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Total pharyngo-laryngo-esophagectomy (TPLE) is indicated for either cervical esophageal cancer or synchronous double cancer of the thoracic esophagus and head and neck and this operation is extremely ...invasive. We adopted minimally invasive surgery for three patients who underwent this operation : VATS (video-assisted thoracoscopic surgery) esophagectomy was undergone in left semi-prone position and laparoscopic approach was also applied to reconstruction with gastric tube. After pharyngo-laryngectomy and gastric tube pull-up through post-mediastinal route, cervical anastomosis was performed. Free jejunal interposition was added in a case, while microvascular venous anastomosis between short gastric vein and cervical vein in another two cases. All patients recovered well without any postoperative complications. This is the first report, which describes minimally invasive TPLE using both VATS and laparoscopic technique in addition with plastic surgery.
咽頭喉頭食道全摘術は，異時性同時性頭頸部合併食道癌症において適応となるが，大きな侵襲を伴う手術である．我々は，咽喉食摘が必要な3例に対して低侵襲な胸腔鏡下食道全摘，腹腔鏡下胃管再建を施行した．左半腹臥位にて胸腔鏡下に食道亜全摘を施行し，仰臥位になった後，腹腔鏡下に胃管作成を施行した．その後，咽喉食摘し，胃管は後縦隔経路にて頸部吻合をおこなった．胃管と咽頭の吻合距離が不十分な時は遊離空腸を間置し再建し，さらに短胃静脈と頸静脈を血管吻合した．全例大きな合併症はなく経過した．これらの手術に胸腔鏡腹腔鏡を用いることは比較的少ないため，当科での経験を報告する．続きを見る
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