【摘要】 目的探讨胸、腹腔镜联合Ivor Lewis食管癌根治术的可行性和近期疗效。方法 2010年9月～2012年3月,胸、腹腔镜联合行Ivor Lewis食管癌根治术12例,腹腔镜下游离胃并清扫腹腔淋巴结,胸腔镜下游离胸段食管,清扫胸部淋巴结,上提胃入胸腔并制作管状胃,于胸腔内行食管胃吻合。结果 12例均顺利完成手术,无中转开胸、开腹,手术时间220～320 min,平均260 min,其中腹腔镜手术时间80～150 min,胸腔镜手术时间70～170 min;术中出血量100～280 ml,平均200 ml。术后4～8 d(平均5.2 d)拔除胸腔闭式引流管,胸腔引流总量480～1040 ml。清扫腹腔及胸腔淋巴结6～12枚,平均8.2枚,其中3例发现阳性淋巴结。术后住院8～11 d,平均9 d。术后无严重并发症,恢复顺利。12例随访3～14个月,平均12个月,无肿瘤复发或转移。结论胸、腹腔镜联合行Ivor Lewis食管癌根治术可行,近期疗效满意。更多还原

【Abstract】 Objective To explore the feasibility and short-term effect of Ivor-Lewis esophageal carcinoma radical mastectomy by using thoracoscopy combined with laparoscopy.Methods From September 2010 to March 2012,12 patients with esophageal carcinoma underwent Ivor-Lewis radical resection by thoracoscopy combined with laparoscopy in our hospital.With laparoscopy,we freed the stomach and cleaned the abdominal lymph nodes,and then the thoracic esophageal was separated and the intrathoracic lymph nodes was removed under thoracoscopy.Afterwards,we pulled the stomach into the chest cavity to build tubular stomach,and then performed esophagus-stomach anastomosis in the chest cavity.Results No patient was converted to open surgery during the operation.The total operation time ranged from 220 to 320 minutes with a mean of 260 minutes,among which,laparoscopic surgery time ranged from 80 to 150 minutes,and thoracoscopic procedures took 70 to 170 minutes.The intraoperative blood loss was 100 to 280 ml with a mean of 200 ml.The thoracic drainage tube was withdrawn in 4 to 8 days afterwards(mean:5.2 days),and the total drainage volume ranged from 480 to 1040 ml.A mean of 8.2(6-12) lymph nodes were removed,and positive lymph nodes were detected in three of the patients.The mean postoperative hospital stay was 9 days(ranged from 8-11 days).No severe complications occurred after the procedure,and no recurrence or metastasis of the tumor was found during a mean of 12-month follow-up(3-14 months).Conclusion Ivor-Lewis esophageal carcinoma radical mastectomy by using thoracoscopy combined with laparoscopy is feasible with a good short-term outcome.更多还原