摘要
目的总结探讨经颈腹双单孔微创食管癌根治术的疗效及安全性分析。方法回顾性收集2021年1月至2022年10月福建医科大学附属第一医院收治的28例接受经颈腹双单孔微创食管癌根治术患者的临床和病理资料,男18例,女10例,年龄58~80(72±4)岁。所有患者取平卧位,先行单孔经颈纵隔操作部分,再行单孔腹腔操作部分,最后颈部吻合。观察患者的手术时间、术中出血量、术后下床活动时间、术后引流管拔除时间、术后近期并发症、术后病理学检查结果、术后出院时间并进行随访。结果28例患者中,有26例患者顺利完成行经颈腹双单孔微创食管癌根治术,有2例因渗血导致视野不清,中转经右侧胸腔镜手术,无中转开腹或扩大切口。手术时间125~215(152±32)min,其中纵隔部分时间43~100(56±15)min,腹腔部分时间35~63(40±5)min。术中出血量55~100(45±20)ml;纵隔清扫淋巴结数目8~14(11±3)枚,腹腔清扫淋巴结数目7~15(9±3)枚。28例患者均于术后第1~2天下床活动。患者术后2 d拔除左颈引流管。全组无吻合口瘘、吻合口狭窄、肺部感染、乳糜胸、胃排空障碍并发症发生。2例出现胸腔积液,均为术中胸膜破损者,术后予以穿刺引流后治愈;2例出现声音嘶哑,1例进食呛咳,均顺利进食流质后出院。术后住院时间[M(Q_(1),Q_(3))]为7(6,9)d。全组患者术后病理学检查结果均为鳞癌,术后病理分期为pT1~3N0~1M0期。术后随访时间[M(Q_(1),Q_(3))]为25(5,35)个月,随访期间无并发症发生,无复发转移及死亡。结论经颈腹双单孔微创食管癌根治术安全可行,近期疗效较好,为高龄、心肺功能差、胸腔条件不足患者提供了手术根治机会。
Objective To summarize the efficacy and safety of minimally invasive esophagectomy through cervical and abdominal double single-port.Methods A total of 28 patients who underwent cervical and abdominal double single-port minimally invasive radical resection of esophageal cancer from January 2021 to October 2022 in the First Affiliated Hospital of Fujian Medical University were retrospectively collected,including 18 males and 10 females,aged 58-80(72±4)years.All patients were placed in the supine position,the single port was operated through the cervical mediastinum first,then the single port was operated through the abdominal cavity,and finally the neck was anastomosed.The operative time,intraoperative blood loss,postoperative ambulation time,postoperative drainage tube removal time,postoperative complications,postoperative pathological examination results,postoperative discharge time of patients were recorded and followed.Results In the included 28 patients,there were twenty-six patients successfully completed the cervical and abdominal double single-port minimally invasive radical resection of esophageal cancer,and two patients were transferred to the right thoracoscopic surgery due to oozing of blood and unclear visual field,without conversion to laparotomy or enlargement of the incision occurred.The operation time was 125 to 215(152±32)minutes,including 43 to 100(56±15)minutes in the mediastinum and 35 to 63(40±5)minutes in the abdominal cavity.Intra-operative blood loss was 55-100(45±20)ml.There were 8 to 14(11±3)lymph nodes dissected in the mediastinum and 7 to 15(9±3)lymph nodes dissected in the abdominal cavity.Twenty-eight patients were active in bed 1 to 2 days after surgery.The left cervical drainage tube was removed 2 days after surgery.There was no anastomotic fistula,anastomotic stenosis,pulmonary infection,chylothorax and stomach emptying disorder in the whole group.Pleural effusion occurred in 4 cases,all of them had pleural damage during the operation,and were cured after postoperative punc
作者
刘波
邱明链
罗荣刚
谢锦宝
李旭
Liu Bo;Qiu Minglian;Luo Ronggang;Xie Jinbao;Li Xu(Department of Thoracic Surgery,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2023年第23期1767-1773,共7页
National Medical Journal of China
基金
福建省自然科学基金(2020J01953)
福建省财政专项经费(BPB-2022LB)
福建省高校产学合作项目(2020Y4008)
关键词
食管肿瘤
单孔充气式纵隔镜
单孔腹腔镜
微创手术
横断面研究
Esophageal neoplasms
Single-port inflatable mediastinoscopy
Single-port laparoscopy
Minimally invasive surgery
Cross-sectional study
