Mafune K, Tanaka Y, Makuuchi M
Second Dept. of Surgery, Faculty of Medicine, University of Tokyo, Japan.
Gan To Kagaku Ryoho. 1997 Mar;24(5):525-31.
To reduce the high morbidity rate associated with esophagectomy for esophageal cancer, thoracoscopic approach has been recently introduced. However thoracoscopic esophagectomy has been performed as a palliative operation like the transhiatal esophagectomy. We have developed a technique of video-assisted thoracic surgery (VATS) using thoracoscopy or mediastinoscopy as a radical esophagectomy. For the extensive lymph node dissection, especially along bilateral recurrent nerves, could be successfully performed in more than 20 patients by VATS with thoracoscopic instruments through the usual thoracotomy. And we have also applied VATS with small thoracotomy to the radical esophagectomy. Using this technique, we could performed esophagectomy almost same as the radical esophagectomy through usual thoracotomy even in small number of cases. Furthermore, disadvantages of the transhiatal esophagectomy, inherent in the blind dissection involved, was almost conquered by VATS using mediastinoscopy. These initial results of ours indicate that video-assisted esophagectomy is a feasible procedure as the radical operation for esophageal cancer.
为降低食管癌食管切除术相关的高发病率，最近引入了胸腔镜手术方法。然而，胸腔镜食管切除术一直作为一种姑息性手术进行，就像经裂孔食管切除术一样。我们开发了一种利用胸腔镜或纵隔镜作为根治性食管切除术的电视辅助胸外科手术（VATS）技术。通过VATS使用胸腔镜器械经常规开胸术，能够成功地为20多名患者进行广泛的淋巴结清扫，尤其是沿双侧喉返神经的清扫。并且我们还将小切口开胸的VATS应用于根治性食管切除术。使用这种技术，即使在少数病例中，我们也能够进行几乎与经常规开胸术的根治性食管切除术相同的食管切除术。此外，经裂孔食管切除术所固有的盲目解剖的缺点，几乎被使用纵隔镜的VATS克服。我们的这些初步结果表明，电视辅助食管切除术作为食管癌的根治性手术是一种可行的手术方法。
