
《中国微创外科杂志》
北大核心
2025年第8期464-468,共5页
Chinese Journal of Minimally Invasive Surgery
关键词
非充气式纵隔镜
腹腔镜
食管癌根治术
心肺疾病
Non-inflatable mediastinoscopy
Laparoscopy
Radical resection of esophageal cancer
Cardiovascular and pulmonary diseases
