上段食管癌的非开胸切除

No-thoracotomy of upper esophagus carcinoma

目的 探讨上段食管癌的手术治疗术式和操作要点。方法 回顾分析了我科 1 996年 4月至 2 0 0 2年 1 2月收治上段食管癌 74例患者 ,肿瘤下缘均在主动脉弓上缘以上 ,采用非开胸切除 ,胃或结肠代食管颈部吻合。结果 74例均顺利完成手术 ,32例上胸骨劈开 ,全喉全食管切除 5例 ,结肠代食管 6例 ,吻合口瘘 5例 ,肺部感染 2例 ,喉返神经损伤 2例 ,胃排空障碍 1例 ,呼吸衰竭死亡 1例。结论 本报告方法避免开胸、创伤小 。

Objective To evaluate the surgical procedure for the treatment and main points of the procedure of upper esophagus carcinoma.Methods 74 patients with upper esophagus carcinoma who had received surgical treatment in our surgery department from April 1996 to December 2002 were reviewed retrospectively. The patients were enrolled in this study. The lower line of tumors were above the convexity of the aortic arch. We used the methods of no thoracotomy and anastomosed esophagus replaced with stomach or colon in cervical part. Results 74 patients had completed successfully. 32 patients splitted the superior sternum, 5 patients total laryngectomy and total esophagectomy, 6 patients esophagus replacement with colon, 5 patients anastomotic leakage, 2 patients pulmonary infection, 2 patients recurrent laryngeal nerve injuried, 1 patient gastric emptying difficultly, 1 patient died of respiratory failure. Conclusions The advantages of the surgical procedure are obvious; a thoracotomy is avoided, thus minimizing the physiological insult of the operation; its simplicity and satisfactory results, and its wide application seem justified.