经左胸腹全胸腔镜食管胃交界区腺癌外科治疗(附17例报告)宿学家张志勇(通讯作者)朱斌谭鑫范波(解放军第八十八医院心胸外科山东泰安271000)【摘要】R的研究探讨胸腔镜卜食管胃交界部脱癌(adenocarcinomaoftheesophagogastricjunctionAEG)的手术体位、入路和手术方法的可行性及安全性。方法2011年11月至2014年03月对17例AEG行右侧卧位经左胸腹完全腔镜下根治术：右侧卧位经左胸行腔镜下下段食管的游离及清扫纵隔淋巴结，开膈肌,第七肋间肋弓下、腹直肌外缘做5cm长切口，腔镜辅助K游离贲门、胃及清扫胃左动脉、网膜淋巴结，普通消化道吻合器行食管胃吻合。结果无屮转开胸。总手术时间:110-190min,平均146min。术中无大出血,总出血量30-150ml,平均110ml。共清扫纵隔淋巴结104枚，平均每例6.1枚；清扫腹腔淋巴结133枚，平均每例7.8例。术后住院9-14d，平均lid。住院期间病人无死亡。术后并发症：肺部感染2例，无吻合门漏。结论右侧卧位经左胸腹全腔镜下AEG的外科治疗是可行安全的，近期效果良好，并发症少，达到左侧开胸手术效果。但其长期疗效需要进一步研究、随访。【关键词】右侧卧位微创食管胃交界区肿瘤胸腔镜【中图分类号】R725.2【文献标识码】A【文章编号】2095-1752(2014)14-0071-02Thetreatmentofadenocarcinomaoftheesophagogastricjunction(AEG)byendoscopicradicaloesophagectomy(reportof17cases)Xue-jiaSuZhi-yongZhangBinZhu,XinTanBoFan.(DepartmentofCardiothoracicSurgery,TheNo.88HospitalofJinanMilitaryRegion,ShandongProvinceTaian,271000,P.R.China)【Abstract】ObjectiveTostudythefeasibilityandsafetyofthoracoscopicsurgerypostu---本文来源于网络，仅供参考，勿照抄，如有侵权请联系删除---ralsandmethodsoftheadenocarcinomaoftheesophagogastricjunction(AEG).MethodsAtotalof17patientswithAEGwereoperatedwiththerightlateralendoscopicradicaloesophagectomyfromNovember2011toMarch2014:freeingtheloweresophagusandcleanmediastinallymphnodesusingthoracoscopyundertherightsideofthesupineline,thenopeningthediaphragmandcuting5cmlongincisionundertheleftseventhribandtheouterrectusabdominis,nextbyendoscopic-assistingfreeingcardia,stomachandsweepingleftgastricarteryandomentallymphnodes,lastesophagogastrostomyusingacommongastrointestinalstapling.ResultsNotransitthoracotomy.Thetotaloperationtime:110-190min,average146min.Nomassivehemorrhage,bleedingvolume30-150ml,average110ml.Sweepingatotalof104mediastinallymphnodes,withanaverageof6.1percase;cleaningabdominallymphnode133,withanaverageof7.8casespercase.Postoperativehospitalstaywas9-14d,theaveragelid.Duringhospitalizationofpatientswithnodeaths.Postoperativecomplications:pulmonaryinfectionin2patients,noanastomoticleakage.ConclusionTherightlateralendoscopicAEGsurgicaltreatmentisfeasibleandsafe,andtherecentgoodresults,fewercomplications,reachingaleftthoracotomyeffect.However,itslong-termefficacyneedsfurtherstudyandfollow-up.【Keywords】rightlateralpositionminimallyinvasivetumoroftheesophagogastricjunctionthoracoscopy食管胃交界部腺癌(adenocarcinomaoftheesophagogastricjunctionAEG)是指发生在食管胃交界部的腺癌，即贲门癌，外科通常采用左胸、左侧胸腹联合切口及经腹等径路，2011年11月至2013年03月完成右侧卧位经左胸腹全胸腔镜下AEG的外科治疗17例，在胸腔镜下行根治术达到与幵胸冋等效果，取得良好疗效，现报道如下：1资料与方法1.1一般资料---本文来源于网络，仅供参考，勿照抄，如有侵权请联系删除---本组17例，男13例，女4例。年龄44-78岁，平均62岁。其中SiewertI型1例，SiewertII型16例，肿瘤人小3cm以内。术前均行胃镜、胸部和上腹部CT、超声、PET-CT、骨骼全身显像检查等排除肿瘤明显外侵及远处转移。术前均做肺功能、超声心动图等检查，符合全胸腔镜下手术。1....
