胸腹腔鏡聯合食管癌根治術的手術配合

孫佳 鄭鳳燕 鄭瓊

胸腹腔鏡聯合食管癌根治術的手術配合

孫佳 鄭鳳燕 鄭瓊

目的 探討胸腹腔鏡聯合食管癌根治術的手術配合。方法 回顧性分析2013年8月至2016年10月150例行胸腹腔鏡聯合食管癌根治術的臨床及護理資料。結果 150例患者手術均順利完成，無圍術期死亡，其中1例患者因病灶與氣管粘連緊密無法在腔鏡下完成食管游離，開胸后仍無法完成游離，僅行姑息性切除，3例患者因誤斷胃網膜右血管中轉開腹，其余手術順利完成。手術時間2～6h，平均4h。結論 熟知手術步驟，掌握手術中的要點，密切配合才能保證手術順利完成，時間縮短，手術并發癥降低，效果提高。

胸腹腔鏡 食管癌 手術配合

Objective To investigate the operative coordination of radical resction of esophageal carcinoma under combination of thoracoscopy and laparoscopy c. Methods The clinical and nursing data of 150 cases undergoing radical resction of esophageal carcinoma under combination of thoracoscopy and laparoscopy from August 2013 to October 2016 were analyzed retrospectively. Results All the operations of 150 cases were performed successfully and no perioperative mortality. One of the patients with the lesion adhered to the trachea closely could not be operated under the endoscope or the thoracotomy，Instead，the palliative resection had been operated. 3 patients had to be conversion to open surgery because of the division of the right gastroepiploic artery by mistake. The time of operation was 2 to 6hours，with an average of 4 hours. Conclusions It is important to be familiar with the operation procedure，master the key points of the operation and cooperate properly to ensure the successful operation，shorten the operative time，reduce the operative complications and improve the effect.

Thoracoscopy Laparoscopy Esophageal carcinoma Operative cooperation

食管癌是我國消化道惡性腫瘤之一，病死率高。目前根治性手術仍然是主要治療手段［1］。傳統開胸食管癌三切口手術創傷大，恢復慢，并發癥多。近年來，隨著手術技術的進步及腔鏡器械的快速發展，食管癌的外科治療已逐漸由傳統開胸手術轉向微創腔鏡手術。食管癌的微創腔鏡手術因其創傷小、疼痛輕等優點逐漸被接受和應用［2］。但因該手術難度大，復雜，涉及胸腔腹腔的血管多，且手術時間長，術中需更換體位等問題，故手術風險大，技術要求高，對護理配合要求也較高。2013年8月至2016年10月本院成功為150例患者實施胸腹腔鏡聯合食管癌切除術，術中護理效果滿意，現報道如下。

1 臨床資料

1.1 一般資料 本組食管癌患者150例（中上段食管癌：腫瘤直徑不＞5cm，并無明顯外侵及轉移。……