胸腔鏡下食道癌手術—胸腔鏡下食道切除術と開胸術式との比較

Thoracoscoy and thoracotomy: A comparison between the two different approaches to the esophagogastrectomy for esophageal cancer.

　胸部食道癌の胸腔鏡下食道切除術（以下，ts）7例と従来の開胸先行，胸部操作，胃管による頸部吻合（以下，open）4例，開腹先行，（頸部操作），胸腔内吻合（以下，th anast）4例の術式を比較検討した．ts群に進行例，縦隔内リンパ節転移が多い傾向があった．いずれも胸腔内操作の時間，胸部の出血量に差はなく，胸腔ドレーンの留置日数はtsがopenより短かった．反回神経麻痺がts群で左右1例ずつ，右横隔神経麻痺が1例あった．切除リンパ節数は，縦隔，腹部ともopen群がほかの群より多かった．合併症と合わせtsに手技上の改善を要する．術後の疼痛はts群がopenに比べ少なく，肺活量の回復はts群が良好であった．

We applied three approaches for the surgery of the thoracic esophageal cancer : seven cases of eso-phagectomy through the postero-lateral thoracotomy followed by laparotomy and the gastric pull-up, (open), four operations in which the thoracotomy was substituted with thoracoscopy and four operations in which the laparotomy preceded the thoracotomy (th anast). In the last condition, the anastomosis was car-ried out inside the thorax. The following factors havebeen compared among above-mentioned surgical approaches.