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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。
Objective To investigate the value of laparoscopic gastric minimally invasive surgery in esophageal carcinoma Ivor-Lewis operation. Methods From April 2009 to January 2011, 25 patients with Ivor-Lewis esophageal cancer were retrospectively analyzed. There were 15 males and 10 females, aged from 50 to 72 years (mean, 63 years), middle esophageal cancer (14 cases) Lower esophageal cancer in 11 cases, abdomen operation using the umbilical, right anterior axillary line level of the end of the gallbladder, the left axillary line flat left flange and the aforementioned two holes and umbilical connection midpoint operation hole into the laparoscopic instruments , Scalpel free stomach and clean the abdominal lymph nodes. Results 25 cases of surgery were successful, no transit laparotomy. Laparoscopic operation time 30 ~ 80 min; bleeding about 2 ~ 20 mL, no intraoperative blood transfusion; the left gastric artery, hepatic artery, celiac artery, stomach, small bends and pericardial lymph nodes complete dissection, postoperative patients 2 ~ 4 d anal exhaust, postoperative 5 ~ 7 d to resume eating, postoperative hospital 9 to 12 days; 25 patients were followed up for 1 to 2 years, eating and living quality is good, no recurrence and metastasis and death. Conclusions Laparoscopic gastric minimally invasive surgery is safe and feasible in esophageal cancer Ivor-Lewis surgery. It can completely free the stomach and lymphadenectomy of the abdominal cavity. At the same time, it has the advantages of reducing surgical trauma, less bleeding, less pain, fewer postoperative complications, hospitalization Time reduction and other advantages, it is worth promoting.