[1]王敬涛 高不郎 王国俊** 李瑞欣 张云飞 丁恒轩.基于膜解剖理论的胸、腹腔镜联合食管癌根治术[J].中国微创外科杂志,2024,01(1):1-6.
　Wang Jingtao,Gao Bulang,Wang Guojun,et al.Application of Thoracoscopy Combined With Laparoscopy for Radical Esophagectomy Based on Membrane Anatomy Theory[J].Chinese Journal of Minimally Invasive Surgery,2024,01(1):1-6.
点击复制

基于膜解剖理论的胸、腹腔镜联合食管癌根治术()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2024年1期
页码:
1-6
栏目:
临床论著
出版日期:
2024-01-25

文章信息/Info

Title:
Application of Thoracoscopy Combined With Laparoscopy for Radical Esophagectomy Based on Membrane Anatomy Theory
作者:
王敬涛 高不郎 王国俊** 李瑞欣 张云飞 丁恒轩
(郑州大学第一附属医院胃肠外科，郑州450022)
Author(s):
Wang Jingtao;  Gao Bulang;  Wang Guojun;  et al.
Department of Gastrointestinal Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450022, China
关键词:
食管肿瘤; 食管系膜; 胸腔镜手术; 腹腔镜手术; 膜解剖; 食管癌根治术
Keywords:
Esophageal tumor; Esophageal mesentery; Thoracoscopic surgery; Laparoscopic surgery; Membrane anatomy; Radical resection of esophageal cancer
文献标志码:
A
摘要:
目的探讨膜解剖理论应用于胸、腹腔镜联合食管癌根治术的可行性及临床意义。方法回顾性分析2018年12月~2021年10月行基于膜解剖理论的胸、腹腔镜联合食管癌根治术142例资料。将食管系膜、食管癌以及食管系膜内的神经、血管、淋巴系统、脂肪组织、胃上部、胃左系膜、胃左淋巴结作为一个整体切除。术中可见食管周围含疏松结缔组织的间隙为食管筋膜融合间隙。前10例使用纳米炭示踪标记，显示食管淋巴液引流至胃左淋巴结。结果142例手术顺利，手术时间150~230(184.6±21.3)min，术中出血量20~100(46.7±16.8)ml，清扫淋巴结12~41(23.5±7.3)枚，97例淋巴结阳性；术后胸腔引流时间3~10(7.1±2.5)d，经口进流食时间5~10(7.6±1.7)d，总住院时间9~20(14.0±4.6)d。术后并发症发生率21.8%(31/142)，包括吻合口漏7例(4.9%)，吻合口狭窄9例(6.3%)，声音嘶哑9例(6.3%)，残胃炎6例(42%)。无术后出血、乳糜漏、感染或术后30 d内死亡。142例随访11~35个月，中位数26个月，无复发和死亡。结论食管周围存在构成“信封”的系膜结构，膜解剖理论适用于食管癌的治疗，基于膜解剖理论的食管癌根治术安全、有效、可行。
Abstract:
ObjectiveTo investigate the feasibility and clinical significance of membrane anatomy theory in the application of thoracoscopic and laparoscopic radical esophageal resection.MethodsA retrospective analysis was performed on 142 cases of thoracoscopic and laparoscopic radical esophagectomy based on membrane anatomy theory from December 2018 to October 2021. The esophageal mesangium, esophageal cancer, and nerves, blood vessels, lymphatic system, adipose tissue, upper stomach, left mesangium, and left gastric lymph nodes in the esophageal mesangium were removed as a whole. During the surgery, the space containing loose connective tissue around the esophagus was seen to be the esophageal fascial fusion space. The first 10 cases were labeled with nanocarbon tracer markers, showing esophageal lymphatic drainage to the left gastric lymph node.ResultsAll the 142 patients had smooth surgery. The operation time was 150-230 min (mean, 184.6±21.3 min), the intraoperative blood loss was 20-100 ml (mean, 46.7±168 ml), the number of lymph nodes dissected was 12-41 (mean, 23.5±7.3), and the positive lymph nodes were found in 97 cases. The postoperative chest drainage time was 3-10 d (mean, 7.1±2.5 d), the postoperative oral intake time was 5-10 d (mean, 7.6±17 d), and the total hospital stay was 9-20 d (mean, 14.0±4.6 d). The total incidence of postoperative complications was 21.8% (31/142), including 7 cases (4.9%) of anastomotic leakage, 9 cases (6.3%) of anastomotic stenosis, 9 cases (6.3%) of hoarseness, and 6 cases (4.2%) of residual gastritis. There was no postoperative bleeding, chyllevial leakage, infection, or death within 30 d after surgery. The followups of the 142 patients lasted for 11-35 months, with a median of 26 months, and there was no recurrence and death. ConclusionsThere is a mesangial structure that constitutes an “envelope” around the esophagus. The membrane anatomy theory is suitable for the treatment of esophageal cancer, and radical resection of esophageal cancer based on the theory is safe, effective, and feasible.

参考文献/References:

[1]Sung H,Ferlay J,Siegel RL,et al.Global cancer statistics 2020:Globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin,2021,71(3):209-249.
[2]Morgan E,Soerjomataram I,Rumgay H,et al.The global landscape of esophageal squamous cell carcinoma and esophageal adenocarcinoma incidence and mortality in 2020 and projections to 2040:new estimates from globocan 2020.Gastroenterology,2022,163(3):649-658.e642.
[3]Merritt RE,Kneuertz PJ,D’Souza DM,et al.Total laparoscopic and thoracoscopic Ivor Lewis esophagectomy after neoadjuvant chemoradiation with minimal overall and anastomotic complications.J Cardiothorac Surg,2019,14(1):123.
[4]Booka E,Takeuchi H,Kikuchi H,et al.Recent advances in thoracoscopic esophagectomy for esophageal cancer.Asian J Endosc Surg,2019,12(1):19-29.
[5]郑晓东,张卫民,侯建彬,等.电视胸腔镜食管癌切除术围术期并发症分析及预防.中国微创外科杂志,2019,19(6):526-530.
[6]杨智,杨力涛,贾永,等.微创食管癌手术“镂空法”清扫双侧喉返神经链旁淋巴结39例.中国微创外科杂志,2019,19(1):81-83.
[7]Heald RJ.Total mesorectal excision is optimal surgery for rectal cancer:a Scandinavian consensus.Br J Surg,1995,82(10):1297-1299.
[8]Heald RJ,Husband EM,Ryall RD.The mesorectum in rectal cancer surgery:the clue to pelvic recurrence?Br J Surg,1982,69(10):613-616.
[9]Hohenberger W,Weber K,Matzel K,et al.Standardized surgery for colonic cancer: complete mesocolic excision and central ligation:technical notes and outcome.Colorectal Dis,2009,11(4):354-364.
[10]Tachimori Y.Total mesoesophageal esophagectomy.Chin Med J (Engl),2014,127(3):574-579.
[11]龚建平.胃癌第五转移途径与根治术第三原理.中华胃肠外科杂志,2013,16(2):109-110.
[12]谢大兴,申杰,孟伟健,等.膜解剖理论在胃癌根治术领域的发展历程.中华胃肠外科杂志,2023,26(7):707-712.
[13]龚建平.膜解剖的兴起与混淆.中华胃肠外科杂志,2019,22(5):401-405.
[14]刘惠滨,邱仙土,郑长悦,等.基于膜解剖的胃后间隙入路在全腹腔镜近端胃切除双通道吻合术中的应用.中国微创外科杂志,2023,23(9):709-714.
[15]Cuesta MA.Minimally invasive mesoesophageal resection.J Thorac Dis,2019,11(Suppl 5):S728-S734.
[16]Weijs TJ,Goense L,van Rossum PSN,et al.The periesophageal connective tissue layers and related compartments:visualization by histology and magnetic resonance imaging.J Anat,2017,230(2):262-271.
[17]Escrig Sos J,Gomez Quiles L,Maiocchi K.The 8th edition of the AJCCTNM classification:new contributions to the staging of esophagogastric junction cancer.Cir Esp,2019,97(8):432-437.
[18]魏鑫,千雷.完全腹腔镜与腹腔镜辅助胃癌根治术的近期临床疗效对比.临床普外科电子杂志,2023,11(1):33-36.
[19]国家卫生健康委员会.食管癌诊疗规范(2018年版).中华消化病与影像杂志(电子版),2019,9(4):158-192.
[20]王欣,韦植.食管癌微创手术治疗的临床研究进展.微创医学,2020,15(2):129-133.
[21]van der Sluis PC,Schizas D,Liakakos T,et al.Minimally invasive esophagectomy.Dig Surg,2020,37(2):93-100.
[22]Heald RJ.The “holy plane” of rectal surgery.J R Soc Med,1988,81(9):503-508.
[23]Hwang SE,Kim JH,Bae SI,et al.Mesoesophagus and other fascial structures of the abdominal and lower thoracic esophagus:a histological study using human embryos and fetuses.Anat Cell Biol,2014,47(4):227-235.
[24]Cuesta MA,Weijs TJ,Bleys RL,et al.A new concept of the anatomy of the thoracic oesophagus:the mesooesophagus.Observational study during thoracoscopic esophagectomy.Surg Endosc,2015,29(9):2576-2582.
[25]Matsubara T,Ueda M,Nagao N,et al.Cervicothoracic approach for total mesoesophageal dissection in cancer of the thoracic esophagus.J Am Coll Surg,1998,187(3):238-245.
[26]李卓毅,傅俊惠,郑春鹏,等.胸、腹腔镜下食管全系膜切除在食管癌根治术中的临床意义.中国基层医药,2017,24(2):181-184.
[27]Lisik K,Krokosz A.Application of carbon nanoparticles in oncology and regenerative medicine.Int J Mol Sci,2021,(15):8341.
[28]李沈,李子禹,李双喜,等.纳米炭淋巴结示踪技术在术前行放化疗食管胃结合部腺癌根治术中的应用价值.中华消化外科杂志,2019,18(8):780-784.
[29]Liu BR,Ahmed MR,He D,et al.Endoscopic mediastinal lymph node identification and resection using carbon nanoparticles in a porcine model.Gastroenterology,2019,156(5):1250-1252.e1.
[30]Hosseini SM,Mohammadnejad J,NajafiTaher R,et al.Multifunctional carbonbased nanoparticles: theranostic applications in cancer therapy and diagnosis.ACS Appl Bio Mater,2023,6(4):1323-1338.
[31]Liu P,Tan J,Tan Q,et al.Application of carbon nanoparticles in tracing lymph nodes and locating tumors in colorectal cancer:a concise review.Int J Nanomedicine,2020,15:9671-9681.
[32]朱旭华,蔡茂明.胸段食管癌微创根治术后胃左动脉旁淋巴结转移危险因素分析.现代医学,2021,49(8):945-949.

备注/Memo

备注/Memo:
基金项目：河南省科学技术厅2020河南省重点研发与推广专项(科技攻关)研究(202102310117)；河南省高等学校重点科研项目计划(20B320029) **通讯作者，Email：fccwanggj@zzu.edu.cn
更新日期/Last Update: 2024-04-15