Dexter S P, Martin I G, McMahon M J
Leeds Institute for Minimally Invasive Therapy, The General Infirmary at Leeds, Great Britain.
Surg Endosc. 1996 Feb;10(2):147-51. doi: 10.1007/BF00188361.
Much of the morbidity of conventional esophagectomy for cancer is thought to relate to the thoracotomy wound and while transhiatal esophagectomy removes the need for a thoracotomy, it is not oncologically sound. Videothoracoscopy could potentially provide an oncologically sound means for resecting the thoracic esophagus without the need for a thorcotomy.
Between June 1991 and June 1994, thoracoscopic mobilization of the thoracic esophagus combined with radical lymphadenectomy was attempted in 24 patients as part of three-stage esophagectomy for cancer (5 squamous and 19 adenocarcinomas). Mean age was 59 years (range 43-76). Eight patients were ASA grade I, 10 were ASA II, and 6 ASA III. Two patients had early lesions (T1N0) but all other cancers were T2 or T3. Dissection of the thoracic esophagus was attempted via a right-sided approach, followed by a laparotomy and a cervical incision.
The thoracoscopic procedure was successful in 22 patients; it was abandoned in one patient with dense pleural adhesions and in another with inoperable tumor. Mean duration of the thoracic component was 184 min(120-330). There were three post-operative deaths. Ten further patients had major complications. Median post-operative stay was 18 days(9-129). Mean node harvest was 13 nodes(6-28). Two-year survival (cancer specific) was 33%.
Radical thoracoscopic mobilization of the esophagus is feasible, but the potential for complications remains high and requires further study.
传统食管癌切除术的大部分发病率被认为与开胸伤口有关，虽然经裂孔食管癌切除术无需开胸，但在肿瘤学上并不完善。电视胸腔镜检查有可能提供一种在肿瘤学上合理的方法来切除胸段食管，而无需开胸。
1991年6月至1994年6月期间，对24例患者尝试进行胸腔镜下胸段食管游离联合根治性淋巴结清扫术，作为癌症三阶段食管癌切除术的一部分（5例鳞状细胞癌和19例腺癌）。平均年龄为59岁（范围43 - 76岁）。8例患者为ASA I级，10例为ASA II级，6例为ASA III级。2例患者为早期病变（T1N0），但所有其他癌症均为T2或T3期。尝试通过右侧入路进行胸段食管的解剖，随后进行剖腹术和颈部切口。
22例患者胸腔镜手术成功；1例因胸膜粘连严重、另1例因肿瘤无法切除而放弃手术。胸段手术的平均持续时间为184分钟（120 - 330分钟）。有3例术后死亡。另有10例患者出现严重并发症。术后中位住院时间为18天（9 - 129天）。平均淋巴结清扫数为13个（6 - 28个）。两年生存率（癌症特异性）为33%。
根治性胸腔镜下食管游离术是可行的，但并发症的可能性仍然很高，需要进一步研究。
