【作者】 徐宝川；

【导师】 魏大中； 徐美青； 马冬春； 戎保林；

【作者基本信息】 安徽医科大学 ， 外科学， 2010， 硕士

【摘要】 目的与开胸食管癌根治术对比,探讨全胸腔镜(VATS)下食管癌根治术治疗Ⅰ、Ⅱ期食管癌的安全性和有效性。方法2007,9~2010,3通过VATS食管癌切除术治疗Ⅰ、Ⅱ期食管癌患者,其中男22例,女14例,中位年龄60.5岁(38~78),方法为胸腔镜下经右胸游离胸段食管及肿瘤,清扫胸腔内淋巴结,上腹部正中切口完成胃的游离及清扫腹腔内淋巴结,颈部切口完成食管癌切除胃食管颈部吻合术。并与同时期接受传统开胸手术治疗的36例患者进行对比分析,对比两组术前、术中、术后近期情况。结果36例患者胸部手术均通过胸腔镜完成,无中转开胸,发生吻合口瘘2例,乳糜胸2例,无院内死亡病例,效果满意。两组在年龄、性别分布、术前主要合并症等方面差异无统计学意义(P>0.05)。VATS组与开胸组相比,胸部手术时间(110.56±36.41)min对(133.33±22.55)min(P<0.05);术中出血(125.82±47.82)ml对(215.28±46.99)ml(P<0.001);淋巴结清扫数目(11.47±5.91)对(16.19±8.54)(P<0.05);术后第一天胸引量(274.44±127.13)ml对(456.11±184.43)ml(P<0.001);术后胸引管带管时间(6.53±1.87)d对(9.89±2.61)d(P<0.001);术后36小时疼痛VAS(3.36±0.96)对(6.81±1.72)(P<0.001);术后胸部引流总量(1094.2±405.6)ml对(1687.9±689.6)ml(P<0.001);术后72小时右上肢功能恢复(5.08±1.27)cm对(16.00±3.62)cm(P<0.001);住院总花费(2.97±0.81)万元对(2.78±0.76)万元(P>0.05)。结论两种术式在治疗Ⅰ、Ⅱ期食管癌具有相似的完全性和彻底性,电视胸腔镜食管切除术在技术上是安全可行的。VATS食管癌根治术较开胸食管癌根治术的胸部手术出血量少,术后胸引流量少,术后疼痛轻微,上肢活动恢复快。但是VATS临床应用有局限性,不能完全代替常规开胸手术,对手术操作难度大的病变或较大的肿瘤仍选择常规开胸手术为宜。胸腔镜食管癌切除术有其适应证,对医生提出更高的技术要求,目前仍有争议,全盘否定或盲目应用都会影响胸外科的发展。更多还原

【Abstract】 Objective To compare the results and safety between video-assisted thoracic surgery(VATS)radical operation and conventional thoractomy in patients with stageⅠ,Ⅱesophageal carcinoma. Methods From September 2007 to March 2010,video-assisted thoracoscopic esophagectomy was performed in 36 patients. There were 22 men , 14 women. Median age was 60.5 years ( range ,38 - 78) . Under thoracoscopy via thoracic and cervical incisions, the esophagus and tumor were disconnected and the intrathoracic lymph nodes were cleared through the right thorax. Then a median incision was made at the epigastrium. Through the incision the stomach was disconnected and intraabdominal lymph nodes were removed. Afterwards, esophagectomy and gastroesophagostomy were performed by way of the cervical incision. Retrospectively reviewed 72 patients with stageⅠ,Ⅱesophageal carcinoma underwent either VATS radical operation (VATS group,n=36) or standard radical operation via thoractomy (open group,n=36) . Patients’s operative characteristics and postoperative courses were comparable between two groups. Results The results were satisfactory and no operative mortality , anastomotic leak 2 case , chylothorax 2 case . The operative time was (110.56±36.41)min in the VATS group and (133.33±22.55)min in the open group(P<0.05);The number of mediastinal lymphonode resection was (11.47±5.91) and (16.19±8.54)(P<0.05);The time of postoperative chest tube was(6.53±1.87)d and(9.89±2.61)d(P<0.001);The postoperative pain(VAS) was (3.36±0.96) and(6.81±1.72)(P<0.001);The postoperative locomotor activity of right upper extremity was(5.08±1.27)cm and (16.00±3.62)cm(P<0.001). Conclusion Compare with thoractomy,VATS thoracic surgery for patients with stageⅠ,Ⅱesophageal carcinoma appears to be as effective but less morbid . Video-assisted thoracoscopic esophagectomy is technically feasible and safe. It has the potential to replace open esophagectomy in selected patients. However, the VATS can not fill the place of thoracotomy for its limitedness. Regular thoracotomy is preferable in cases of high risks or with larger tumor. Thoracoscope has its indications in treatment of the esophageus carcinoma. Strict requirement of the doctors thoracoscope skill must be performed. Dispute was exist in the use of thoracoscope. Total negation or blind application would holdback the development of thoracoscope surgery .更多还原