Video-Assisted Thoracoscopic Surgery for Early Cancer of the Thoracic Esophagus

電視輔助胸腔鏡施行早期食道癌切除手術

賴重佑(Chung-Yu Lai) ； 林同森(Torng-Sen Lin) ； 鄭清源(Ching-Yuan Cheng) ； 孫茂勝(Maw-Soan Soon) ； 賴富美(Fu-Mei Lai) ； 謝坤洲(Kun-Chou Hsin) ； 侯振泰(Chen-Tay Hou) ； 江友馨(Ching-Yuan Cheng)吳金燕(Chin-Yen Wu) ； 張靖苓(Chin-Ling Chang)

《The Changhua Journal of Medicine》 7卷4期 (2002/10) Pp. 201-206

摘要

背景及目的：傳統的食道手術對於胸腔外科醫生而言，是一複雜而且具挑戰性的手術，它可能産生一些明顯的並發症及死亡率。我們將介紹電視輔助胸腔鏡施行早期食道癌切除手術。
方法：從1997年3月至2001年9月，有5位T1食道癌的病人併入此研究。其中有4位男性及1位女性，其平均年齡爲57歲（從45至68歲）。在手術中，全部的病人皆需要接受雙管氣管內插管麻醉。首先我們將病人採左側躺姿勢，目前僅需要參個壹公分的傷口，分別在第6，7，8肋間和壹個兩公分在第5肋間，我們便可來完成使用胸腔鏡影像輔助來游離食道，並且清除縱膈腔淋巴結，然後再將病人翻身平躺，將雙管氣管內插管麻醉改變成單管氣管內插管麻醉，施行壹個約十五公分的上腹部切口，利用胃做食道替代物，經由後胸骨後方路徑，將胃提昇至頸部高度，來做食道胃吻合。
結果：平均的出血量爲210升（110至350毫升）。平均待在加護病房的時間爲1天（從0到3天），平均的住院爲9天（從7到10天）。病理學檢查發現有四例麟狀上皮癌及壹例腺癌，我們並沒有發生手術併發症及死亡病例，很幸運的所有病人的癌瘤都局限在粘膜層，而且沒有淋巴線轉移現象。這些病人在經過平均34.6個月（7到60個月）的追蹤，他們目前都飲食正常，也沒有腫瘤復發的情形。
結論：胸腔鏡影像輔助食道切除手術，對T1食道癌的病人，是一種合理又安全的手術方式。

關鍵字

電視輔助胸腔鏡手術 ； 電視輔助胸腔食道切除手術 ； 食道癌 ； 食道重建

並列摘要

Background and purpose: Traditional esophageal surgery is a complex and challenging procedure for thoracic surgeons to perform, and it is associated with significant morbidity and mortality. Here, we introduce a new method of video-assisted thorácoscopic surgery for T1 esophageal carcinoma.
Methods: From March 1996 to September 2001, we enrolled five patients diagnosed with T1 esophageal carcinoma via chest computerized tomography and transesophageal ultrasound. Of the patients, four were male and one was female. The average age was 57 years (range: 45 to 68 years). All patients were placed in a left lateral position under double lumen intubated anesthesia. Thoracoscopic esophagectomy was performed through three 1-cm incisions at the sixth, seventh, and eighth intercostal spaces and one 2-cm incision at the fifth intercostal space. These incisions were sufficient to accomplish thoracoscopic esophageal mobilization and dissection of the mediastinal lymph nodes, such as the right recurrent laryngeal nodes, paratracheal nodes, subcarinal nodes, and inferior pulmonary nodes. After this procedure, gastric mobilization using an upper midline laparotomy for cervical esophagogastrostomy through the retrosternal space was performed.
Results: The average blood loss during the operation was 210 ml (range: 110 to 350mL), and the average operative time was 5.2 hours (range: 4.5-6.2 hours). The thoracoscopic esophagectomy and mediastinal lymph node dissection took about 154 minutes (range: 100 to 190 minutes). Pathological reports identified that the four squamous cell carcinoma and one adenocarcinoma in our patients involved only the mucosal layer without evidence of lymph node metastasis. The average intensive care unit stay was 1 day (range: 0 to 3 days), and the average hospital stay was 9 days (range: 7 to 10 days). There were no surgical complications and no deaths. Since having the procedure, all the patients have tolerated solid food well without evidence of tumor recurrence after a mean 34.6 months of follow-up (range: 7 to 60 months).
Conclusion: Video-assisted thoracoscopic surgery is a feasible and safe procedure for patients with Ti esophageal carcinoma.

並列關鍵字

video-assisted thoracoscopic surgery ； video-assisted thoracoscopic esophagectomy ； esophageal carcinoma ； esophageal reconstruction