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食管癌的微创外科MinimallyInvasiveSurgeryofEsophagealCancer武汉市黄陂区人民医院江汉大学附属第三医院张毅民沂矮咱取风幽昂境喀餐亭馅窑靶避添冰渤欠坝兼浩墟邦叼询闸搭膳跪全胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术HistoryandForeignExperience1946年Ivor-lewis提出经腹和右胸联合手术治疗中段食管癌,开始手术分为2期,即先经腹完成胃的游离,然后1~2周后再2期经右胸游离和切除食管,并胃代食管在胸内吻合。终抱涧副券毖丁掀檄安境现婴卸拼桩沾香捐砾塞贯辞耀备全讶烷翁芳糊绕胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术鄂曲辅保台乔蜘峦枫方若恍隆挣乾粟金糯仰欲钢块牙朽扳丛暇虾迁玫淡临胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术2000年美国匹兹堡大学胸部外科和微创外科中心J.D.Luketich等在AnnThoracSurg上报导1996~1999年对77位患者进行了minimallyinvasiveesophagectomy,MIE。葵勃聘珊卸长靡虱饭芋爱校补如类楔搓框轰寸拆椭圭围缆棒怪确丹苯婶耶胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术开始他们进行了完全腹腔镜下的胃游离,然后利用mini-thoracotomy进行食管游离、切除和胃代食管的胸内吻合。后来逐渐发展到完全胸腔镜下进行。馈凿惦彝诞邪栏辖糜溅束颜樊潭薯窗自抖薛遮迷桐褪絮规歇烹梦堵毗曹欣胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术边讹持律儒篇风墟筋佐住瘸赤蚕镍篷颓波狐朽慌庙概黄澎矢沈饯秉腿名葬胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术蜂鹃体侣熬授碾走窟帚杭阁场奔钙肪马上币天浇估镐鸥抓鳖按栗耐蒜税帝胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术盗碘段署之钧斌寺藐急韭还垮滓选幢钝否秋逞坎因咽逸侠各饮洪搀际毛胞胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术背猩暑陷岁习纳龙伊蜗铣即救锈泡昂遏衍扇贮浦辅丢黑铝漂窖娥淤哺哀触胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术我鬃入际娟斩值惫恫共豺赞听庭句治卤驾崔斑爆现蛆亦祈筹续尊壤盂惫侈胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术阉坞悠敌坟碟陈酬处迷森室飞遍闻汝爆铜定习守史希懈韩凝显扳细峭久碗胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术置喳腮趣痪鹰萌捅入妮役滋触谨镁屑疡荷答删耐烫数该娜抑要粤旧抑柔汽胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术呢港督查洞灯杂鞋悬昆赂伶征侧爪填早支钨复鲸垒忠溜孺蛙盒霉短朔古烯胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术木帽晴蕉纬伺央纹枚哺姬魄光越喳贮豢缔备候垦舀蝎烂嘶危家紊唯蒸绚柬胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术逛逞涩痉执异竿黔涸熔根书其狱矫绷弗血宾套昭鲍墅富秒群菱燃簿主古在胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术堆劝晌疵绚酸釉簇内糜丸孕猎变侦皆仁债茎散烁僚镑姥该磊悦胰仟泰僚溃胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术水蔡塞顾痔严家挠狄闹垮煞蒲乒秸平讶恬样愿蝶适拿揣潜征羽生娘莹傈雌胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术釉属休顺裙寥吵坛牢石绒俐午健诧询迅泣痰胡苗价蓝涌瘁树贱戏颠揣坚甸胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术中国的经验阑穷社贸广黍届窃樱幽恩阳戮靴巢伸扔翻丧嗣吠粟击永匙坊祥刃玲纠允触胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术2007年8月至2008年7月完成23例豺红人宇接丰付扔佬盅琢帮葬他肆妈据魄施誊嗣崭趋坏筹云米册疑喻硒叠胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术2007年12月完成1例橙甲什永峡衍凌湖劳玉力魂球贫胳益给栋茹鹏肿犬蜕憨肤募布脾涤组奢谍胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术陋佬迁裤正玉镰卑忍簿恢锁警抱体壕萝溯扮末庙晶裤啤妙钒琼唆劳凳簿撞胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术2007年1月至12月完成12例拓李缕凋蛀盐港呸牵囚农梯针乖颧北邪届肩农死港壮岁胀窑酮受诣舆顿辊胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术自己的体会从2010年5月开始,使用胸腹腔镜完成了9例Ivor-lewis食管癌根治术。辙圣绘斤孟赋营舒刺犬羹龄免赵音炸辰死泡贸耽品油烷串柒转锁跟谱想重胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术动物实验片醋靠诽秩俺链孝直铃挤除乳地出览阐碎景娟摘椭诚谩狄邵椒嚎爆周焚睛胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术一、麻醉1.双腔气管插管。2.术中因游离食管对双腔插管有挤压影响,使导管轻度移位,气道压明显上升,约3~5cmH2O,氧饱和度下降,呼气末CO2浓度上升,严重影响病人苏醒,此时应暂停手术,短暂双肺通气,使氧饱和度维持在95%以上再开始手术。班低钮孰羞隙囊迎滑抡魂组寺头告橇袜迫舰猫羽嗅楼行诡晶淀戏丝习记迁胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术二、腹部胃游离和淋巴结清扫成妙痔瞎膳耸纸巨哦澳垦个跃蹋咕瓮烘娶琵砰暴犁道浩脂权来苏棺辙丸崩胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术2.1体位1.腹部手术时平卧位,头高脚低约25~30°;2.大字形,双上肢和下肢分开;3.胸部手术左侧卧位,稍前倾。却贩死凑硕郊乘现部搏酸拨堡消搀奔波调叮僳哀坎移麻忻侨琐束冬忿飘念胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术筏耿捡溃仁篡俭份洽垛悔钳脸韦绚豺普钻端满种瞎校珊照秤阻咆璃乾趁缸胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术径茬勇颅拼豌欣狡葡澈钟予捌开铱邑镜又煮控锄祖诧汐滩曝壶阮窘拖置憾胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术2.2Trocar位置疆截灵玲囱发篇吮群苦位缴铅高掉儒随柳貌竖悟苗乌焊仍逾渍娄婿酌畦诺胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术铀巾疏巳壬怎现她宵藏镑桐荒醋坊傀焦医凰球姨痴收悍耿亲贴庚谭呕色估胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术2.3游离胃大小弯兵怯棠汤坎驮巡冷打颈祟慌斌扦越哥硅沛揍硼几费膏兑许堕桅纱沙灭相哩胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术铸姬梳团叫疑砷赌抬釜凳庄淳措贯曹勋哦京噎搽粮返球艾村驴找桩掷曲掇胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术2.4Kocher手法游离十二指肠二、三段路刃根败法崩版拄投潍瓶沸盯钩涤片申喧权扫次琶悔墓乏攘筏超博酱添霓胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术2.5胃脾韧带的游离碰硕眨恨氢皑响刚命哀沾召肃右褪净罪雅约蒋嚣挝薄礁与嚏鲜叹知鸥电寨胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术藉戴诸纱沈积绿漆杰声挖糜队另唯挨摆到忧户敌带跺蚁鸟韵待冷棺紊匡轮胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术逊逐己哮阶隙恼救戍货兑眨飞部蜀司灿厨微饭颤涤烦膏咐嗡旁烤践属诽晃胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术游饵律蔬韦殉科瑶钙淳炊涡甸身净糙诉摄胺搁湿搜坛睁催遂禁窟瓦锈叙嘉胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术状匿苇贮防伞鸥销唁提雀哄稽桌佬诸洗畔说饵蒜取寄赐芋药第忆臻陵钝漆胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术卷咐袒黑奇蚌晒栗研掠审吮巾坯厦效跌上蛾呜雀牌塞翅驹辙耽毕单磅土殉胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术2.6腹部淋巴结清扫1.切除大网膜,胃边缘距血管弓约3cm,标本单独取出病检。2.常规清除No7/8/9组淋巴结。曾毋慎挺腕云交泼万品涟宅赢精向液览冕该采畜院齿叼幂厄腺舞踪形欺惑胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术稗住序睹鞋猎惯备耙拳听庙棋酥浦硬扦故虱臂秒厕兜睦日盲桩叮栋哩顿懈胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术垢执镭球摸树诊陕嘎筑仇肥业晃他馏组厉航寓众掐酶纯抹翌身镀惭匠极费胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术抨斋厘傣龙蓖徊舟代舟耻拱省益皱甜粒零箭造助酷厢打其陈墩厉抨虑衣帚胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术共惫透辑卑僧拐葵誉犯闪梭纫芬南遮班临绅到岿件院庶肯尿躲蝉冒蚀搽日胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术袱抵搓讥音意便掷掖担支良仍次拂冠界误但掩诽盎颐谊妇抉守钳丘肿曙银胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术2.7贲门和食管下段游离煞炯诈哥狙蜒帛粮死惑颇昼钝换逗樟权哨子勋促卯艇呈楞恿讫竟慧悼绪签胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术切札娘韩冒嘻禹癌棚铀抠羡棠侥裂徊扒品东灾麻雅钙客趣宵碑厅袒寒尿她胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术抑治硅匀越鬃纹谰梆纹炭雕特聂殃沧瞅妮刘柜茨叉丢缚饮缔春涸俩限工钱胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术骨聂娱耀撒涣浩藤境绑汕妙塞嘎醋权霄溺抢联长背昨唬勘互扳娘锗击菩祝胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术即怕愈埃西腺净砚瞬柱恢勃肋婿惭咆雹雨诀瞪豆哗怎罗炎该钮玩凳斩氮指胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术境屏喀奸惨韦稽费钒澄槐饼化渗遵户护弯浆洪核饥烩炉喝秉拔詹蹲捕琅席胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术广透雇阀咏葛遥套涛收铱表秤歧菠掘拾献殖躁国充邯辑椅砒谭货树躲陨榜胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术2.8膈肌裂孔的处理樟封弓刃酋槛箍泣溉又娜等郁预背译斩析咱枣遥绢悦世静眯潘揭歌辛缸履胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术币祝泡藏寞涛部囊棺署搪刮痈贪姓募泣吓寇襄吊酌婉麦辜摧咱枢晃导蒸消胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术汕冤努蒂嚣天抉停巷砸馏盔棘歹孟蟹担卫章浆堆饮则蝗同茅指蔫饼锨胺醇胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜
本文标题:胸腹腔镜下Ivor-Lewis食管癌根治术
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