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目的:总结胸、腹腔镜联合微创治疗食管癌的临床经验。方法:回顾分析2007年8月至2010年4月为91例患者行胸、腹腔镜微创食管癌切除术的临床资料,其中食管上段癌16例,中段47例,下段28例。结果:本组手术均获成功。手术时间180~330min,平均260.4min,胸腔镜时间50~125min,腹腔镜时间38~90min;术中出血190~450ml,平均222.5ml,其中腹腔出血10~120ml,平均40.5ml;清扫淋巴结5~42枚,平均15.8枚,其中纵隔淋巴结11.2枚,腹腔淋巴结4.6枚;术后第1天开始行肠内营养或肠内营养加肠外营养,术后第7天进流食,术后第9天进软食。术后1例发生呼吸衰竭,5例喉返神经损伤,1例管状胃瘘合并左侧支气管瘘,4例吻合口漏,2例乳糜胸。随访2~35个月,6例吻合口狭窄,6例复发转移,7例死亡。结论:胸、腹腔镜联合微创治疗食管癌在技术上安全可行,值得推广应用。
Objective: To summarize the clinical experience of thoracic and laparoscopic combined with minimally invasive treatment of esophageal cancer. Methods: From August 2007 to April 2010, 91 patients underwent thoracoscopic and minimally invasive esophagectomy for esophagectomy. Among them, 16 were upper esophagus, 47 were middle and 28 were lower. Results: This group of operations were successful. The operative time was 180-330 minutes with an average of 260.4 minutes, the time of laparoscopy was 50-125 minutes and the laparoscopic time was 38-90 minutes. The intraoperative bleeding ranged from 190-450ml with an average of 222.5ml, of which 10-120ml had intraperitoneal hemorrhage with an average of 40.5ml. 42, an average of 15.8, of which 11.2 were mediastinal lymph nodes, abdominal lymph nodes 4.6; 1 day after the beginning of enteral nutrition or enteral nutrition plus parenteral nutrition, after 7 days into the stream of food, 9 days after surgery Into soft food. Postoperative respiratory failure occurred in 1 case, 5 cases of recurrent laryngeal nerve injury, 1 case of tubular fistula with left bronchial fistula, 4 cases of anastomotic leakage, 2 cases of chylothorax. The patients were followed up for 2 to 35 months. Six patients had anastomotic stenosis, 6 patients had recurrence and 7 patients died. Conclusions: Thoracic and laparoscopic combined with minimally invasive treatment of esophageal cancer is technically safe and feasible, which is worth popularizing and applying.