体位对纵隔淋巴结的影响课件

2010新版分期中N的重新定义2010版分期中食管癌淋巴结引流区域胸腔镜下如何做到纵隔淋巴结清扫？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胸腔镜下食管旁淋巴结清扫不存在争议胸腔镜隆突下淋巴结清扫规范的左上纵隔（喉返神经旁）淋巴结清扫左侧卧位时如何做到ThoracoscopicportsiteplacementforMIO:leftlateral

decubitusposition.A,B5-mmports.C,D10-mmports俯卧位的优势ThoracoscopicportsiteplacementforMIO:proneposition.A,

C5-mmports.B10-mmport俯卧位右侧喉返神经的显露俯卧位左侧喉返神经的显露ThoracoscopicoesophagectomyinpronepositionimprovesthequalityofdissectionTheoesophagusandaorto-pulmonarywindowarereachedunderexcellentvisibility,despiteapartiallydeflatedlung,whichbecauseofgravitywillalwaysremainoutofharmsway.Smalltomoderatebleedingwillnotobscuretheoperativefield.Dissectionwiththelongendoscopicinstrumentsismoreaccurateduetothesupportprovidedbytheentrancesiteattheparietallevelandtheergonomicpositionofsurgeon.G.B.CadieSurgEndosc(2006)20:1308–1309以在主动脉弓上暴露左侧颈总动脉为标准评价不同体位下左喉返神经的显露Noshiro等认为俯卧位有助于左侧喉返神经的显露，减少损伤的几率.NoshiroSurgEndosc.2010;24:2965-2973.中山医院胸外科的临床结果