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电视胸腔镜食管切除术是治疗食管癌的一种新的手术方法 ,该方法在食管外科中的地位仍在争论之中。作者自 2 0 0 0年 5月至 2 0 0 2年 5月开展了 9例食管癌胸腔镜食管切除术。其中男 7例 ,女 2例 ;年龄 42～ 5 6岁 ,平均 5 1岁 ;颈段肿瘤 1例 ,上胸段 2例 ,中胸段 5例 ,下胸段 1例 ;病理均为鳞状细胞癌 ,分期为II期以下。 1例因肿瘤外侵粘连重 ,术中中转为开胸手术 ,8例顺利行胸腔镜食管切除及胃食管颈部吻合术。胸腔镜游离食管时间平均 70min(4 0～ 12 0min) ,总手术时间平均 2 5 2min(2 3 0～ 2 70min) ,术中平均出血量为 2 5 0ml(15 0～ 40 0ml) ,平均摘除胸部淋巴结 7个 (5～ 12个 )。术后并发喉返神经损伤 1例 ;颈部切口感染 1例 ,经保守治疗后痊愈。结果提示 ,胸腔镜食管切除术安全可行 ,近期结果与开胸术相当 ,远期结果及其在食管外科中的地位有待于进一步证实和探讨。
Video-assisted thoracoscopic esophagectomy is a new surgical method for the treatment of esophageal cancer. The status of this method in esophageal surgery is still in dispute. The authors conducted thoracoscopic esophagectomy for esophageal cancer from May 2000 to May 2002. 7 males and 2 females; aged 42-56 years old, average 51 years old; cervical tumor in 1 case, upper thoracic 2 cases, 5 cases in the middle thoracic, 1 case in the lower thoracic; pathological squamous Cell cancer is staged below stage II. In 1 case, due to extravasation of the tumor, the patient was transferred to a thoracotomy, and 8 patients underwent thoracoscopic esophagectomy and gastroesophageal neck anastomosis. The average time of free esophageal thoracoscopy was 70 minutes (40 to 120 minutes), the average operation time was 252 minutes (230 to 270 minutes), and the average intraoperative blood loss was 250 ml (150 to 400 ml). Chest lymph nodes were 7 (5-12). After operation, there was 1 case of recurrent laryngeal nerve injury and 1 case of neck incision infection. He recovered after conservative treatment. The results suggest that thoracoscopic esophagectomy is safe and feasible. The recent results are comparable to open chest surgery. The long-term outcome and its status in esophageal surgery need to be further confirmed and discussed.