目的 探讨侧俯卧位胸、腹腔镜联合食道癌根治术的临床效果.方法 对46例食管癌行侧俯卧位胸腹腔镜联合食管癌根治术:先左侧侧俯卧位行胸腔镜下胸段食管的游离及淋巴结清扫；胸部手术完成后改平卧位行腹腔镜下胃的游离及淋巴结清扫；胃游离后剑突下小切口完成管状胃的制作,再将管状胃经食管床拉至左颈部与颈段食管行端侧吻合.结果 无中转开胸及开腹.总手术时间:210～330m in,平均266m in;腹腔镜手术时间45～120min,平均78 min；胸腔镜手术时间65～125m in,平均87 min.术中无大出血,总出血量80～180mL,平均135mL,其中腹腔出血10～30mL,平均15mL.共清扫纵隔淋巴结429枚,平均每例9.3枚；清扫胃左动脉旁、贲门旁淋巴结159枚,平均每例3.5枚.术后住院9～13d,平均9.6 d.住院期间患者无死亡.术后并发症:无吻合口漏,快速房颤2例,肺部感染3例.结论 侧俯卧位胸腹腔镜联合食道癌根治术在技术上是可行的,并且是安全的.%[ Objective ] To investigate the clinical results of thoracoscopic and laparoscopic in lateral prone position with esophagectomy for esophageal cancer. [Methods] Thoracoscopic and laparoscopic operation were carried out in lateral prone position on 16 patients with esophageal cancer: Each patient was given thoracoscopic esophagus mobilization in lateral-prone position, which was followed by lymphadenectomy; laparoscopic mobilization of stomach and lymphadenectomy in a supine position was then conducted after thoracic operation; When the stomach had been completely mobilized, a subxiphoid small incision was made to allow the gastric tube production. A gastric tube was then pulled to the left cervix through esophageal bed by side-to-side cervical esophageal anastomosis. [Results] No thoracotomy or laparotomy was conducted. Duration of surgery in total: 210～330 min, 266 min on average; duration of laparoscopic surgery: 45～120 min, 78 min on average; duration of thoracoscopic surgery: 65～125 min, 87min on average without massive hemorrhage. Total blood loss: 80～180 ml, 135ml on average; Abdominal bleeding: 10～30 ml, 15ml on average. Totally 429 mediastinum lymph nodes, 9.3 per case on average; 159 left gastric artery lymph nodes and paracardial lymph nodes, 3.5 per case on average. Postoperative hospital stay: 9～13d, 9.6d on average. No patients died during hospitalization. Postoperative complications: no anastomotic leakage, 2 case of atrial fibrillation, 3 case of pulmonary infection. [Conclusion] The thoracoscopic and laparoscopic esophagectomy for esophageal cancer using the lateral prone position is technically feasible and safe.
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