论著 Original Article

单操作孔胸腔镜在全腔镜食管癌根治胸内吻合术中的应用评估

Published at: 2014年第34卷第6期

马晓 1,2 , 郭威 1,2 , 李鹤成 1,2 , 马龙飞 1,2 , 张裔良 1,2 , 张亚伟 1,2 , 相加庆 1,2
1 复旦大学附属肿瘤医院胸外科,上海 200032
2 复旦大学上海医学院肿瘤学系,上海 200032
通讯作者 鹤成 李 Email: lihecheng2000@hotmail.com
DOI: 10.3978/j.issn.2095-6959.10.3978/j.issn.2095-6959.2014.06.021
基金:
上海市科技启明星跟踪计划 11QH1400600
国家自然科学基金资助项目 81272608

摘要

目的:评估单操作孔胸腔镜在全腔镜食管癌根治胸内吻合术中(Ivor-Lewis手术)(totally minimally invasive Ivor-Lewis esophagectomy,MIIE)的安全性和可行性。方法:自2013年2月至2014年02月前 瞻性的连续收集接受MIIE的48例中下胸段食管鳞癌的患者,病例分为两组,四孔胸腔镜组36例, 单操作孔胸腔镜组12例。比较了两组围手术期的相关指标,包括:转为开放手术的例数,平均手 术时间,平均术中出血,术中输血,平均术后住院时间,术后平均ICU时间,胸部平均清扫淋巴 结数,腹部平均清扫淋巴结数,术后并发症,围手术期的死亡率及病理分期。结果:两组均顺利 完成手术,围手术期无死亡病例,四孔胸腔镜组有1例中转开腹,平均手术时间264 min,而单操 作孔胸腔镜组平均手术时间275 min,两组比较差异无统计学意义(P=0.226);四孔胸腔镜组平均术 中出血205 mL,单操作孔胸腔镜组平均术中出血220 mL,两组差异无统计学意义(P=0.403),两组 均无术后输血。两组术后并发症比较差异无统计学意义(P=0.659)。四孔胸腔镜组胸部平均淋巴结 清扫数与单操作孔胸腔镜组相比,差异无统计学意义(P=0.256),四孔胸腔镜组腹部平均淋巴结清 扫数与单操作孔胸腔镜组相比,两组差异均无统计学意义(P=0.840)。结论:单操作孔胸腔镜食管 癌根治胸内吻合术对于治疗中下段胸段食管鳞癌是可行和安全的,手术创伤小,近期效果满意, 值得在临床推广。


The evaluation of totally minimally invasive Ivor-Lewis esophagectomy with single-utility incision video-assisted thoracoscopic surgery

Abstract

Objective: To evaluate the safety and availability of totally minimally invasive Ivor-Lewis esophagectomy (MIIE) with single-utility incision video-assisted thoracoscopic surgery. Methods: Forty-eight patients with middlelower thoracic esophageal cancer were prospectively treatment with MIIE from February 2013 to February 2014 at Fudan University Shanghai Cancer Center, the first 36 patients who were treated with esophagectomy by four-port VATS, while the others were treated with single-utility incision VATS. Clinicopathological parameters were examined, including conversion to open, average operative duration, average operative blood loss, blood transfusion, postoperative hospital stay, postoperative ICU stay, average thoracic lymph node yield, average abdominal lymph node yield postoperative morbidity, pathological staging and operative complications. Results: The operations were carried out successfully in two groups, there was no perioperative death in all patients. There was no statistical difference in the case number of conversion to open, average operative duration, average operative blood loss, blood transfusion, postoperative hospital stay, postoperative ICU stay, average thoracic lymph node yield, average abdominal lymph node yield postoperative morbidity, pathological staging and operative complications between the two groups. Conclusion: MIIE with single-utility incision video-assisted thoracoscopic surgery is technically feasible and safe in patients with mid-lower thoracic esophageal cancer with minimized trauma. The recent result is satisfactory.


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引用

引用本文: 晓 马, 威 郭, 鹤成 李, 龙飞 马, 裔良 张, 亚伟 张, 加庆 相. 单操作孔胸腔镜在全腔镜食管癌根治胸内吻合术中的应用评估[J]. 临床与病理杂志, 2014, 34(6): 743-747.
Cite this article as: MA Xiao, GUO Wei, LI Hecheng, MA Longfei, ZHANG Yiliang, ZHANG Yawei, XIANG Jiaqing . The evaluation of totally minimally invasive Ivor-Lewis esophagectomy with single-utility incision video-assisted thoracoscopic surgery[J]. Journal of Clinical and Pathological Research, 2014, 34(6): 743-747.