Laparoscopic Gastric Mobilization in Ivor-Lewis Esophagectomy for Esophageal Cancer_West China Medical Journal

Authors：

LUO Shiyun ,  LI Wenzhong , WU Jian , SHI Lu , HE Jiajie , CHEN Haolin , LI Yi.

Department of Thoracic Surgery, No. 363 Hospital of Chengdu, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LI Wenzhong, Email: luoshiyun12@sohu.com

Keywords：

食管癌; Ivor-Lewis术式; 腹腔镜; 胃微创游离

DOI：

10.7507/1002-0179.20130072

Video：

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目的　探讨腹腔镜胃微创游离术在食管癌Ivor-Lewis术式的应用价值。方法　回顾性分析2009年4月－2011年1月行Ivor-Lewis术式食管癌患者25例，其中男15例，女10例，年龄50～72岁，平均63岁，食管中段癌14例，食管下段癌11例，腹部操作均采用经脐部、右腋前线平胆囊底水平、左腋前线平左侧肋缘及前述两操作孔与脐部连线中点做操作孔置入腹腔镜器械，超声刀游离胃并清扫腹腔淋巴结。结果　25例手术均取得成功,无中转开腹。腹腔镜操作时间30~80 min;出血约2~20 mL，无术中输血；行胃左动脉、肝总动脉、腹腔干动脉、胃大、小弯及贲门旁淋巴结完全清扫,术后患者2～4 d肛门排气,术后5～7 d恢复进食，术后住院9～12 d ；25例患者随访1～2年，进食及生活质量良好，无复发转移及死亡者。结论　食管癌Ivor-Lewis术式中采用腹腔镜胃微创游离术是安全可行的，可充分游离胃、腹腔淋巴结清扫彻底同时具有减少手术创伤、出血少、疼痛轻、术后并发症少、住院时间减少等优点，值得推广。

Citation： LUO Shiyun,LI Wenzhong,WU Jian,SHI Lu,HE Jiajie,CHEN Haolin,LI Yi.. Laparoscopic Gastric Mobilization in Ivor-Lewis Esophagectomy for Esophageal Cancer. West China Medical Journal, 2013, 28(2): 227-229. doi: 10.7507/1002-0179.20130072 Copy

1.	Collard JM, Lengele B, Otte JB, et al. En bloc and standard esop hagectomies by thoracoscopy[J]. Ann Thorac Surg, 1993, 56(3): 675-679．.
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7.	Akutsu Y, Matsubara H, Okazumi S, et al. Impact of preoperative dental plaque culture for predicting postoperative pneumonia in esophageal cancer patients[J]. Dig Surg, 2008, 25(2): 93-97.
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9.	Simonneau G, Vivien A, Sa～ene R, et al. Diaphragm dys-function induced by upper abdominal surgery. Role of postoperative pain[J]．Am Rev Respir Dis, 1983, 128(5): 899-903.
10.	Depaula AL, Macedo AI, Cernea CR, et al. Reconstruction of upper digestive tract: reducing morbidity by laparoscopiepullup[J]．Otolaryngol Head Neek Surg, 2006, 135(5): 710．.
11.	纪勇, 陈国强, 黄斌, 等.胸段食管鳞癌淋巴结转移规律及淋巴结清扫方式探讨[J]. 山东医药, 2010, 50(38): 17.
12.	兰碧洋, 黄绍华, 罗强, 等. 切除胸段食管癌胃周淋巴结的临床意义[J]. 广西医学, 2010，32(1): 53.
13.	胡建昆, 张波, 陈心足, 等.新型超声刀在胃癌根治术中的应用及技巧[J]. 中国普外基础与临床杂志. 2008, 15(10): 718-721.
14.	Nduka CC, Poland N, Kennedy M, et al. Does the uhrasoni cally activated scalpel release viable airborne cancer cells[J]. Surg Endosc, 1998, 12(8): 1031.
15.	Hamouda AH, Forshaw MJ, Tsigritis K, et al. Perioperative outcomes after transition from conventional to minimally invasive Ivor-Lewis esophagectomy in a specialized center[J]. Surg Endosc, 2010, 24(4): 865-869．.
16.	陈彤宇, 周嘉, 陈长志.食管癌切除术后胸胃排空障碍的治疗[J].中国胸心血管外科临床杂志, 2007, 14(2): 62-64.
17.	于修义, 王武军, 曲家骐, 等．食管癌及贲门癌术后幽门梗阻的病因分析和治疗[J]．广东医学杂志, 2005, 26(4): 436-437．.

1. 　Collard JM, Lengele B, Otte JB, et al. En bloc and standard esop hagectomies by thoracoscopy[J]. Ann Thorac Surg, 1993, 56(3): 675-679．.
2. 　徐志飞, 吴彬, 仇明, 等.腔镜在食管癌根治术中的应用(附40例报道)[J]. 中华胸心血管外科杂志, 2006, 22(6): 361.
3. 　肖文光, 陈利华, 任光国, 等 . Lewis手术治疗胸段食管癌44例的临床分析[J]. 四川医学, 2004, 25(9): 976-977.
4. 　王群, 谭黎杰.食管癌手术径路的评价.中华胃肠外科杂志[J]. 2008, 11(1): 14-15.
5. 　Decker G, Coosemans W, De Leyn PD, et al. Minimally invasive eso hagectomy for cancer[J]. Eur J Cardiothorac Surg, 2009, 35(1): 13-21.
6. 　Abunasra H, Lewis S, Beggs L, et al. Predictors of operatve death after oesophagectomy for carcinoma[J]. Br J Surg, 2005, 92(8): 1029-1033．.
7. 　Akutsu Y, Matsubara H, Okazumi S, et al. Impact of preoperative dental plaque culture for predicting postoperative pneumonia in esophageal cancer patients[J]. Dig Surg, 2008, 25(2): 93-97.
8. 　Dumont P, Wihlm JM, Hentz JG, et al. Respiratory complications after surgical treatment of esophageal cancer. A study of 309 patients according to the type of resection[J]. Eur J Cardiothorac Surg，1995，9(10): 539-543．.
9. 　Simonneau G, Vivien A, Sa～ene R, et al. Diaphragm dys-function induced by upper abdominal surgery. Role of postoperative pain[J]．Am Rev Respir Dis, 1983, 128(5): 899-903.
10. 　Depaula AL, Macedo AI, Cernea CR, et al. Reconstruction of upper digestive tract: reducing morbidity by laparoscopiepullup[J]．Otolaryngol Head Neek Surg, 2006, 135(5): 710．.
11. 　纪勇, 陈国强, 黄斌, 等.胸段食管鳞癌淋巴结转移规律及淋巴结清扫方式探讨[J]. 山东医药, 2010, 50(38): 17.
12. 　兰碧洋, 黄绍华, 罗强, 等. 切除胸段食管癌胃周淋巴结的临床意义[J]. 广西医学, 2010，32(1): 53.
13. 　胡建昆, 张波, 陈心足, 等.新型超声刀在胃癌根治术中的应用及技巧[J]. 中国普外基础与临床杂志. 2008, 15(10): 718-721.
14. 　Nduka CC, Poland N, Kennedy M, et al. Does the uhrasoni cally activated scalpel release viable airborne cancer cells[J]. Surg Endosc, 1998, 12(8): 1031.
15. 　Hamouda AH, Forshaw MJ, Tsigritis K, et al. Perioperative outcomes after transition from conventional to minimally invasive Ivor-Lewis esophagectomy in a specialized center[J]. Surg Endosc, 2010, 24(4): 865-869．.
16. 　陈彤宇, 周嘉, 陈长志.食管癌切除术后胸胃排空障碍的治疗[J].中国胸心血管外科临床杂志, 2007, 14(2): 62-64.
17. 　于修义, 王武军, 曲家骐, 等．食管癌及贲门癌术后幽门梗阻的病因分析和治疗[J]．广东医学杂志, 2005, 26(4): 436-437．.

West China Medical Journal

Laparoscopic Gastric Mobilization in Ivor-Lewis Esophagectomy for Esophageal Cancer

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