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目的总结主动脉弓水平食管癌颈、胸、腹常规三切口及电视胸腹腔镜辅助下完成肿瘤切除及消化道重建的外科治疗方法。方法 20例主动脉弓水平食管鳞癌患者,术前经内镜及组织病理检查确诊,并经胸部CT检查证实肿瘤与主动脉弓及奇静脉关系密切,选择经常规颈、胸、腹三切口或在电视胸腹腔镜辅助下完成食管癌根治及消化道重建。结果 17例常规颈、胸、腹三切口完成手术,3例在电视胸腹腔镜辅助下完成手术;无围手术期死亡病例;常规三切口手术患者发生颈部吻合口瘘4例,胃不全梗阻2例,胃瘫1例,均经对症治疗痊愈;胸腹腔镜辅助下手术患者术后恢复良好,无明确并发症发生。结论对主动脉弓水平食管癌,经颈、胸、腹三切口手术切除肿瘤及消化道重建术安全、疗效确切,电视胸腹腔镜辅助下完成该类手术具有创伤小、恢复快等优势。
Objective To summarize the methods of surgical treatment of tumor resection and digestive tract reconstruction with the assistance of thoracoscopic and laparoscopic cervical, thoracic and abdominal conventional triple incision in aortic arch horizontal esophageal cancer. Methods Twenty patients with esophageal squamous carcinoma of the aortic arch were diagnosed by endoscopy and histopathology before operation. Thoracic CT examination confirmed the close relationship between the tumor and aortic arch and azygous vein. Laparoscopic assisted radical esophageal cancer and gastrointestinal reconstruction. Results 17 cases of conventional neck, thoracic and abdominal incision to complete the operation in 3 cases under the help of the television thoracoscopic laparoscopic surgery; no perioperative deaths; conventional triple incision occurred in patients with neck anastomotic fistula in 4 cases, incomplete gastric obstruction 2 cases, stomach paralysis in 1 case, were cured by symptomatic treatment; thoracoscopic laparoscopic assisted surgery in patients with good recovery, no clear complication. Conclusion It is safe and effective to resect the tumor and digestive tract reconstruction in the aortic arch with horizontal esophageal carcinoma through the thoracic, thoracic and abdominal incision. The operation of the thoracoscopic and laparoscopic assisted thoracoscopy has the advantages of less trauma and faster recovery.