目的 評價胸腹腔鏡聯(lián)合食管切除、食管胃胸內(nèi)吻合術治療食管癌新術式的可行性及安全性?!》椒ā』仡櫺詫φ辗治?010年3月至2012年3月首都醫(yī)科大學附屬北京朝陽醫(yī)院收治食管癌患者40例的臨床資料,按照手術方式不同分為兩組,采用胸腹腔鏡聯(lián)合食管切除食管胃胸內(nèi)吻合術22例(腔鏡手術組),同期經(jīng)右胸腹食管癌切除術18例(開放手術組)。對比兩組患者的手術時間、術中出血量、淋巴結清掃情況、術后并發(fā)癥發(fā)生率、住院時間及住院費用等。?結果?腔鏡手術組住院總費用較開放手術組顯著增高 [(78 181.5±8 958.8) 元 vs. (61 717.2±35 159.4)元,Z=4.078,P=0.000];腔鏡手術組與開放手術組手術時間[(292.0±74.8) min vs. (256.1±41.0) min,t=1.838,P=0.074],術中出血量[(447.7±597.0) ml vs. (305.6±125.9) ml,Z=0.401,P=0.688)], 淋巴結清掃總數(shù)(230枚vs. 215枚,t=1.714,P=0.095),術后并發(fā)癥發(fā)生率 [22.7% (5/22) vs. 33.3% (6/18),χ2=0.559,P=0.498],術后恢復進食時間 [(8.5±3.5) d vs. (11.1±9.6)d ,t=1.202,P=0.237],術后住院時間 [(11.6±5.7) d vs. (13.3±9.4) d,t=0.680, P=0.501] 等差異無統(tǒng)計學意義。腔鏡手術組按開展該手術時間先后分為早期10例和后期12例,做分層分析,后期患者手術時間較早期患者顯著縮短[(262.9±64.9)min vs. (327.5±73.0) min,t=2.197,P=0.040],與開放手術組差異無統(tǒng)計學意義 [(262.9±64.9)min vs. (256.1±41.0) min,t=0.353,P=0.727]?。后期患者術中出血量也較早期患者顯著減少 [(220.8±149.9) ml vs. (720.0±808.0) ml,Z=3.279,P=0.001)],與開放組相比也為少 [(220.8±149.9) ml vs. (305.6±125.9) ml,Z=2.089, P=0.037]。 結論 胸腹腔鏡聯(lián)合食管切除食管胃胸內(nèi)吻合術應用于食管癌治療安全有效。
引用本文: 游賓,李輝,侯生才,胡濱. 胸腹腔鏡聯(lián)合食管癌切除食管胃胸內(nèi)吻合術的初步臨床應用. 中國胸心血管外科臨床雜志, 2012, 19(6): 624-628. doi: 復制
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2. | Hoppo T, Jobe BA, Hunter JG. Minimally invasive esophagectomy:the evolution and technique of minimally invasive surgery for esophageal cancer. World J Surg, 2011, 35 (7):1454-1463. |
3. | Allen MS. Ivor Lewis esophagectomy. Semin Thorac Cardiovasc Surg, 1992, 4 (4):320-323. |
4. | Bains MS. Ivor Lewis esophagectomy. Chest Surg Clin N Am, 1995, 5 (3):515-526. |
5. | Marangoni G, Villa F, Shamil E, et al. OrVilTM-assisted anastomosis in laparoscopic upper gastrointestinal surgery:friend of the laparoscopic surgeon. Surg Endosc, 2012, 26 (3):811-817. |
6. | Campos GM, Jablons D, Brown LM, et al. A safe and reproducible anastomotic technique for minimally invasive Ivor Lewis oesophagectomy:the circular-stapled anastomosis with the trans-oral anvil. Eur J Cardiothorac Surg, 2010, 37 (6):1421-1426. |
7. | Jaroszewski DE, Williams DG, Fleischer DE, et al. An early experience using the technique of transoral OrVil EEA stapler for minimally invasive transthoracic esophagectomy. Ann Thorac Surg, 2011, 92 (5):1862-1869. |
8. | Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy:review of over 1000 patients. Ann Surg, 2012, 256 (1):95-103. |
9. | Berger AC, Bloomenthal A, Weksler B, et al. Oncologic efficacy is not compromised, and may be improved with minimally invasive esophagectomy. J Am Coll Surg, 2011, 212 (4):560-566. |
10. | Li H, Hu B, You B, et al. Completely minimally invasive Ivor Lewis esophagectomy:the preliminary experience of circular-stapled anastomosis with the trans-oral anvil. Zhonghua Wai Ke Za Zhi, 2010, 48 (22):1747-1750. |
11. | Ben-David K, Sarosi GA, Cendan JC, et al. Technique of minimally invasive Ivor Lewis esophagogastrectomy with intrathoracic stapled side-to-side anastomosis. J Gastrointest Surg, 2010, 14 (10):1613-1618. |
12. | Bonavina L, Laface L, Abate E, et al. Comparison of ventilation and cardiovascular parameters between prone thoracoscopic and Ivor Lewis esophagectomy. Updates Surg, 2012, 64 (2):81-85. |
13. | Bakhos CT, Fabian T, Oyasiji TO, et al. Impact of the surgical technique on pulmonary morbidity after esophagectomy. Ann Thorac Surg, 2012, 93 (1):221-226. |
14. | Atkins BZ, Shah AS, Hutcheson KA, et al. Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg, 2004, 78 (4):1170 -1176 . |
15. | Pham TH, Perry KA, Dolan JP, et al. Comparison of perioperative outcomes after combined thoracoscopic-laparoscopic esophagectomy and open Ivor-Lewis esophagectomy. Am J Surg, 2010, 199 (5):594-598. |
16. | Hamouda AH, Forshaw MJ, Tsigritis K, et al. Perioperative outcomes after transition from conventional to minimally invasive Ivor-Lewis esophagectomy in a specialized center. Surg Endosc, 2010, 24 (4):865-869. |
17. | Kinjo Y, Kurita N, Nakamura F, et al. Effectiveness of combined thoracoscopic-laparoscopic esophagectomy:comparison of postoperative complications and midterm oncological outcomes in patients with esophageal cancer. Surg Endosc, 2012, 26 (2):381-390. |
- 1. Maas KW, Biere SS, Scheepers JJ, et al. Minimally invasive intrathoracic anastomosis after Ivor Lewis esophagectomy for cancer:a review of transoral or transthoracic use of staplers. Surg Endosc, 2012, 26 (7):1795-1802.
- 2. Hoppo T, Jobe BA, Hunter JG. Minimally invasive esophagectomy:the evolution and technique of minimally invasive surgery for esophageal cancer. World J Surg, 2011, 35 (7):1454-1463.
- 3. Allen MS. Ivor Lewis esophagectomy. Semin Thorac Cardiovasc Surg, 1992, 4 (4):320-323.
- 4. Bains MS. Ivor Lewis esophagectomy. Chest Surg Clin N Am, 1995, 5 (3):515-526.
- 5. Marangoni G, Villa F, Shamil E, et al. OrVilTM-assisted anastomosis in laparoscopic upper gastrointestinal surgery:friend of the laparoscopic surgeon. Surg Endosc, 2012, 26 (3):811-817.
- 6. Campos GM, Jablons D, Brown LM, et al. A safe and reproducible anastomotic technique for minimally invasive Ivor Lewis oesophagectomy:the circular-stapled anastomosis with the trans-oral anvil. Eur J Cardiothorac Surg, 2010, 37 (6):1421-1426.
- 7. Jaroszewski DE, Williams DG, Fleischer DE, et al. An early experience using the technique of transoral OrVil EEA stapler for minimally invasive transthoracic esophagectomy. Ann Thorac Surg, 2011, 92 (5):1862-1869.
- 8. Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy:review of over 1000 patients. Ann Surg, 2012, 256 (1):95-103.
- 9. Berger AC, Bloomenthal A, Weksler B, et al. Oncologic efficacy is not compromised, and may be improved with minimally invasive esophagectomy. J Am Coll Surg, 2011, 212 (4):560-566.
- 10. Li H, Hu B, You B, et al. Completely minimally invasive Ivor Lewis esophagectomy:the preliminary experience of circular-stapled anastomosis with the trans-oral anvil. Zhonghua Wai Ke Za Zhi, 2010, 48 (22):1747-1750.
- 11. Ben-David K, Sarosi GA, Cendan JC, et al. Technique of minimally invasive Ivor Lewis esophagogastrectomy with intrathoracic stapled side-to-side anastomosis. J Gastrointest Surg, 2010, 14 (10):1613-1618.
- 12. Bonavina L, Laface L, Abate E, et al. Comparison of ventilation and cardiovascular parameters between prone thoracoscopic and Ivor Lewis esophagectomy. Updates Surg, 2012, 64 (2):81-85.
- 13. Bakhos CT, Fabian T, Oyasiji TO, et al. Impact of the surgical technique on pulmonary morbidity after esophagectomy. Ann Thorac Surg, 2012, 93 (1):221-226.
- 14. Atkins BZ, Shah AS, Hutcheson KA, et al. Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg, 2004, 78 (4):1170 -1176 .
- 15. Pham TH, Perry KA, Dolan JP, et al. Comparison of perioperative outcomes after combined thoracoscopic-laparoscopic esophagectomy and open Ivor-Lewis esophagectomy. Am J Surg, 2010, 199 (5):594-598.
- 16. Hamouda AH, Forshaw MJ, Tsigritis K, et al. Perioperative outcomes after transition from conventional to minimally invasive Ivor-Lewis esophagectomy in a specialized center. Surg Endosc, 2010, 24 (4):865-869.
- 17. Kinjo Y, Kurita N, Nakamura F, et al. Effectiveness of combined thoracoscopic-laparoscopic esophagectomy:comparison of postoperative complications and midterm oncological outcomes in patients with esophageal cancer. Surg Endosc, 2012, 26 (2):381-390.