Khat'kov I E, Izrailov R E, Domrachev S A, Kononets P V, Vasnev O S, Koshkin M A
Khirurgiia (Mosk). 2014(10):45-51.
Extirpation or subtotal resection of esophagus was performed in 14 patients by using of thoracolaparoscopic technique in terms from November 2011 to March 2014. The mean patients' age was 56 years old (27-67 years). In 10 patients indications for surgery included benign esophagus diseases such as cardiospasm stage IV (2 cases), peptic stricture (5 cases) and burn stricture (3 cases). 4 patients were operated for esophagus cancer including middle one-third cancer in 1 patient, lower one-third cancer in 3 cases. 10 patients underwent extirpation of esophagus with peristaltic gastric tube plasty. 1 patient had esophagus substituted by segment of the left colon. Esophageal anastomoses were formed on the neck (interrupted sutures were applied in 7 patients; staplers - in 3 cases). Lewis operation with intrapleural esophageal-gastric anastomosis forming was performed in 3 patients. The mean surgery duration was 579 minutes (305-710 min), mean blood loss - 141 ml (from 50 to 300 ml). Postoperative period had not complications in 8 of 14 patients. Different complications including partial failure of the anastomosis on the neck (5 cases), intrapleural anastomosis failure (1 case) were observed in 6 patients. Partial failure of the anastomosis on the neck was treated by using of therapy. All patients recovered. Patient with intrapleural anastomosis failure required additional surgery which included uncoupling of anastomosis, esophagostomy on the neck and gastrostomy forming. This patient died from recurrent myocardial infarction. Thus the authors consider that complete thoracolaparoscopic technique provides precise preparation of esophagus and stomach, adequate lymphadenectomy with minimal blood loss and operative trauma. The results after these operations are comparable with those after open interventions. Thoracolaparoscopic simultaneous operations must be applied in clinics having sufficient experience in esophagus surgery and thoracolaparoscopic technique.
2011年11月至2014年3月期间，14例患者采用胸腹腔镜技术进行了食管切除或次全切除。患者平均年龄为56岁（27 - 67岁）。10例患者的手术适应证包括良性食管疾病，如IV期贲门失弛缓症（2例）、消化性狭窄（5例）和烧伤后狭窄（3例）。4例患者因食管癌接受手术，其中1例为食管中段癌，3例为食管下段癌。10例患者行食管切除并带蠕动胃管成形术。1例患者用左结肠段替代食管。食管吻合在颈部进行（7例采用间断缝合；3例采用吻合器）。3例患者行Lewis手术并在胸腔内形成食管胃吻合。平均手术时间为579分钟（305 - 710分钟），平均失血量为141毫升（50至300毫升）。14例患者中有8例术后无并发症。6例患者出现不同并发症，包括颈部吻合口部分漏（5例）、胸腔内吻合口漏（1例）。颈部吻合口部分漏采用相应治疗。所有患者均康复。胸腔内吻合口漏的患者需要再次手术，包括拆除吻合口、颈部食管造口术和胃造口术。该患者死于复发性心肌梗死。因此，作者认为完整的胸腹腔镜技术能精确地游离食管和胃，充分清扫淋巴结，失血和手术创伤最小。这些手术的结果与开放手术相当。胸腹腔镜联合手术必须在具有足够食管手术和胸腹腔镜技术经验的临床科室开展。
