摘要
目的探讨胸腔镜下食管、肺双原发癌同期手术的临床价值。方法回顾性分析2005年7月~2015年12月我科同期胸腔镜手术治疗食管、肺双原发癌17例资料。如术前肺部病灶活检明确诊断为癌,先行患侧胸腔镜肺楔形切除、肺段切除或肺叶切除术,再行右侧胸腔镜食管癌切除术。术前肺部病灶病理未明确者,先行患侧胸腔镜下肺楔形切除或肺段切除术,快速病理检查,病理结果为原位癌行肺段切除并淋巴结采样,病理结果提示浸润癌行肺叶切除、纵隔淋巴结清扫术,再行右侧胸腔镜食管癌切除术。结果 17例均完成同期手术,1例术后7天因肺栓塞死亡。术后颈部吻合口漏1例,声音嘶哑2例,肺部感染1例,均治愈。术后病理证实17例食管癌均为鳞癌;17例肺癌中腺癌13例,腺鳞癌3例,小细胞癌1例。术后随访死亡8例,生存时间12~36个月,平均33.6月;存活8例,随访12~60个月,平均45.6月。结论胸腔镜下同期手术治疗食管、肺双原发癌,围手术期治疗效果及预后较好,风险可承受,手术方式安全可行。
Objective To explore the clinical value of video-assisted thoracoscopic surgery(VATS)for coinstantaneous primary carcinoma of esophagus and lung.Methods A retrospective analysis was made on17cases of VATS for coinstantaneous primary carcinoma of esophagus and lung in our hospital from July2005to December2015.The surgical approach was chosen mainly based on the location of lung lesions and intraoperative frozen-section examinations.Generally,if the preoperative lung biopsies confirmed cancer,the surgical wedge resection,pulmonary segmentectomy or pulmonary lobectomy was performed firstly,and then thoracoscopic resection of esophageal carcinoma was carried out on the right side.When preoperative lung tumor pathology was not clear,thoracoscopic pulmonary wedge or segment resection was performed,and then according to the intraoperative rapid pathological examination,segment resection with lymph node biopsy for carcinoma in situ or lobectomy with mediastinal lymph node dissection for invasive carcinoma was conducted,followed by thoracoscopic radical surgery for esophageal carcinoma on the right side.Results The concurrent operation was accomplished in all the17cases.One patient died of pulmonary embolism on the7th day.The complications contained1case of anastomotic leakage,2cases of hoarseness,and1case of lung infection,all of which were cured.Postoperative pathology results showed that17cases of esophageal cancer were all squamous cell carcinoma,and among the17cases of lung cancer there were13cases of adenocarcinoma,3cases of adenosquamous carcinoma,and1case of small cell carcinoma.Eight patients died in the period from12to36months,with a mean survival time of33.6months.The other8patients were followed up for12-60months(mean,45.6months).Conclusions Concurrent video-thoracoscopic surgery in the treatment of esophageal carcinoma complicated with pulmonary cancer has a good perioperative treatment effect prognosis and acceptable risks.The surgical method is safe and feasible.
作者
耿国军
于修义
米彦军
刘鸿鸣
马杰
李宁
王军
尹攀
汪亮亮
姜杰
Geng Guojun;Yu Xiuyi;Mi Yanjun(Department of Thoracic Surgery,First Hospital Affiliated to Xiamen University, Xiamen 361003 , China)
出处
《中国微创外科杂志》
CSCD
北大核心
2018年第3期213-216,共4页
Chinese Journal of Minimally Invasive Surgery
基金
福建省自然科学基金科技项目(2015J01546)
福建省自然科学基金重点项目(2014D020)
福建省自然科学基金科技项目(2016J01636)
厦门市科技局项目(3502z20159013)
关键词
胸腔镜
食管癌
肺癌
双原发癌
Thoracoscope
Esophageal cancer
Lung cancer
Coinstantaneous primary carcinoma
