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目的探讨电视胸腔镜(VATS)下微创手术治疗食管癌的适应证及操作特点。方法对36例食管癌胸腔镜下经右胸游离食管、肿瘤,清扫淋巴结,经上腹切口游离胃,并经胸骨后上提,行左颈食管胃吻合。结果成功完成30例VATS下食管癌切除手术,6例VATS辅助小切口完成手术。手术时间160~270 min,胸部操作时间60~90 min,术中出血300~400 mL,无手术死亡。术后吻合口瘘2例,吻合口狭窄1例,喉返神经损伤1例;平均住院时间12(10~14)d。结论VATS下微创手术治疗食管癌,手术创伤明显减轻,为高龄、肺功能差的患者增加了手术机会,也为早期食管癌患者缩短了术后恢复时间。
Objective To investigate the indications and operating characteristics of minimally invasive surgery for esophageal cancer under VATS. Methods Thirty-six patients with esophageal cancer underwent thoracoscopic esophageal esophagectomy via the right thoracic esophagus, tumor and lymph node dissection. Results Successful resection of esophagectomy under VATS was achieved in 30 cases, and VATS assisted small incision in 6 cases completed the operation. The operation time was 160-270 minutes, the operation time of the chest was 60-90 minutes, and the intraoperative blood loss was 300-400 mL. There was no operative death. Anastomotic fistula in 2 cases, anastomotic stenosis in 1 case, recurrent laryngeal nerve injury in 1 case; average length of stay 12 (10 ~ 14) d. Conclusions Minimally invasive surgical treatment of esophageal cancer under VATS significantly reduces the surgical trauma and increases the chances of surgery for elderly patients with poor pulmonary function. It also shortens the postoperative recovery time for patients with early esophageal cancer.