體位對(duì)縱隔淋巴結(jié)的影響課件

2010新版分期中N的重新定義2010版分期中食管癌淋巴結(jié)引流區(qū)域胸腔鏡下如何做到縱隔淋巴結(jié)清掃？AdvantagesofradicalVAEthemagnifyingeffectofthesurgicalfieldandalterationoftheviewpointofthesurgeonVAEisperformedusingcommonvisualinformationsharedbyallofthesurgicalstaff.Udagawaetal.Rationaleforvideo-assistedradicalesophagectomyGenThoracCardiovascSurg(2009)57:127–131Disadvantagesofvideo-assistedsurgerylossofthree-dimensionalrecognitionlimitedtactilesensationThealterationoftheviewpointrequirestechnicallymoresophisticatedhand–eyecoordination.Udagawaetal.Rationaleforvideo-assistedradicalesophagectomyGenThoracCardiovascSurg(2009)57:127–131AdvantageofusingVATS(example1)TherightrecurrentlaryngealnervecanbeobservedinmoredetailedfashionwithVATS.IdentificationofitssmallbranchesanddissectionofthenervearemoreaccurateCorrespondingoperativefieldunderconventionalthoracotomy.rrln,rightrecurrentlaryngealnerve;rv,rightvagusnerve;rsc,rightsubclavianarteryAdvantageofusingVATS(example2)LeftrecurrentlaryngealnervecanbeobservedinmoredetailedfashionwithVATS.IdentificationofitssmallbranchesanddissectionofthenervearemoreaccurateCorrespondingoperativefieldunderconventionalthoracotomy.lrln,leftrecurrentlaryngealnerve;tr,trachea;sn,sympatheticnervebranch;ln,dissectedlymphnodes胸腔鏡下食管旁淋巴結(jié)清掃不存在爭(zhēng)議胸腔鏡隆突下淋巴結(jié)清掃規(guī)范的左上縱隔（喉返神經(jīng)旁）淋巴結(jié)清掃左側(cè)臥位時(shí)如何做到ThoracoscopicportsiteplacementforMIO:leftlateral

decubitusposition.A,B5-mmports.C,D10-mmports俯臥位的優(yōu)勢(shì)ThoracoscopicportsiteplacementforMIO:proneposition.A,

C5-mmports.B10-mmport俯臥位右側(cè)喉返神經(jīng)的顯露俯臥位左側(cè)喉返神經(jīng)的顯露ThoracoscopicoesophagectomyinpronepositionimprovesthequalityofdissectionTheoesophagusandaorto-pulmonarywindowarereachedunderexcellentvisibility,despiteapartiallydeflatedlung,whichbecauseofgravitywillalwaysremainoutofharmsway.Smalltomoderatebleedingwillnotobscuretheoperativefield.Dissectionwiththelongendoscopicinstrumentsismoreaccurateduetothesupportprovidedbytheentrancesiteattheparietallevelandtheergonomicpositionofsurgeon.G.B.CadieSurgEndosc(2006)20:1308–1309以在主動(dòng)脈弓上暴露左側(cè)頸總動(dòng)脈為標(biāo)準(zhǔn)評(píng)價(jià)不同體位下左喉返神經(jīng)的顯露Noshiro等認(rèn)為俯臥位有助于左側(cè)喉返神經(jīng)的顯露，減少損傷的幾率.NoshiroSurgEndosc.2010;24:2965-2973.中山醫(yī)院胸外科的臨床結(jié)果