Kim Kwhanmien, Park Joon S, Seo Hoon
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
Surg Laparosc Endosc Percutan Tech. 2013 Jun;23(3):303-8. doi: 10.1097/SLE.0b013e31828b8841.
Although the use of a minimally invasive approach in esophageal cancer surgery is gradually increasing, it is generally performed using cervical anastomosis because of the difficulty of intrathoracic anastomosis. Here, we describe our technique for performing intrathoracic esophagogastrostomy using a typical video-assisted thoracic surgery (VATS) approach.
Between September 2009 and July 2011, VATS esophagectomy and intrathoracic anastomosis was performed in 31 esophageal cancer patients with a utility incision made by a segmental rib resection to enhance the extracorporeal insertion of the end-to-end stapler. We retrospectively reviewed the clinical records of these patients.
There were no intraoperative events related to the VATS procedure. The mean VATS time was 180.2 ± 39.2 min. The mean postoperative hospital stay was 15.2 days (range, 11 to 38 d). No significant pulmonary complications were observed. Five patients developed vocal cord palsy due to radical mediastinal lymphadenectomy. No anastomotic complications such as leaking or stricture were observed. Only 1 patient had postoperative pain requiring analgesics.
Our technique can be safely and effectively performed for intrathoracic anastomosis in esophageal surgery with favorable early outcomes and reduced postoperative pulmonary complications.
尽管食管癌手术中微创方法的使用正在逐渐增加，但由于胸内吻合困难，通常采用颈部吻合。在此，我们描述了一种使用典型电视辅助胸腔镜手术（VATS）方法进行胸内食管胃吻合术的技术。
2009年9月至2011年7月期间，对31例食管癌患者进行了VATS食管切除术和胸内吻合术，通过节段性肋骨切除做实用切口，以增强端端吻合器的体外插入。我们回顾性分析了这些患者的临床记录。
没有与VATS手术相关的术中事件。VATS平均时间为180.2±39.2分钟。术后平均住院时间为15.2天（范围11至38天）。未观察到明显的肺部并发症。5例患者因根治性纵隔淋巴结清扫出现声带麻痹。未观察到吻合口漏或狭窄等吻合口并发症。只有1例患者术后疼痛需要使用镇痛药。
我们的技术可安全有效地用于食管手术中的胸内吻合，早期效果良好，术后肺部并发症减少。
