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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2020, Vol. 13 ›› Issue (04): 233 -238. doi: 10.3877/cma.j.issn.1674-6899.2020.04.009

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改良反穿刺吻合技术在全腔镜Ivor Lewis食管癌根治术中消化道重建的应用体会
史校铭 1, 陈仕林 2 , †( ), 沈晓康 2, 朱大伟 1, 冯冬杰 2, 杨坡 1, 邓凡新 1, 裘海涛 2, 曹秀锋 1, 王晓俊 2, 沈伟忠 2, 王中秋 2   
  1. 1. 211100 南京医科大学附属逸夫医院心胸外科
    2. 210000 南京医科大学附属肿瘤医院胸外科
  • 收稿日期:2020-04-24 出版日期:2020-08-30
  • 通信作者: 陈仕林

Modified reverse-puncture anastomosis technique for total endoscopic Ivor Lewis esophagectomy

Xiaoming Shi 1, Shilin Chen 2 , †( ), Xiaokang Shen 2, Dawei Zhu 1, Dongjie Feng 2, Po Yang 1, Fanxin Deng 1, Haitao Qiu 2, Xiufeng Cao 1, Xiaojun Wang 2, Weizhong Shen 2, Zhongqiu Wang 2   

  1. 1. Department of Thoracic Surgery, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, China
    2. Department of Thoracic Surgery, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210000, China
  • Received:2020-04-24 Published:2020-08-30
  • Corresponding author: Shilin Chen
  • About author:
    Corresponding author: Chen Shilin, Email:
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目的

探讨反穿刺吻合技术行全腔镜Ivor Lewis食管癌根治术的可行性及近期疗效。

方法

收集南京医科大学附属逸夫医院2014年2月至2018年6月期间应用改良反穿刺吻合技术行全腔镜Ivor Lewis食管癌根治术的48例中下段食管癌患者资料。手术分为三大步骤：首先用腹腔镜游离胃和腹段的食管并清扫腹腔淋巴结；其次取侧卧位，游离胸段食管，切除病变食管并清扫胸腔淋巴结；最后应用反穿刺吻合技术行胸内胃食管吻合术。

结果

48例均在腔镜下完成吻合，手术过程顺利，未行胸腹部辅助切口，无中转开胸手术。手术时间(253.4±57.2)min，其中胸腔镜操作时间(175.6±64.5)min；术中出血量(107.3±87.4)ml，清扫淋巴结数目(15.2±2.5)枚。术后1例重度肥胖、糖尿病、高血压患者出现重症肺部感染及吻合口瘘，经保守治疗后治愈，吻合口瘘发生率2.1%(1/48)；术后3例出现吻合口狭窄，其中1例严重，行吻合口机械扩张缓解，吻合口狭窄率6.3%(3/48)。48例中47例的术后进流食时间(7.2±1.3)d，术后住院时间10～16 d、平均11 d。

结论

利用改良反穿刺吻合技术行全腔镜Ivor Lewis食管癌根治术治疗中下段食管癌是安全、可行的，是经济、有效的。

关键词: 改良反穿刺吻合技术, 胸内吻合, 食管癌, 全腔镜食管癌根治术
Objective

To explore the clinical applications and early results of modified reverse-puncture anastomosis technique for total endoscopic Ivor Lewis esophagectomy.

Methods

A retrospective analysis was made of 48 patients with medial and lower esophageal cancer who underwent modified reverse-puncture anastomotic technique between Feb.2014 and Jun. 2018.The operation was divided into three steps: The first step was laparoscopic mobilization of the stomach and the abdominal segment of the esophagus and dissection of the abdominal lymph node.Thoracoscopic mobilization of thoracic segment of esophagus and tumor and dissection of the thoracic lymph node was following.Last, intrathoracic anastomosis was finished by modified reverse-puncture anastomosis technique.

Results

All 48 patients underwent anastomosis under the endoscope. The operation was smooth. There were no thoracoabdominal auxiliary incision and transit thoracotomy performed. The mean overall operation time was (253.4±57.2) min, the mean thoracoscopic operation time was (175.6±64.5) minutes.The mean estimated blood loss was (107.3±87.4) ml. The mean number of nodes harvested from every patient was (15.2±2.5). Severe pulmonary infection and anastomotic fistula was observed in one patient with obesity, diabetes and hypertension (1/48, 2.1%), which was cured with conservative treatment.Anastomotic stenosis was observed in another three patients(3/48, 6.3%). The duration of liquid feeding was (7.2±1.3) days and the mean length of hospital stay was 10-16 days(range, 11 days; except one case with anastomotic leak).

Conclusions

The good short-term outcomes that were achieved suggested that the use of modified reverse-puncture anastomotic technique is safe and feasible for total endoscopic Ivor Lewis esophagectomy.

Key words: Modified reverse-puncture anastomotic technique, Intrathoracic anastomosis, Esophageal cancer, Total endoscopic Ivor Lewis esophagectomy
图1 制成反穿刺装置
图4 "U"形缝合1根管状胃的控制线自副操作孔穿出
图7 His角上方1 cm处将中下段食管、贲门及胃小弯淋巴结做肿瘤整块切除
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