Thoracoscopic esophagectomy for esophageal cancer
Thoracoscopic esophagectomy for esophageal cancer
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DOI：
10.1016/s0039-6060(97)90257-9
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发表时间：
1997-07-01
期刊：
影响因子：
3.8
通讯作者：
Wong, J
中科院分区：
文献类型：
--
作者：
Law, S;Fok, M;Wong, J
背景资料。微创手术是食道手术中开放手术的一种替代方法。它在肿瘤切除中的作用存在争议。22例手术风险增加的患者接受了胸腔镜下的食道切除术。将这些患者的术后结果与同期接受开胸切除的63例患者的结果进行比较。18例患者完成胸腔镜术。3例患者因肿瘤局部进展需要中转开胸，另1例患者因胸腔镜术中通风不良及发现转移性疾病而行旁路手术。胸腔镜术时间中位数为110分钟(55~165分钟)。胸腔镜组和开胸组总手术时间分别为240分钟(165~360分钟)和250分钟(190~420分钟)，P=0.5。术中出血量明显少于开腹手术，胸腔镜组中位数为450ml(200~800ml)，开胸组中位数为700ml(300~2500ml)，P<；0.01。胸腔镜组的中位淋巴结清除量为7个(2~13个)，而开胸组为13个(5~34个)。两组患者中有17%患上了支气管肺炎。只有一名患者中转开胸手术死亡。1例术后发生口部复发。两组总体存活率无显著差异。胸腔镜下食道切除术是一种可行的手术方案。尽管选择接受胸镜检查的患者表现较差，但并未显示出明显优于开胸手术的优势。这项技术值得在专门的中心进行进一步的研究。
Background. Minimal access surgery is an alternative to open surgery in esophageal surgery. Its role in cancer resection is controversial.Methods. Thoracoscopic esophageal resection was attempted in 22 patients who had increased operative risk. Postoperative outcomes of these patients were compared with the outcomes of 63 patients who underwent open thoracotomy resection during the same period.Results. Thoracoscopy was completed in 18 patients. Conversion to thoracotomy was necessary because of locally advanced tumor in three patients, and a bypass procedure was performed in another patient because of poor ventilation during thoracoscopy and the finding of metastatic disease. The median thoracoscopy time was 110 minutes (range, 55 to 165 minutes). The total operating times were 240 minutes (range, 165 to 360 minutes) and 250 minutes (range, 190 to 420 minutes) for thoracoscopy and thoracotomy, respectively, p = 0.5. Blood loss was significantly less than that of open resection; medians were 450 ml (range, 200 to 800 ml) and 700 ml (range, 300 to 2500 ml) for thoracoscopy and thoracotomy, respectively, p < 0.01. The median number of lymph nodes removed at thoracoscopy was 7 (range, 2 to 13) compared with 13 (range, 5 to 34) in the thoracotomy group. Bronchopneumonia affected 17% of both groups of patients. Only one patient who was converted to open thoracotomy died. Port site recurrence developed in one patient. Overall survival rates were not significantly different.Conclusions. Thoracoscopic esophageal resection was a feasible option. Clear advantages over open thoracotomy were not demonstrated, although patients who were selected for thoracoscopy had worse performance status. This technique deserves further investigation in dedicated centers.