目的探讨大网膜袖套式包埋吻合口在微创Ivor-Lewis术中全胸腔镜下食管胃胸内吻合治疗食管癌中的应用价值。方法回顾性分析2012年1月～2014年12月我科148例行微创Ivor-Lewis手术全胸腔镜下大网膜包埋吻合口治疗中下段食管癌的临床资料。在腹腔镜游离胃时预留蒂连于胃的大网膜条，胸腔镜下完成食管胃胸内吻合后，网膜条袖套式包绕吻合口区一周并与吻合口上方纵隔胸膜及下方的胃浆肌层缝合固定。术后1周行上消化道碘水造影判断有无吻合口漏，每3个月随访行胃镜检查了解吻合口情况。结果全组均顺利完成大网膜包埋吻合口。网膜制作时间8～17 min，平均10 min，吻合口包埋时间6～12 min，平均10 min。无围手术期死亡，术后1周碘水造影示吻合口漏6例（4．1％，6／148），均为线状漏，无发热及液气胸等胸内吻合口漏表现，保守治疗6～12天再次造影检查未见漏。随访6～42个月，平均20个月，吻合口狭窄11例（7．4％）。未发现胸胃残端漏、食管气管瘘或食管主动脉瘘等严重并发症。结论大网膜包埋吻合口的术式吻合口漏发生率低，增加微创Ivor-Lewis术的安全性，更有助于该术式的发展和推广。%Objective To evaluate the function of pedicled omentum in the minimally invasive Ivor-Lewis esophagectomy in total thoracoscopic thoracic esophagogastric anastomosis for esophageal carcinoma . Methods We retrospectively evaluated 148 patients’ perioperative data with middle-lower part of esophageal carcinoma who received minimally invasive Ivor-Lewis esophagectomy in our center between January 2011 and December 2014.We reserved an omental flap during laparoscopic gastric mobilization , with the omental flap remained attached to the mobilized stomach . The pedicled omentum was used for wrapping loosely around the esophagogastric suture lines , and several sutures were placed to maintain the position of the omentum between the stomach and pleura in operation .An upper gastrointestinal contrast study containing iodine was used to evaluate the leakage after 7 days of postoperation . All of the patients received a follow-up every 3 months, during which anastomosis strictures were recorded by the findings of endoscopy . Results All the 148 patients with esophageal carcinoma received minimally invasive Ivor-Lewis esophagectomy successfully .The mean time for creation of pedicled omentum was 10 min (range, 8-17 min), and the mean time for pedicled omentum flap wrapping was 10 min (range, 6-12 min).No deaths occurred during perioperative period .The upper gastrointestinal contrast images showed 6 cases (4.1%, 6/148) suffered from liner anastomotic leakage , which were cured with 6-12 days of conservative therapy .Among the patients who had leakage , no adverse outcomes such as fever or hydropneumothorax occurred .There were 11 anastomosis strictures (7.4%) occurred during a follow-up for 6-42 months (mean, 20 months).In addition, there were no severe complications, such as conduit failure , conduit airway fistula or aorto-esophageal fistula , after esophagectomy . Conclusions Omental pedicle flap wrapped around esophagogastric anastomosis can significantly decrease anastomotic leakage in parents with middle or lower esophageal carcinoma.This technique is safe and improve the development and the promotion of minimally invasive Ivor -Lewis oesophagectomy .
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