不需“开胸剖腹”，“小切口”完成胸科“大手术”

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近日，成都市郫都区人民医院外三科先后成功完成多例“胸腔镜联合腹腔镜食管癌根治术”，此项手术的成功开展标志着我区食管癌微创治疗取得新突破，跻身我市先进水平，为我区及周边食管癌患者提供了更为优质、高效、便捷的医疗服务，以实际行动助力实现“大病不出区”的目标。

64岁的马大爷家住汶川，近两月来吃饭总觉得咽不下去，遂来到成都市郫都区人民医院检查，不料想因吃饭咽不下去，竟是得了食管癌，谈癌色变，全家人都陷入了不安。

食管癌是常见的消化道肿瘤，我国是世界上食管癌高发地区之一，发病年龄多在40岁以上。食管癌典型的症状为进行性咽下困难，先是难咽干的食物，继而是半流质食物，最后水和唾液也不能咽下，所以早发现、早诊断、早治疗至关重要。

食管癌

制定个体化治疗方案

在检查过程中，发现马大爷有较严重的冠心病，但手术治疗是治疗食管癌的首选方式，但传统开胸手术治疗风险极大，面对患者及其家属对医院和医务人员的信任，胸外组主治医师张智光立即邀请心血管内科、麻醉科会诊，并根据马大爷的病情制定了详细个体化治疗方案，最终选择创伤小、出血少、疼痛轻、恢复快且在我院较成熟的新技术—

胸腔镜联合腹腔镜

食管癌根治术

200分钟

充分准备后，马大爷的手术开始了。

马大爷从推入手术室到手术结束苏醒总共耗时不到200分钟，手术操作是在9个不到1公分的切口内通过微创手术器械完成的。这9个小孔替代了传统手术造成胸腹部近50公分的大切口。其中，胸部有4个小切口，主要是游离胸段全部食管，清扫食管旁淋巴结，切除癌变部位，腹部有5个小切口，用于游离全胃，清扫淋巴结，并将胃做成管状，最后将胃拉至颈部进行吻合，这就是手术全过程。

手术第二天，马大爷已能与前来查房的医生互动，并能下床活动，未出现并发症，6天后拔除胸部引流管，一周后开始进水，现已出院。

#微创手术优点#

传统食管癌根治术是以经胸腹二切口或颈胸腹三切口手术，手术创伤大、失血多、时间长、术后并发症多，目前是外科三个特大手术之一。此微创方式避免了传统手术大切口才能完成的食管癌根治术缺陷，其优点是对胸部和腹部脏器影响小，手术创伤小，患者术后疼痛明显减轻，术后康复快，大大降低了术后并发症风险，手术效果明显优于传统手术方式。

胸腹腔镜下术野更清晰，可最大程度地避免术中血管损伤，淋巴结清扫也更清楚，提高肿瘤的根治性。

优秀论文

评选现场

近年来，我院积极致力于微创腔镜技术，先后派出多名医务人员到四川大学华西医院、四川省人民医院等大型医院学习微创腔镜技术，在熟练掌握腔镜技术的基础上，先后开展了肺大疱、纵膈肿瘤、食管良性疾病、食管癌、肺良恶性肿瘤等多种胸部疾病的微创治疗，同时，张智光主治医师凭借论文《三野淋巴结清扫与二野淋巴结清扫在胸中上段食管鳞癌治疗中临床疗效的回顾性研究》获得第十三届全国食管癌学术大会优秀论文奖，为成功开展腔镜下高难度手术奠定了基础。

注意咯！

温馨提示

若出现哽噎感、异物感、胸骨后疼痛不适感以及喛气、反酸甚至呕吐，千万不可大意，要到正规医院就诊。

专家介绍

张智光

主治医师，中共党员。现任郫都区人民医院团支部书记，毕业于川北医学院临床医学专业。从事工作近10年来，在胸外科临床、教学方面具有丰富的经验。曾先后于四川大学华西医院心胸外科、上海胸科医院胸外科、四川省肿瘤医院胸外科进修学习。在胸外科常见病、多发病及疑难病的诊断和治疗方面具有丰富的临床实践经验，尤其擅长食管肿瘤、肺肿瘤、纵隔肿瘤、胸壁肿瘤、肺大疱、气胸、胸腔积液、脓胸、肺脓肿、肋骨骨折、胸骨骨折等疾病的诊断和治疗。目前专注于胸科创伤及肿瘤专业，擅长食管、肺、纵隔、胸壁的微创手术治疗。

坐诊时间：周四上午

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