摘要食管癌是我国常见恶性消化道肿瘤之一,有着较高的发病率和死亡率.手术治疗目前仍是食管癌综合治疗中最重要的一部分.食管癌常规开放手术创伤大,并发症发生率高.近年来,随着手术器械以及技术的进步,食管癌的微创治疗越来越多地应用于临床.与传统的开放手术相比,微创手术优势何在,临床医生应当如何选择？本文将微创食管癌手术的发展历程及目前常见的术式进行概括,并总结国内外相关研究的大量文献报道.从围手术期各项指标和术后康复情况、淋巴结清扫结果及长期生存3个方面对食管癌微创手术和开放手术进行比较,结果显示:微创手术术中出血、术后肺部并发症发生率、住院时间及ICU住院时间均显著少于开放手术的患者;术后吻合口瘘、围手术期病死率、R0切除率及清扫淋巴结阳性数目方面未见明显差异;而在手术时间、喉返神经损伤、淋巴结清扫数目及长期生存方面尚未得出明确结果.这仍有赖于大规模的前瞻性临床观察或随机对照研究结果来进一步明确微创手术是否优于常规开放手术.此外,本文还对机器人技术在微创食管癌手术中的应用和发展进行综述,介绍了当前机器人技术在微创食管癌手术中的使用现状,并对机器人技术的前景加以展望.目前限制机器人技术推广普及的重要原因,主要包括费用问题以及手术适应证的把控,希望在未来几年能够得到妥善的解决.

abstractsEsophageal cancer is one of the most common malignant digestive system cancers in China,which has high incidence and mortality.Nowadays,surgery remains the most important part of the comprehensive treatments.Conventional open esophagectomies are highly traumatic with high morbidity,while minimally invasive esophagectomy has been increasingly used with the development of surgical instruments and techniques in recent years.Compared with conventional open esophagectomy (OE),what are the advantages of minimally invasive esophagectomy (MIE) and which is preferable? This review briefly introduces the developing history of MIE and common procedures.Then we review large amounts of relevant literatures,comparing MIE with OE in perioperative rehabilitation,lymph node dissection and long-term survival.Results showed that compared with OE,MIE had less blood loss during operation,less postoperative pulmonary complications,shorter hospital stay and ICU time,meanwhile,there were no significant differences in the incidence of anastomotic leak,perioperative mortality,R0 resection and total number of resected lymph nodes.However,there are still no clear results of comparisons on operative time,recurrent laryngeal nerve palsy,and long-term survival,thus,more supportive evidences from prospective large-sample observation studies or randomized controlled trials are still needed.Furthermore,this review also presents the application and the progress of robotic-assisted MIE (RAMIE),demonstrates the current use of robotic technology during esophagectomies,meanwhile forecasts the future advancements of RAMIE.For the moment,the limitations of RAMIE to be widely used mainly include the cost and controlling of surgical indications,and we hope these can be settled in the coming years.