目的：评价胸腹腔镜联合治疗食管癌的安全性及可行性。方法回顾性分析2013年9月—2014年7月行胸腹腔镜联合治疗食管癌的20例患者的资料，手术先左侧卧位，胸腔镜下游离食管并清扫胸部淋巴结；然后平卧位，腹腔镜下游离胃并清扫腹腔淋巴结，制作管状胃行左颈部机械吻合术。结果全组无中转开胸开腹病例，胸腔镜手术时间（90±30）min，腹腔镜手术时间（65±20）min，总手术时间（210±40）min。术中胸腔失血量60～200 mL，平均110 mL，术中腹腔失血量30～100 mL，平均60 mL，每例患者清扫胸部淋巴结8～15枚，平均11．2枚，清扫腹腔淋巴结6～12枚，平均8．4枚。术后胸腔引流量200～650 mL，平均为350 mL，术后进食时间6～8天，平均7．0天。术后住院时间11～14天，平均12．0天，术后病理诊断20例均为鳞状细胞癌，术后分期（ T1－3 N0－1 M0），上下切缘阴性，无吻合口瘘，术后肺部感染1例，术后出现喉返神经损伤1例，随访6个月后恢复，术后3个月出现吻合口狭窄1例，予以内镜下扩张三次后治愈。术后随访20例，随访时间为2～10个月，无复发转移及死亡病例。结论胸腹腔镜联合治疗食管癌具有手术创伤小，术后并发症少，安全可行，值得推广应用。%Objective To evaluate of safety and feasibility of thoracoscopic and laparoscopic esophagec -tomy for the treatment of esophageal carcinoma .Methods Retrospective analyses were performed on chest com-bined with laparoscopy in the treatment of 20 patients with esophageal cancer information from september 2013 to July 2014 .The patients were placed at a left lateral decubitus position ,with the thoracoscopic mobilization of the intrathoracic esophagus and lymph node dissection;then in the lithotomy position .Laparoscopic mobilization of the stomach and lymph node dissection were cleared .Finally we pulled out the gastric tube from the esophageal bed to the neck and made stapled esophagogastrostomy in the left neck .Results All patients were not to be opened tho-racic surgery and abdominal surgery .The mean operation time for thoracoscopy was (90 ±30)minutes,The mean operation time for laparoscopic was(65 ±20)minutes,The total operation time was(210 ±40)minutes.The tho-racic blood loss ranged from 60 to 200 mL( mean,110 mL) ,The abdominal blood loss ranged from 30 to 100 mL (mean,60 mL).mean number of mediastinal lymph nodes resected was ranged from 8 to 15(11.2 per ease), mean number of abdominal lymph nodes resected was ranged from 6 to 12(8.4 per ease).Postoperative thoracic drainage was ranged from 200 to 650 mL( mean,350 mL) .mean time to resume oral intake was ranged from 6 to 8 days(mean,7 days),mean postoperative hospital stay was ranged from 11 to 14 days(mean,12 days),All the patients were diagnosis for esophageal squamous cell cancer after operation .Postoperative pathologicalcat staging identified stage T 1~3 N0~1 M0 .There was not tumor at the upper rejection margin and the lower margin .There was not anastomotic leak in postoperative .Postoperative lung infection in1 case.Postoperative recurrent laryngeal nerve injury in 1case.It was successfully followed up with durations 6 months.anastomotie stricture in 1 case after post-operative 3 months,And in endoscopic probe dilatation for patients with anastomotie stricture was successful in three times.20 cases were successfully followed up with durations ranged from 2 to 10 months.There was not spreaded and died in cases .Conclusion Combined thoracoscopic and laparoscopic esophagectomy can reduce trauma and postoperative complications ,which is safe and feasible therapeutic method .
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