胸腹腔镜食管癌切除术临床剖析.docVIP

胸腹腔镜食管癌切除术临床剖析 　　[摘要] 目的 探讨联合胸腹腔镜手术在食管癌切除中的安全性、手术方法及临床效果。 方法 2012年12月～2015年12月共52例食管癌患者采用联合胸腹腔镜切除术，左侧俯卧位下胸腔镜游离食管及胸部淋巴结清扫；再平卧位，腹腔镜游离胃及腹部淋巴结清扫，然后将胃制成管状，并左颈部手工分层吻合。 结果 本组资料无围手术期死亡，所有患者均好转出院。除1例因肿瘤明显外侵中转开胸完成手术外，其余51例顺利完成手术。术后发生乳糜胸1例，肺部感染4例，声音嘶哑4例，颈部吻合口瘘2例。 结论 胸腹腔镜联合行食管癌切除术具有微创、恢复快、安全可靠、近期疗效满意等特点，有一定临床推广应用价值，但相关术后并发症需提高警惕。 　　[关键词] 食管癌；食管切除术；胸腔镜；腹腔镜 　　[中图分类号] R735.1 [文献标识码] B [文章编号] 1673-9701（2017）15-0049-03 　　[Abstract] Objective To evaluate the safety， surgical method and clinical effect of combined thoracic laparoscopic surgery in the resection of esophageal carcinoma. Methods A total of 52 patients with esophageal cancer from December 2012 to December 2015 underwent combined thoracic and laparoscopic resection. The patients were treated with thoracoscopic dissociating esophagus and thoracic lymph node dissection in left prone position， and laparoscopic dissociating stomach and abdomen lymph node dissection in supine position. Then the stomach of the patients was made into tubular， and the left neck was the hand-structured anastomosed. Results There were no perioperative deaths in this study. All patients were improved and discharged. Except for one case of converting to thoracotomy due to significant tumor invasion of the tumor， the remaining 51 cases successfully completed the operation. There was 1 case of chylothorax， 4 cases of pulmonary infection， 4 cases of hoarseness and 2 cases of neck anastomotic fistula after operation. Conclusion Thoracoscopic laparoscopic resection of esophageal carcinoma has the characteristics of minimally invasive， fast recovery， safe and reliable， satisfactory curative effect in the near future. It has certain clinical application value， but the related postoperative complications need to be vigilant. 　　[Key words] Esophageal cancer； Esophagectomy； Thoracoscopy； Laparoscopy 　　食管癌（esophageal carcinoma）是人?的常见恶性肿瘤，而我国属于食管癌高发的地区，发病率位居恶性肿瘤的第5位，死亡率位居恶性肿瘤的第4位[1]。目前治疗早中期食管癌的主要方法仍是手术，传统开胸手术方式创伤大，并发症较多，病死率较高。近年来，由于腔镜技术的快速发展，食管癌微创手术（minima