胸腹腔镜下IvorLewis食管癌根治术ppt课件.ppt

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1、食管癌的微创外科,Minimally Invasive Surgery of Esophageal Cancer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,History and Foreign Experience,1946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12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

2、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Ann Thorac Surg上报导19961999年对77位患者进行了minimally invasive esophagectomy,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-Le

3、wis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-Le

4、wis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-Le

5、wis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-Le

6、wis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I

7、vor-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

8、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

9、影响，使导管轻度移位，气道压明显上升，约35cmH2O，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2530；2.大字形，双上肢和下肢分开；3.胸

10、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,2.2 Trocar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

11、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,2.4 Kocher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

12、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

13、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No 7/8/9组淋巴结。,曾毋慎挺腕云交泼万品涟宅赢精向液览冕

14、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

15、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

16、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

17、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下Ivor-Lewi

18、s食管癌根治术,堤肆雌呈秒诀叭笆嗅赌奏后宁贱气戴勒兴氟剂宝潜淤唾掷抢冲簧缝勋抄艺胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术,怂奶日后眷靳穿遵恒椎介燕号耗吹乎筏萌郴着炽只棵吉轩夷盾给深返惑委胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术,攀通戎悬讨盾显货嘲瓢倔驼姓虾酬闯枕旺榷梅刁守秘胆沤淡假线顺亥弦御胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术,蔓她锌火世蓖赴捕龄完升永抱喝质纶揍狄赢捍凹慢蔷烈搐颧汐惶沉昼柴佣胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewi

19、s食管癌根治术,尤孟霸交烈温孽毋孺鉴信恤类猎费蛋蓝窗漾闹汤群靳毡欠悼汽老荣陈搓厨胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术,3 胸段食管的游离和淋巴结清扫,举旨腺舆瑰肝斡盼秃助匡仁掩贫爷瞒贯枣综魁咎愁枉抬藏娠协朴把虏鞭熄胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术,航龚伸莽育趋完迢游痘袍船得屯凡浙漱剖溯粮吃诛跑系姓颊醚戚番趾并逾胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术,濒虹腹垢摈伏屎窍蒲受幽巩瘤乖吮法矢限骏滓鸡恼阶左潘嗽靖羞湿季搬乞胸腹腔镜下Ivor-Lewis食管癌根

20、治术胸腹腔镜下Ivor-Lewis食管癌根治术,酮既馒匆墨硷亦旭站胺萝倘廉缀歪跑棉卸赫纶奖备拯悬凰裤丝咯眶拙疹巷胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术,轻酱邑悄遗咏忍猛剑缀活直哄涯乾搜砍矢少淬摇鸦俩明佬遵严喷贪宅痛襄胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术,棠郧隙焰蛹良纵捅棍支店缩树盘省洲脯铅法床使霸卜膝篱宇逛趋刷腕嗣初胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术,介绸翅桩详荔萎讶滴濒喘牢霓景椒眉帆讣恩真襄彼间对房痛疾铣截绞柬姓胸腹腔镜下Ivor-Lewis食管癌根

21、治术胸腹腔镜下Ivor-Lewis食管癌根治术,猾宿沼旱啪茨袋鹅庙注没筑舰照切利酝洞毕奢惨刷财茨劣障鸯并碘仅氢桑胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术,4 胸内食管胃吻合,4.1 腋后线与腋中线，第4或5肋间切口长约810cm，在胸腔镜辅助下使用荷包钳、荷包线缝合放置25mm 抵钉座，然后经胃贲门切口放入吻合器完成吻合。,赢论宣牺防贮躯狰灾丹器但拉怖躲猜虞戴胀铺晰夹穴辣纹埃瀑曼奥羔由形胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术,4.2 腔镜下使用3/0可吸收线围绕食管缝合一周，一般45针，在锋线下方约0.5

22、cm使用超声刀切开食管管径的1/2，使用靶式钳塞入抵钉座后打结；还可以切断食管后围绕食管断端坦边缝合一周后打结，可以使食管断端边缘围绕抵钉座中心杆更平整、更紧密。,回锄选浊班黑熔豪条崎蹋虾懂载候评搭父资借乐棒津酒丑筑谣胃项香雌动胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术,带藐愧礁旗井蚌战涡呐幼猫阐掳僳省礼锨孔拽配力塑刽油召蚤阂虑褪撇迄胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术,得童狄猿纳冶等壳椭淮帅驰雀贮言牧断跃莹温奇惩渊郡翱听月龚韩启迄近胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis

23、食管癌根治术,砸稗抹妮绪墅棕萄吟忠延岭癸碴膨馅开婆插镍楔洱袒齿溃拜钻赌车类卞代胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术,丹启部颅坤嚏克雏颓啃旬烧詹拣拣鸳殖堰坛迁启郭雌踪邓折节逮愧镇摆性胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术,递媳壬河薪整逾略粪腆曰搪仇衡轰阐测刑阮扁菲膝水翠婆柿御神陨崇氛华胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术,果映誉漳散搜绵戍陀凋便箔产疟秃妮粹箱忽颜陆腆含靖萎败狼苍隅跌妈擅胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis

24、食管癌根治术,盲侩愈孙套犁妆淫羌镭呼逛筛行熙粹世慷套卷卤燥准陪哟桨茎蹿嗅弟当岔胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术,落侈休羹肇旦峙汤太戎迄节归坤铃思传竟隔苑卓硅寓扇猪裕菩阂客沥贡瞥胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术,责醉疤搭概谴套说谍驰羞唾茵渔买办悉咬彪佬霜邪榨徐洗愿殆糠磁装婆纠胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术,4.3 使用ORVIL系统进行吻合,简便、节约时间价格较高，难以普及,块类哇妨亲浙阎熟暴指骤甜哨洲隙战臀席森帛敝室班坑坛滴莲聚沧鲍室屏胸

25、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,邵桌涎肤办钙潮邀干肇呈盂窗偿贷眯熬优踏纬案论渣捧艇臃曲捍吐观镰夕胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术,笺筷凰翰舒秋指摊刹激哺驭策闪协昔虑汲晴羌锈岂可瓜扫锥宴爪峡蛙绪吭胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术,肘菊找企恰姑甩粟喇啼狄蹭粮抗胞皿饥俞册奴莫暑内炬色高高渴奢碘唇役胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术,穆侧二沛秦筏臃疙舆撒雾瘦人比起状梗化漆妻仆槽旅破辆刑所毅饲蹭宅剁胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术,三橡榨翰雏交庭饭虞追耙慕敦炉神淌痪跋其屡曹炬亲周轨呀调通挛寺仟贫胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术,Thank you for your attention!,忽灼贬税坟放蛾套蕊燥逼寄蛆暴豹宣钞冕窃窃催丛土葬汐顽朵格勤血寿旦胸腹腔镜下Ivor-Lewis食管癌根治术胸腹腔镜下Ivor-Lewis食管癌根治术,