Clinical Case Study Of Combination Of Thoracoscopic And Laparoscopic Esophagectomy With Circular Stapler Esophagogastric Anastomosis Via Left Cervical Route

Objective:As the thoracoscopy and laparoscopy develop, Thoracic surgery has entered into the Era of minimally invasion.How to have the patient get the best therapeutic effect under minimal trauma must be seriously taken into consideration by every thoracic surgery doctor. Nowadays, Combination of Thoracoscopic and Laparoscopic Esophagectomy are increasingly applied in clinical esophagus carcinoma treatment. This article aims to compare the therapeutic effect of recent period between Combination of Thoracoscopic and Laparoscopic Esophagectomy and Circular Stapler Esophagogastric Anastomosis Via Left Cervical Route and the traditional thoracic surgery, Meanwhile, analysis the value of clinical application and deficiencies which need improvement.Methods:retrospective study the clinical surgical datas of 368 patients who underwent combination of thoracoscopy and laparoscopy+left cervical esophagogastric anastomosis, and 132 patients who underwent traditional thoracic surgery during January 2011 to December 2015 in Department of Thoracic Surgery of Qilu Hospital. Comparative analysis the short-term records during recent period of the two groups (endoscope group and thoracic group), such as time of operation, average median blood loss, lymph nodes dissection and positive rate, flow of the first day after surgery, total flow after surgery, the time of postoperative extubation, times of postoperative analgesia, the average hospitalization time after surgery, postoperative complications and so on. Compare and evaluate the superiority-inferiority of the two kinds of surgeries on short-term efficacy.Results:All the patients taken into comparison were proved to be esophageal carcinoma in the middle-lower section, and there are no statistic differences of age, sex or clinical pathologic staging between the two groups. Considering the average median blood loss, times of postoperative analgesia, the rate of postoperative arrhythmia, the rate of lung infection, the rate of chylothorax, the combination of thoracoscopy and laparoscopy group was better than traditional thoracic surgery group (p< 0.05); While considering time of operation, flow of the first day after surgery, the traditional thoracic surgery group was better than combination of thoracoscopy and laparoscopy group (p< 0.05); In lymph nodes dissection and positive rate, total flow after surgery, the time of postoperative extubation, the average hospitalization time after surgery, the combination of thoracoscopy and laparoscopy group has few significant statistics differences compared to traditional thoracic surgery group (p) 0.05); The combination of thoracoscopy and laparoscopy group was then separated into two groups by the operation date, the early group including 200 patients and the later group including 168 patients for hierarchical analysis. In later Thoracoscopic and Laparoscopic Esophagectomy,the average bleeding, times of postoperative analgesia, the rate of postoperative arrhythmia, the rate of complications,such as lung infection, chylothorax, obviously declined than the early surgeries. While the cervical anastomotic fistula (about 10%) remains to be improved.Conclusions:Taken safety and thoroughness into consideration, the two kinds of surgeries both had its own superiorities. These two kinds of surgeries both are optional for esophagus cancer therapy. As the experience of minimal invasive operation accumulated and the surgery instruments develop, the patients get minimal invasion, more effective and few rate of complications, the Combination of Thoracoscopic and Laparoscopic Esophagectomy with Circular Stapler Esophagogastric Anastomosis via Left Cervical Route enjoyed satisfactory short-term results and, In a word,worthy of clinical promoted application.