• 南京醫(yī)科大學(xué)第一附屬醫(yī)院 心胸外科,南京 210029;

目的 探討非開胸食管內(nèi)翻拔脫術(shù)治療食管癌的適應(yīng)證、手術(shù)技巧及并發(fā)癥處理?!》椒ā』仡櫺苑治?002年7月至2010年7月南京醫(yī)科大學(xué)第一附屬醫(yī)院105例食管癌患者行食管內(nèi)翻拔脫術(shù)(其中28例輔助使用電視縱隔鏡)的臨床資料,其中男59例,女46例;年齡63 (48~81)歲。食管上段癌51例,中段癌18例,下段癌36例;分析手術(shù)效果和安全性?!〗Y(jié)果 手術(shù)時(shí)間153 (140~210) min,術(shù)中出血量150 (100~250) ml,住院時(shí)間15 (10~35) d。全組無手術(shù)死亡,殘端未見腫瘤細(xì)胞殘留。27例術(shù)后發(fā)生并發(fā)癥,其中3例吻合口瘺,4例喉返神經(jīng)損傷,5例胸腔積液,2例氣胸,3例合并肺部感染,3例心律失常,1例乳糜胸,2例切口感染,2例胃排空障礙,2例吻合口狹窄,經(jīng)治療后均痊愈。術(shù)后隨訪16個(gè)月~5年,隨訪97例,失訪8例,已生存1年以上患者94例,生存3年以上67例,生存5年以上34例,部分患者待進(jìn)一步隨訪。 結(jié)論 食管內(nèi)翻拔脫術(shù)損傷小、恢復(fù)快,可使不能耐受經(jīng)胸或不宜經(jīng)胸手術(shù)的Ⅱ期及更早的食管癌患者獲益。

引用本文: 翁文俊,張石江,邵永豐,章斌. 非開胸食管內(nèi)翻拔脫術(shù)治療食管癌105例. 中國胸心血管外科臨床雜志, 2013, 20(1): 59-62. doi: 復(fù)制

1.  曹秀峰, 肖建, 王山, 等. 食管內(nèi)翻拔脫術(shù)治療食管癌71例體會(huì). 臨床腫瘤學(xué)雜志, 2007, 12 (6):441-444.
2.  毛友生, 赫捷, 程貴余. 我國食管癌外科治療的現(xiàn)狀與未來對(duì)策. 中華腫瘤雜志, 2010, 32 (6):401-404.
3.  郭偉, 王如文, 蔣耀光. 食管切除術(shù)圍手術(shù)期處理進(jìn)展. 中國胸心血管外科臨床雜志, 2010, 17 (2):145-149.
4.  D'journo XB, Michelet P, Avaro JP, et al. Respiratory complications after oesophagectomy for cancer. Rev Mal Respir, 2008, 25 (6):683-694.
5.  Barreto JC, Posner MC. Transhiatal versus transthoracic esophagectomy for esophageal cancer. World J Gastroenterol, 2010, 16 (30):3804-3810.
6.  李軼川, 伍佇, 蔣良雙, 等. 食管內(nèi)翻拔脫術(shù)治療食管癌46例. 中國胸心血管外科臨床雜志, 2007, 14 (6):480-480.
7.  Venissac N, Pop D, Mouroux J. Video-assisted mediastinoscopy as a therapeutic tool. Surg Endosc, 2009, 23 (11):2466-2472.
8.  Pop D, Venissac N, Mouroux J. Video-assisted mediastinoscopy improved radical resection for cancer in transhiatal esophagectomy. J Thorac Cardiovasc Surg, 2007, 133 (1):267-268.
9.  Mimatsu K, Oida T, Kawasaki A, et al. Mediastinoscopy-assisted esophagectomy is useful technique for poor surgical-risk patients with thoracic esophageal cancer. Surg Laparosc Endosc Percutan Tech, 2009, 19 (1):e17-e20.
10.  譚黎杰, 徐正浪, 仇德惠, 等. 電視縱隔鏡輔助食管切除術(shù)安全性探討. 中國微創(chuàng)外科雜志, 2003, 3 (5):406-407.
11.  王中林, 張蕾, 陸一民, 等. 電視縱隔鏡手術(shù)治療早期食管癌89例報(bào)告. 中國微創(chuàng)外科雜志, 2010, 10 (3):262-263.
12.  王志恒, 林若柏. 電視縱隔鏡檢查的臨床應(yīng)用. 國際外科學(xué)雜志, 2008, 35 (3):189-191.
13.  邵豐, 蘇宜江, 許棟生, 等. 電視縱隔鏡手術(shù)診治胸部疾病36例. 中國胸心血管外科臨床雜志, 2009, 16 (1):76-78.
14.  吳彬, 徐志飛, 仇明, 等. 縱隔鏡下食管癌切除. 中華消化外科雜志, 2007, 6 (6):407-409.
15.  Turkyilmaz A, Eroglu A, Aydin Y, et al. The management of  esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma. Dis Esophagus, 2009, 22 (2):119-126.
16.  Delgado Gomis F, Gómez Abril SA, Martínez Abad M, et al. Assisted  laparoscopic transhiatal esophagectomy for the treatment of esophageal cancer. Clin Transl Oncol, 2006, 8 (3):185-192.
17.  Tabatabai A, Hashemi M, Mohajeri G, et al. Incidence and risk factors  predisposing anastomotic leak after transhiatal esophagectomy. Ann Thorac Med, 2009, 4 (4):197-200.
18.  Colvin H, Dunning J, Khan OA. Transthoracic versus transhiatal  esophagectomy for distal esophageal cancer:which is superior ? Inte ract Cardiovasc Thorac Surg, 2011, 12 (2):265-269.
19.  Homesh NA, Alsabahi AA, Al-Agmar MH, et al. Transhiatal versus transthoracic resection for oesophageal carcinoma in Yemen. Singapore Med J, 2006, 47 (1):54-59.
20.  Boshier PR, Anderson O, Hanna GB. Transthoracic versus transhiatal esophagectomy for the treatment of esophagogastric cancer:a meta-analysis. Ann Surg, 2011, 254 (6):894-906.
  1. 1.  曹秀峰, 肖建, 王山, 等. 食管內(nèi)翻拔脫術(shù)治療食管癌71例體會(huì). 臨床腫瘤學(xué)雜志, 2007, 12 (6):441-444.
  2. 2.  毛友生, 赫捷, 程貴余. 我國食管癌外科治療的現(xiàn)狀與未來對(duì)策. 中華腫瘤雜志, 2010, 32 (6):401-404.
  3. 3.  郭偉, 王如文, 蔣耀光. 食管切除術(shù)圍手術(shù)期處理進(jìn)展. 中國胸心血管外科臨床雜志, 2010, 17 (2):145-149.
  4. 4.  D'journo XB, Michelet P, Avaro JP, et al. Respiratory complications after oesophagectomy for cancer. Rev Mal Respir, 2008, 25 (6):683-694.
  5. 5.  Barreto JC, Posner MC. Transhiatal versus transthoracic esophagectomy for esophageal cancer. World J Gastroenterol, 2010, 16 (30):3804-3810.
  6. 6.  李軼川, 伍佇, 蔣良雙, 等. 食管內(nèi)翻拔脫術(shù)治療食管癌46例. 中國胸心血管外科臨床雜志, 2007, 14 (6):480-480.
  7. 7.  Venissac N, Pop D, Mouroux J. Video-assisted mediastinoscopy as a therapeutic tool. Surg Endosc, 2009, 23 (11):2466-2472.
  8. 8.  Pop D, Venissac N, Mouroux J. Video-assisted mediastinoscopy improved radical resection for cancer in transhiatal esophagectomy. J Thorac Cardiovasc Surg, 2007, 133 (1):267-268.
  9. 9.  Mimatsu K, Oida T, Kawasaki A, et al. Mediastinoscopy-assisted esophagectomy is useful technique for poor surgical-risk patients with thoracic esophageal cancer. Surg Laparosc Endosc Percutan Tech, 2009, 19 (1):e17-e20.
  10. 10.  譚黎杰, 徐正浪, 仇德惠, 等. 電視縱隔鏡輔助食管切除術(shù)安全性探討. 中國微創(chuàng)外科雜志, 2003, 3 (5):406-407.
  11. 11.  王中林, 張蕾, 陸一民, 等. 電視縱隔鏡手術(shù)治療早期食管癌89例報(bào)告. 中國微創(chuàng)外科雜志, 2010, 10 (3):262-263.
  12. 12.  王志恒, 林若柏. 電視縱隔鏡檢查的臨床應(yīng)用. 國際外科學(xué)雜志, 2008, 35 (3):189-191.
  13. 13.  邵豐, 蘇宜江, 許棟生, 等. 電視縱隔鏡手術(shù)診治胸部疾病36例. 中國胸心血管外科臨床雜志, 2009, 16 (1):76-78.
  14. 14.  吳彬, 徐志飛, 仇明, 等. 縱隔鏡下食管癌切除. 中華消化外科雜志, 2007, 6 (6):407-409.
  15. 15.  Turkyilmaz A, Eroglu A, Aydin Y, et al. The management of  esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma. Dis Esophagus, 2009, 22 (2):119-126.
  16. 16.  Delgado Gomis F, Gómez Abril SA, Martínez Abad M, et al. Assisted  laparoscopic transhiatal esophagectomy for the treatment of esophageal cancer. Clin Transl Oncol, 2006, 8 (3):185-192.
  17. 17.  Tabatabai A, Hashemi M, Mohajeri G, et al. Incidence and risk factors  predisposing anastomotic leak after transhiatal esophagectomy. Ann Thorac Med, 2009, 4 (4):197-200.
  18. 18.  Colvin H, Dunning J, Khan OA. Transthoracic versus transhiatal  esophagectomy for distal esophageal cancer:which is superior ? Inte ract Cardiovasc Thorac Surg, 2011, 12 (2):265-269.
  19. 19.  Homesh NA, Alsabahi AA, Al-Agmar MH, et al. Transhiatal versus transthoracic resection for oesophageal carcinoma in Yemen. Singapore Med J, 2006, 47 (1):54-59.
  20. 20.  Boshier PR, Anderson O, Hanna GB. Transthoracic versus transhiatal esophagectomy for the treatment of esophagogastric cancer:a meta-analysis. Ann Surg, 2011, 254 (6):894-906.