Pan Saibo, Wang Lian, Wu Ming, Wang Qi, Shen Gang, Chen Gang
Department of Thoracic Surgery, Second Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, China .
J Laparoendosc Adv Surg Tech A. 2017 Nov;27(11):1198-1202. doi: 10.1089/lap.2017.0147. Epub 2017 May 15.
We present a laparoscopic and single intercostal space thoracoscopic approach (SICS group) for Ivor Lewis minimally invasive esophagectomy (MIE) and provide postoperative analgesia with a continuous multiple intercostal nerve blocking technique. The characters of this technique are evaluated.
From October 2015 to April 2016, 18 consecutive patients with esophageal cancer were treated with Ivor Lewis MIE by a SICS group. Moreover, from July 2014 to September 2015, 48 patients with esophageal cancer received Ivor Lewis MIE by four-port video-assisted thoracic surgery (VATS) approach. Among those patients, by using propensity-score matching, 18 matched patients who underwent four-port VATS MIE (four-port group) were retrospectively selected for further statistical analysis. Patient demographics, short-term postoperative outcomes were recorded.
None of the patients in the SICS group required conversion to an open procedure. No failure of the intrathoracic esophagogastrostomy occurred. No perioperative mortality or readmission was observed in this series. No patient suffered from anastomotic leak or complained remarkable dysphasia during follow-up. SICS group had a shorter duration of both docking procedure and closure of chest incisions compared with four-port group. The visual analog scale (VAS) pain scores on 24 hours after surgery was significantly lower in SICS group than in four-port group, while the values on 6 hours were comparable. The level of creatine kinase on postoperative day (POD) 1 was significantly lower in SICS group than in four-port group.
Single intercostal space thoracoscopic procedure is safe and technically feasible and can therefore be viewed as an attractive alternative approach for performing Ivor Lewis MIE.
我们介绍一种用于艾弗·刘易斯微创食管切除术（MIE）的腹腔镜联合单肋间胸腔镜入路（SICS组），并采用连续多肋间神经阻滞技术进行术后镇痛。对该技术的特点进行评估。
2015年10月至2016年4月，18例连续的食管癌患者接受了SICS组的艾弗·刘易斯MIE治疗。此外，2014年7月至2015年9月，48例食管癌患者接受了四孔电视辅助胸腔镜手术（VATS）入路的艾弗·刘易斯MIE治疗。在这些患者中，通过倾向评分匹配，回顾性选择了18例接受四孔VATS MIE的匹配患者（四孔组）进行进一步的统计分析。记录患者的人口统计学资料、术后短期结局。
SICS组患者均无需转为开放手术。胸内食管胃吻合术无失败病例。本系列未观察到围手术期死亡或再次入院情况。随访期间无患者发生吻合口漏或出现明显吞咽困难。与四孔组相比，SICS组的对接手术和胸壁切口关闭时间均较短。SICS组术后24小时的视觉模拟评分（VAS）疼痛评分显著低于四孔组，而6小时时的评分相当。SICS组术后第1天的肌酸激酶水平显著低于四孔组。
单肋间胸腔镜手术安全且技术可行，因此可被视为进行艾弗·刘易斯MIE的一种有吸引力的替代方法。
