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目的探索一种不使用胸腔镜辅助,单纯经开胸小切口微创治疗食管癌及贲门癌的手术方法。方法采用保留胸肌、不切断肋骨的微创开胸小切口技术,使用普通加长手术器械操作加单手入胸辅助的方法根治性治疗食管、贲门癌126例(研究组)。其中贲门癌29例,胸中、上段食管癌76例,胸下段食管癌21例。选取同期行常规开胸手术治疗的食管、贲门癌患者98例作为对照组。结果研究组的平均手术时间(167.4±29.4)min,切口长度平均(14.1±1.3)cm,开胸失血量小于30ml,手术中撑开肋骨(9.0±1.0)cm,全部未使用电视胸腔镜辅助,均获得满意的暴露效果。术后并发声音嘶哑2例,颈部吻合口瘘4例,胸部切口脂肪液化6例。全组无手术死亡。患者术后1～2d可下床活动,疼痛轻微,术侧上肢无明显运动受限,自然下垂可遮蔽全部或部分瘢痕,外形美观。结论不使用胸腔镜辅助,单纯经胸小切口单手辅助器械操作微创治疗食管癌是可行的,和电视胸腔镜一样具有损伤小、出血少、恢复快,不影响美观等优点;同时较电视胸腔镜手术时间短,适应证广,费用低廉等,值得推广。
Objective To explore a surgical method of thoracoscope assisted minimally invasive minimally invasive thoracoscopic esophagectomy and cardia cancer. Methods A minimally invasive minimally invasive thoracotomy, which retained the pectoral muscle and did not cut off the ribs, was used to treat 126 esophageal and cardiac cancers (study group). Cardiac cancer in which 29 cases, chest, upper esophageal cancer in 76 cases, 21 cases of lower esophageal cancer. Select the same period routine thoracotomy in patients with esophageal and cardiac cancer in 98 cases as a control group. Results The mean operative time (167.4 ± 29.4) min, mean length of incision (14.1 ± 1.3) cm, blood loss less than 30ml in thoracotomy and (9.0 ± 1.0) cm in operation were all not used in video-assisted thoracoscopy , Have been satisfied with the exposure. 2 cases had hoarseness after operation, 4 cases had anastomotic fistula in the neck and 6 cases had fat liquefaction in the chest incision. The whole group died without surgery. Patients may be out of bed 1 ~ 2d postoperative activity, minor pain, surgery side of the upper limb without significant movement limitation, natural sagging can cover all or part of the scar, beautiful appearance. Conclusions The use of thoracoscope-assisted surgery with minimally invasive thoracic incision and single-handed operation of minimally invasive devices for the treatment of esophageal cancer is feasible. As with the video-assisted thoracoscopy, it has the advantages of less damage, less bleeding, quicker recovery and no adverse effects on beauty. At the same time, Thoracoscopic surgery a short time, a wide range of indications, low cost, it is worth promoting.