中文摘要：

目的探讨利用常规吻合器在胸、腹腔镜下行Ivor—Lewis食管癌根治、食管一胃胸内吻合术的短期疗效和安全性。方法2013年2月至8月，39例食管癌患者行全腔镜Ivor-Lewis径路食管癌切除、食管一胃胸腔内吻合术，男29例，女10例，均为中下胸段食管癌。先于腹腔镜下游离胃和腹段食管，行空肠造瘘术，然后在胸腔镜下游离胸段食管，切除肿瘤，清扫纵隔和胃周淋巴结。采用普通端端吻合器行胸腔镜下食管-胃胸顶吻合。结果全组手术顺利。无术中并发症，1例中转开腹。中位手术用时245min，出血量中位值210ml，术后中位住院时间7天。39例均为鳞癌，切缘均阴性，淋巴结清扫平均16．5枚。术后2例胃排空障碍；1例术后14天发生吻合口瘘，发现瘘1个月后瘘口愈合；1例发生肺炎、呼吸衰竭。无术后死亡。结论常规吻合器行全腔镜下Ivor-Lewis食管癌根治术可行，能完成所有开放Ivor—Lewis手术的步骤，其远期疗效仍需前瞻性的随机对照临床试验验证。

英文摘要：

Objective Totally MIIE with per-oral placement of anvil has been reported elsewhere, but MIIE with manu- al pursestring and per-thoracic port placement of anvil has been seldomly reported. The feasibility of the latter technique was proved in this study. Methods Patients with mid-lower thoracic esophageal cancer were prospectively treated with totally MIIE at Shanghai Cancer Center of Fudan University from Feberay 28, 2013 to August 31, 2013. Laprescopic intracorporeal con- struction of the gastric conduit and needle catheter J=tube were performed in the first stage of MIIE. In the second stage a hand sewn pursestring was made with endostitch system and the anvil of EEA stapler was inserted via the tenth inter costal port prior to the intrathoracic anastamosis. Short-term clinicopathalogic outcomes were collected. Results 39 cases were treated with to- tally MIIE, media age 61 years, ranged 48-69 years, 10 females and 29 males. There was 1 conversion to open surgery. The median duration of operation was 245 minutes. The median intraoperative blood loss was 210 ml. All the patients were margin negative and staged from pT1NOM0 to pT3N2M0. The average lymph node yields were 16.5 per patient. The median postoper- ative hospital stay was 7 days. There was no mortality. Perioperative morbidity occurred in 4 patients （ 10% ）. 2 patients were complicated with late stage gastric paralysis which began 2 or 3 days after oral feeding and both recovered in 1 month. 1 patient was with minor anastamotic leakage which was endoscopieally demonstrated on the 14th day postoperatively and the patient re- covered in 1 month post leakage. 1 patient was complicated with severe pneumonitus and ARDS; the ICU stay of that case was 19 days and the recovered patient was discharged 27 days postoperatively. Conclusion MIIE with regular EEA stapler and in- trathoracic anastamosis is feasible in patients with thoracic esophageal cancer. Prospective randomized clinical trials could be conducted to compare the open procedure and totally MIIE