手術侵襲よりみた胸腔鏡下食道切除術の評価

Evaluation of Surgical Invasiveness of Thoracoscopic Esophagectomy for Thoracic Esophageal Cancer

　胸腔鏡下食道切除術の手術侵襲と術後呼吸機能の変動を通常開胸例と比較検討した．胸腔鏡下根治術を行った42例と，内視鏡下手術導入以前の内視鏡下手術の適応を満たす通常開胸下根治術施行23例を対象とした．手術時間，出血量，胸腔内出血量は両群間に差がなく，胸腔内操作時間は胸腔鏡例で有意に長かった．リンパ節郭清個数は両群で差がなかった．また，手術開始直前から手術72時間後までの血中interleukin−6値とCRP値の最高値は差がなかった．呼吸機能変動をみると，PaCO₂の変動には差を認めなかった．通常開胸術と同等の郭清を行った場合，胸腔鏡下食道切除術によって，手術侵襲の軽減は得られなかった．

The surgical invasiveness of esophagectomy and lymphadenectomy for esophageal cancer was compared between thoracoscopic surgery and conventional open surgery. Forty two patients with esophageal cancer esophagectomized thoracoscopically between July 1995 and August 1998 and 23 patients, who filled the indication for thoracoscopic surgery, esophagectomized through right thoracotomy before June 1995 were subjected. There was no significant difference in duration of total procedure amount of total or intrathoracic blood loss, whereas duration of thoracic procedure was significantly longer for thoracoscopic surgery than thoracotomy.