Lin Jiang-bo, Kang Ming-qiang, Lin Ruo-bai, Zhen Wei, Chen Chun
Department of Thoracic Surgery, Fujian Medical University, Fuzhou, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2012 Sep;15(9):930-3.
To summarize early experience in combined thoraco-laparoscopic esophagectomy with two-field lymph node dissection for esophageal carcinoma.
A total of 150 patients with thoracic esophageal cancer who underwent combined thoracoscopic and laparoscopic esophagectomy in Union Hospital, Fujan Medical University, were enrolled in this study.
Locations of the tumors included upper esophagus (n=14), middle esophagus (n=95), and lower esophagus (n=41). Pathological type showed squamous cell cancer (n=142) and other types of cancer (n=8). There was no intraoperative death. Conversion to open thoracotomy was required in 6 patients and conversion to open laparotomy in 2 patients. The average total operative time was( 258±45) min. The average operative thoracoscopic time was (140±33) min. The average time for gastric mobilization and neck esophagogastric anastomosis was (119±28) min. The average blood loss during the procedure was (207±130) ml. The average number of harvested lymph node with the specimen was 23.3±8.2. The tumor staging included stage I (n=39), II (n=58) and III (n=53). Postoperative complications occurred in 48(32%) patients including pneumonia (n=17), recurrent laryngeal injury (n=13), anastomotic leak (n=9), arrhythmias (n=9), chyle chest (n=5), delayed gastric emptying (n=5), ileus (n=2), volvulus (n=1), and thrombocytopenia (n=1). Two patients died postoperatively due to respiratory failure resulting from pneumonia.
Thoraco-laparoscopic two-field lymph node dissection of esophageal cancer is a feasible minimally invasive approach.
总结胸腔镜联合腹腔镜食管癌切除术并二野淋巴结清扫的早期经验。
本研究纳入了福建医科大学附属协和医院150例行胸腔镜联合腹腔镜食管癌切除术的胸段食管癌患者。
肿瘤部位包括食管上段（14例）、食管中段（95例）和食管下段（41例）。病理类型显示鳞状细胞癌（142例）和其他类型癌症（8例）。无术中死亡。6例患者中转开胸，2例患者中转开腹。平均总手术时间为（258±45）分钟。平均胸腔镜手术时间为（140±33）分钟。平均胃游离及颈部食管胃吻合时间为（119±28）分钟。术中平均失血量为（207±130）毫升。标本平均清扫淋巴结数为23.3±8.2枚。肿瘤分期包括Ⅰ期（39例）、Ⅱ期（58例）和Ⅲ期（53例）。48例（32%）患者发生术后并发症，包括肺炎（17例）、喉返神经损伤（13例）、吻合口漏（9例）、心律失常（9例）、乳糜胸（5例）、胃排空延迟（5例）、肠梗阻（2例）、肠扭转（1例）和血小板减少（1例）。2例患者术后因肺炎导致呼吸衰竭死亡。
胸腔镜联合腹腔镜食管癌二野淋巴结清扫是一种可行的微创方法。
