Constantinoiu Silviu, Achim Florin, Constantin Adrian
Chirurgia (Bucur). 2018 Nov-Dec;113(6):809-825. doi: 10.21614/chirurgia.113.6.809.
Esophagectomy is standard indication for surgical treatment of resectable esophageal cancer, but it can also be performed for the management of benign conditions. Esophagectomy is followed by esophageal reconstruction using other parts of the digestive tract and is associated with increased postoperative morbidity and mortality. Gastric interposition with intrathoracic or cervical esophago- gastric anastomosis is currently the preferred technique for reconstruction after esophagectomy. The incidence of esophagectomy performed by the minimal invasive approach has increased in recent years due to the advanced technology of endoscopic surgery and image enhancement that provides a better estimate of anatomical plans, facilitates access to narrow spaces and more precise dissection with less tissue trauma. Randomized clinical trials have found a significant reduction in postoperative respiratory complications, decreased hospital stay and equivalent oncological results to open esophagectomy. We present the operative technique of minimally invasive esophagectomy performed in our clinic by three-stage modified McKeown approach thoracoscopic, laparoscopic and cervical with esophageal reconstruction with stomach.
食管切除术是可切除食管癌外科治疗的标准术式，但也可用于良性疾病的治疗。食管切除术后需用消化道的其他部位进行食管重建，且术后发病率和死亡率会增加。目前，采用胸内或颈部食管胃吻合的胃代食管术是食管切除术后重建的首选技术。近年来，由于内镜手术技术的进步以及图像增强技术能够更好地评估解剖结构、便于进入狭窄空间并进行更精确的解剖且组织创伤更小，微创食管切除术的发生率有所增加。随机临床试验发现，与开放食管切除术相比，术后呼吸并发症显著减少，住院时间缩短，肿瘤学效果相当。我们介绍了在我们诊所采用三阶段改良麦克基翁方法（胸腔镜、腹腔镜和颈部）进行微创食管切除术并以胃进行食管重建的手术技术。
