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目的总结胸腔镜下食管切除术治疗食管癌的初步体会。方法分析40例胸腔镜下食管切除术治疗食管癌的方法、手术并发症及近、远期疗效。结果胸腔镜下完成食管癌食管切除术40例,术中平均出血约220mL,清除淋巴结共计294枚,转移度15.3%;并发症发生率32.5%(13/40),全组无手术死亡。随访至2007年5月,失访2例,全组中位生存期51.0个月,1、2、3、4和5年累积生存率分别为89.5%、71.1%、63.2%、53.1%和43.8%。结论胸腔镜下可以满意地完成食管癌食管切除术及淋巴结清扫术。与传统剖胸食管切除术相比,该术式具有手术创伤小、手术出血少、术后疼痛轻等优点。但对病变外侵明显者应做充分术前分期评估并应慎重选用。
Objective To summarize the preliminary experience of thoracoscopic esophagectomy in the treatment of esophageal cancer. Methods 40 cases of thoracoscopic esophagectomy for the treatment of esophageal cancer, surgical complications and short-term, long-term efficacy. Results Thoracoscopic resection of esophagectomy in 40 cases, the average blood loss of about 220mL, remove a total of 294 lymph nodes, the transfer rate of 15.3%; complication rate of 32.5% (13/40), no mortality in the whole group. Followed up to May 2007, two cases were lost to follow-up. The overall median survival time was 51.0 months. The cumulative survival rates at 1, 2, 3, 4 and 5 years were 89.5%, 71.1%, 63.2%, 53.1% and 43.8 %. Conclusions Thoracoscopic surgery can satisfactorily complete esophagectomy and lymph node dissection. Compared with traditional thoracotomy, this procedure has the advantages of less trauma, less bleeding and less postoperative pain. However, the apparent invasion of lesions should be fully preoperative staging assessment and should be carefully selected.