Shirakawa Yasuhiro, Noma Kazuhiro, Maeda Naoaki, Katsube Ryoichi, Tanabe Shunsuke, Ohara Toshiaki, Sakurama Kazufumi, Fujiwara Toshiyoshi
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558,
Acta Med Okayama. 2014;68(2):111-7. doi: 10.18926/AMO/52407.
Thoracoscopic esophagectomy in the prone position (TEPP) might enable solo-surgery in cases requiring resection of the esophagus and the surrounding lymph nodes due to the associated advantages of good exposure of the surgical field and ergonomic considerations for the surgeon. However, no one approach can be for all patients requiring extensive lymphadenectomy. We recently developed an assistant-based procedure to standardize exposure of the surgical field. Patients were divided into 1 of 2 groups:a pre-standardization group (n=37) and a post-standardization group (n=28). The thoracoscopic operative time was significantly shorter (p=0.0037) in the post-standardization group (n=28; 267 ± 31 min) than in the pre-standardization group (n=37;301 ± 53 min). Further, learning curve analysis using the moving average method showed stabilization of the thoracoscopic operative time after the standardization. No significant differences were found in the number of mediastinal lymph nodes dissected or intraoperative blood loss between the 2 groups. There were also no significant differences in the complication rate. Assistant-based surgery and standardization of the procedure resulted in a well-exposed and safe surgical field. TEPP decreased the operative time, even in patients requiring extensive lymphadenectomy.
俯卧位胸腔镜食管切除术（TEPP）由于具有手术视野暴露良好以及对外科医生的人体工程学考虑等相关优势，可能使在需要切除食管及周围淋巴结的病例中实现单人手术。然而，对于所有需要广泛淋巴结清扫的患者，没有一种方法是万能的。我们最近开发了一种基于助手的手术方法来规范手术视野的暴露。患者被分为两组中的一组：标准化前组（n = 37）和标准化后组（n = 28）。标准化后组（n = 28；267 ± 31分钟）的胸腔镜手术时间明显短于标准化前组（n = 37；301 ± 53分钟）（p = 0.0037）。此外，使用移动平均法进行的学习曲线分析表明，标准化后胸腔镜手术时间趋于稳定。两组之间在纵隔淋巴结清扫数量或术中失血量方面未发现显著差异。并发症发生率也没有显著差异。基于助手的手术和手术标准化导致了良好暴露且安全的手术视野。TEPP缩短了手术时间，即使在需要广泛淋巴结清扫的患者中也是如此。
