腹腔镜联合纵隔镜在食管癌根治术中的应用
食管癌,,食管癌;超声刀；LigaSure；腹腔镜；纵隔镜,1资料与方法,2结果,3讨论,参考文献：
【摘要】 目的：探讨腹腔镜联合纵隔镜在食管癌根治术中的应用价值。方法：运用超声刀和LigaSure行腹腔镜下游离胃术、腹腔镜联合纵隔镜经后纵隔食管癌切除、胃食管左颈吻合8例,其中食管中段癌3例、食管下段癌5例,TNM分期为T1～3N0～1M0。结果：全组无手术死亡,无中转开胸或开腹手术,术中无输血,手术时间180～220min,平均200min,术中出血量50～150ml,平均l00ml,纵隔淋巴结清扫0～8枚,平均3.2枚,腹部淋巴结清扫0～6枚,平均1.4枚,术后胃肠功能恢复时间3～4d,平均3.7d,术后住院时间10～19d,平均12d。结论：对于中下段无外侵(≤T3)的食管癌患者在腹腔镜联合纵隔镜下行食管癌根治术可以提高手术的安全性,缩短手术时间,减少术中出血,减轻手术创伤,具有良好的推广应用价值。【关键词】 食管癌;超声刀；LigaSure；腹腔镜；纵隔镜
Application of esophagectomy via laparoscopy combined mediastinoscopy
QIN Xiong,XU Zhifei,QIU Ming,et al.
Changzheng Hospital,Shanghai 200003,China
【Abstract】 Objective:To explore thc value of esophagectomy via laparoscopy combined mediastinoscopy.Methods:Esophagectomy were performed by gastric mobilization,dissection of esophageal carcinoma via laparoscopy and left cervicotomy via mediastinoscopy by using the ultrasonically activated scalpel and ligasure vessel sealer,involving 8 patients with esophageal carcinoma (3 in middle segment,5 in lower segment).The TNM staging was T1～3N0～1M0.Results:All the operations were successful without blood transfusion.No perioperation mortality was observed and no conversion to open surgery was required.The operative time was 180220min(mean 200min),the blood loss was 50150ml(mean 100ml),the number of removed mediastinal lymph nodes was 08(mean 3.2),the number of removed paraleft gastric arterial lymph nodes by laparoscopic surgery was 06(mean l.4).The recovery time of gastrointestinal function was 34 days(mean 3.7 days).The hospitalization was 1019 days(mean 12days).Conclusions:So long as the operative indication is strictly determinated with middle and lower esophageal carcinoma without invasion(≤T3),esophagectomy via laparoscopy combined mediastinoscopy by using the ultrasonically activated scalpel and ligasure vessel sealer can improve the operative safety,shorter operative time,reduce blood loss and lessen tissue injury. ......
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