摘要
目的从转化医学的角度探讨食管系膜的存在,以及在胸、腹腔镜食管癌切除术中食管全系膜切除的方法。方法回顾性分析2011年7月—2012年5月45例胸、腹腔镜下食管癌切除患者围手术期、淋巴结清扫及并发症的情况。结果术中出血量平均80(32～150)ml;总手术时间平均240(220～280)min;清扫淋巴结平均29.1(13～76)个/例,胸区清扫淋巴结数平均15.1个/例,腹区清扫淋巴结数平均8.2个/例,颈区清扫淋巴结数平均7.8个/例,清扫淋巴结组数平均13.5(9～16)组/例;淋巴结转移率为64.4%(29/45);术后住院时间平均9.8(7～19)d。术后早期并发症发生率为24.4%(11/45),主要为肺部感染9例、喉返神经麻痹3例、心律失常2例、胃排空障碍2例。术后随访至2012年11月,随访时间平均8.2(2～14)个月,随访率98.4%,受访患者均生存,3例喉返神经麻痹患者出院后均有所改善。远期并发症:反流性食管炎10例,吻合口狭窄3例。结论建立腔镜下整体解剖观念,明确食管系膜的解剖层面和镜下定位,可提高腔镜食管癌根治术的安全性和根治性。
Objective From the perspective of embryo development of mesoesophagus in translational medicine, to conclude the critical mesoesophagus anatomic marks and surgical method in combined thoracoscopic and laparoscopic esophagectomy. Methods From July 2011 to May 2012, the clinical data of 45 patients who were performed combined thoracoscopic and laparoscopic esophagectomy were analysed retrospectively. Results The median operative blood loss was 80 ml （range 32-150 ml）. The median operative time was 240 min （range 220-280 min）. The median number of lymph nodes dissected was 29. 1 （ range 13- 76）, in thoracic area was 15.1, abdominal area 8.2, and in cervical area was 7.8. The median number of lymph node groups dissected was 13.5 （range 9-16）. The median time of postoperative hospitalization was 9. 8 day （range 7-19 day）. Perioperative complication rate was 24. 4% ,44 patients were followed up with the mean follow up time of 8.2 months （range 2-14 months） , all the patients survived. Conclusion It is possible to improve the safety and feasibility of combined thoracoscopic and laparoscopic esophagectomy that the key anatomic mark and surgical surfaces of mesoesophagus are identified in the overall minimally invasive anatomic concept.
出处
《转化医学杂志》
2013年第2期80-82,85,共4页
Translational Medicine Journal
关键词
食管系膜
胸腹腔镜
食管肿瘤
转化医学
Esophageal neoplasms
Mesoesophagus thoracoscopy combined laparoscopy
Esophageal carcinoma
Thranslational medicine
