经左胸腹全胸腔镜食管胃交界区腺癌外科治疗 附17例报告.docVIP

经左胸腹全胸腔镜食管胃交界区腺癌外科治疗(附17例报 告) 宿学家张志勇(通讯 )朱斌谭鑫范波 (解放军第八十八医院心胸外科 山东泰安271000) 【 】FI的 研究探讨胸腔镜下食管胃交界部腺癌(adenocarcinoma of the esophagogastric junction AEG)的手术体位、入路和手术方法的可行性及安全性。 方法2011年11月至2014年03月对17例AEG行右侧卧位经左胸腹完全腔镜 下根治术：右侧卧位经左胸行腔镜下下段食管的游离及清扫纵隔淋巴结，开膈肌, 第七肋间肋弓下、腹直肌外缘做5cm长切口，腔镜辅助下游离贲门、胃及清扫 胃左动脉、网膜淋巴结，普通消化道吻合器行食管胃吻合。结果 无屮转开胸。 总手术时间：110-190min,平均146min。术中无大出血，总出血量30-150ml, 平均1 lOmL共清扫纵隔淋巴结104枚，平均每例6.1枚；清扫腹腔淋巴结133 枚，平均每例7.8例。术后住院9-14d,平均lid。住院期间病人无死亡。术后 并发症：肺部感染2例，无吻合口漏。结论 右侧卧位经左胸腹全腔镜下AEG 的外科治疗是可行安全的，近期效果良好，并发症少，达到左侧开胸手术效果。 但其长期疗效需要进一步研究、随访。 【关键词】右侧卧位 微创 食管胃交界区肿瘤 胸腔镜 【中图分类号】R725.2 【文献标识码】A 【文章编号】2095-1752 (2014) 14-0071-02 The treatment of ade no carci noma of the esophagogastric junction (AEG) by endoscopic radical oesophagectomy (report of 17 cases) Xue-jia Su Zhi-yong Zhang Bin Zhu, XinTan Bo Fan. (Departme nt of Cardiothoracic Surgery ,The No. 88 Hospital of Ji nan Military Region, Shandong ProvinceTaian, 271000, P.R. China) 【Abstract] Objective To study the feasibility and safety of thoracoscopic surgery posturals and methods of the ade no carci noma of the esophagogastric junction (AEG).Methods A total of 17 patients with AEG were operated with the right lateral endoscopic radical oesophagectomy from November 2011 to March 2014 : freei ng the lower esophagus and clea n mediasti nal lymph no des using thoracoscopy under the right side of the supine line, then opening the diaphragm and cuting 5cm long incision under the left seventh rib and the outer rectus abdominis, next by endoscopic-assisting freeing cardia, stomach and sweeping left gastric artery and ome ntal lymph no des, last esophagogastrostomy using a com mon gastrointestinal stapling. Results No transit thoracotomy. The total operation time :110-190min, average 146min. No massive hemorrhage, bleeding volume 30-150ml, average 110ml. Sweepi ng a total of 104 mediastinal lymph no des, with an average of 6.1 per case; cleaning abdominal lymph node 133, with an average of 7.8 cases per case. Postoperative hospital