新辅助化疗后腹腔镜辅助食管内翻拔脱术治疗颈段食管癌1例报告

摘要

On August 29 2012,laparoscopic transhiatal esophagectomy was performed on a 58-year-old patient after neoadjuvant chemotherapy for cervical esophageal cancer.The patient presented with a six-month history of progressive dysphagia.Gastroscopy and pathology revealed cervical esophageal squamous cell carcinoma.He was treated with 3 standard regimens of neoadjuvant chemotherapy prior to esophagectomy.CT and endoscopic ultrasound suggested the clinical staging degraded from T3 N1 M0 to T2N0M0.Laparoscopic transhiatal esophagectomy was performed.The lesser curvature,the greater curvature and the distal esophagus were mobilized,and the hiatus was dissected with a laparoscopic harmonic scalpel.Four endoscopic linear staplers were used to create a gastric tube.Meanwhile,the cervical esophagus was mobilized and the cervical lymph nodes were dissected.After laparoscopic transhiatal esophagectomy,the gastric tube was rctracted to the patient' s neck.And then,esophagogastric anastomosis was performed.The operaton time was 170 min,the intraoperative blood loss was about 210 ml.He was introduced to liquid diet from the 7th post-operative day.The length of hospital stay was 12 d.No complications occurred during the hospital stay.Post-operative pathology showed no metastases were found in 15 cervical lymph nodes.After 3 months of follow-up,acid reflux on 24-hour pH monitoring was 4-6 times per day.It was more serious at night.%本文报道2012年8月29日1例新辅助化疗后腹腔镜辅助食管内翻拔脱术治疗食管癌.患者男,58岁,吞咽困难进行性加重半年.经胃镜和活检病理诊断为颈段食管鳞状细胞癌.化疗3周期后,分期从T3N1M0降为T2N0M0,行腹腔镜辅助食管内翻拔脱术:腹腔镜下用超声刀游离胃、下段食管和膈食管裂孔,利用腔镜切割缝合器制成管状胃.同时,经颈部游离食管和清理颈部各组淋巴结.腹部悬吊,腹腔镜辅助食管内翻拔脱后,将管状胃牵至颈部,与食管残端吻合.手术时间2 h 50 min.术中出血量约210 ml.术后第7天进清流食,逐渐加量.术后第12天出院.住院期间未发生声嘶等并发症.术后病理:颈部各组淋巴结15枚,未见癌转移.术后3个月,酸反流4～6次/d,多在夜间.