Lata Adrian L, Oaks Timothy, Levine Edward A
Department of Thoracic, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Am Surg. 2010 Jul;76(7):735-40.
We report our initial experience with thoracoscopic assisted esophagectomy (TAE) in patients with esophageal carcinoma. Clinical outcome measures are reported for 14 consecutive patients who underwent thoracoscopically assisted esophagectomy at our institution between January 2007 and June 2009. These outcomes were compared with 18 patients who underwent open esophagectomy (OE) during this time. All 14 patients were male, with a median age of 63. All had distal esophageal adenocarcinoma: stage I (7), II A (2), II B (3), and III (2). Surgical approaches included laparotomy combined with thoracoscopy and cervical (n=12), or intrathoracic anastomosis (n=2). Compared with an open approach, the thoracoscopic assisted esophagectomies were longer (median time 460 vs. 386 minutes), and they were associated with less blood loss (250 mL vs. 500 mL) and less respiratory complications (14.3% vs. 27.8%). In our TAE group more lymph nodes were removed (median number 12 in TAE vs. 10 in OE). The overall morbidity was similar in both groups (42.8% in TAE vs. 50% in OE group), but the in-hospital mortality was reduced with TAE (7.1% with TAE vs. 16.7% with OE). TAE is feasible with a low conversion rate, acceptable morbidity, and low mortality.
我们报告了我们在食管癌患者中进行电视胸腔镜辅助食管癌切除术（TAE）的初步经验。报告了2007年1月至2009年6月期间在我们机构接受电视胸腔镜辅助食管癌切除术的14例连续患者的临床结局指标。将这些结局与同期接受开放食管癌切除术（OE）的18例患者进行比较。所有14例患者均为男性，中位年龄63岁。所有患者均患有远端食管腺癌：I期（7例）、II A期（2例）、II B期（3例）和III期（2例）。手术方式包括剖腹术联合胸腔镜检查及颈部吻合术（n = 12）或胸内吻合术（n = 2）。与开放手术相比，电视胸腔镜辅助食管癌切除术时间更长（中位时间460分钟对386分钟），但术中失血更少（250 mL对500 mL），呼吸并发症更少（14.3%对27.8%）。在我们的TAE组中切除的淋巴结更多（TAE组中位数量为12个，OE组为10个）。两组的总体发病率相似（TAE组为42.8%，OE组为50%），但TAE组的住院死亡率降低（TAE组为7.1%，OE组为16.7%）。TAE是可行的，转换率低，发病率可接受，死亡率低。
