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Iovr-Lewis管状胃纵隔化食管癌根治术

Application of tubular stomach reconstruction via the posterior mediastinal approach in the Iovr-Lewis radical resection of esophageal cancer

摘要:

目的 探讨Iovr-Lewis管状胃纵隔化食管癌根治术的手术技巧及要点,分析其临床疗效.方法 回顾性分析2013年4月至2015年4月成都市第一人民医院收治的63例食管中下段癌患者的临床资料.患者均行Iovr-Lewis管状胃纵隔化食管癌根治术,腹腔镜下完成腹部手术,而后行胸腔镜辅助小切口完成食管-管状胃胸顶吻合,后将管状胃置入食管床并关闭全段纵隔胸膜,完成管状胃纵隔化.患者行常规围术期治疗.术中记录:手术时间、术中出血量、术中输血量、淋巴结清扫数目.术后检测患者吻合口瘘情况:观察胸腔引流情况,观察有无发热、胸痛及血象升高等;肠道功能恢复情况;胸腔闭式引流管拔出时间.患者术后采用电话及门诊方式进行随访,了解患者是否正常进食,有无食管反流,肿瘤进展情况等,随访截止时间为2015年4月.结果 63例患者均顺利完成Iovr-Lewis管状胃纵隔化食管癌根治术.患者无围术期死亡,平均手术时间为230 min,平均术中出血量为300 mL,术中未行输血治疗,术中平均淋巴结清扫数目为16枚.术后2d拔出胃管,术后患者平均胃肠道恢复时间为3d.术后CT检查示管状胃位置良好.患者术后3~4d进食流质饮食,术后7d进食软食,术后10 ~ 12 d进食普通食物.2例患者发生术后并发症,均为轻微肺部感染,经常规处理后治愈.胸腔闭式引流管平均拔出时间为4d.63例患者均获得随访,中位随访时间为8个月(1 ~24个月),随访期间患者无死亡和肿瘤复发发生,无严重反流等并发症发生,均进食普通食物.结论 Iovr-Lewis管状胃纵隔化食管癌根治术是一种安全有效的方法,能较好预防食管吻合口瘘,有利于减少食管癌患者术后肺部感染,加速患者康复.

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abstracts:

Objective To explore the surgical technique and analyze the clinical efficacy of tubular stomach reconstruction via the posterior mediastinal approach after Iovr-Lewis radical resection of esophageal cancer.Methods The clinical data of 63 patients with middle-lower esophageal cancer who were admitted to the First People's Hospital of Chengdu between April 2013 and April 2015 were retrospectively analyzed.All the patients underwent Iovr-Lewis radical resection of esophageal cancer and tubular stomach reconstruction via the posterior mediastinal approach.Video-assisted minithoracotomy (VAMT) was used for anastomosis of esophagus-gastric tube at the top of thorax after laparoscopic abdominal surgery, and then tubular stomach reconstruction via the posterior mediastinal approach was performed by placing gastric tube in the esophageal bed and closing the posterior mediastinal pleura.Patients received regular perioperative treatment.Intraoperative record included operation time, volume of blood loss, volume of blood transfusion and lymph nodes dissection.Postoperative anastomotic leakage was detected by observing thoracic drainage, symptoms of fever, chest pain and elevated hemogram, recovery of intestinal function and closed thoracic drainage-tube removal time.Follow-up was performed by telephone interview and outpatient examination up to April 2015, including with or without normal food intake, gastroesophageal reflux and tumor progression.Results All the patients underwent successful IovrLewis radical resection of esophageal cancer using tubular stomach reconstruction via the posterior mediastinal approach without perioperative death and intraoperative blood transfusion.The average operation time, average volume of intraoperative blood loss and average number of lymph nodes dissected were 230 minutes, 300 mL and 16, respectively.Patients received gastric tube removal at postoperative day 2 with a good condition of tubular stomach by CT examination.The average time of postoperative gastrointestinal tract recovery was 3 days.Patients took fluid diet at postoperative day 3-4, soft diet at postoperative day 7 and regular diet at postoperative day 10-12.Two patients complicated with slight pulmonary infection were cured by conventional treatment.The closed thoracic drainage-tube removal time was 4 days.All the patients were followed up for a median time of 8 months (range,1-24 months) with regular diet intake and without perioperative death, tumor recurrence, severe gastroesophageal reflux and other complications.Conclusions Iovr-Lewis radical resection of esophageal cancer using tubular stomach reconstruction via the posterior mediastinal approach is safe and feasible, with the advantages of preventing the esophageal anastomotic fistula, reducing postoperative pulmonary infection and promoting early diet intake and enhancing postoperative recovery of patients.

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作者: 吴良洪 [1] 宋宇 [1] 石珂 [1] 李海波 [1]
期刊: 《中华消化外科杂志》2015年14卷12期 1042-1046页 ISTICPKUCSCD
栏目名称: 外科天地
DOI: 10.3760/cma.j.issn.1673-9752.2015.12.014
发布时间: 2016-01-08
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