Lewis手术治疗胸段食管癌44例的临床分析

Clinical analysis on Lewis esophagogastrectomy for 44 cases of thoracic esophagus

目的 探讨Lewis手术治疗胸段食管癌的价值。方法 对 44例胸段食管癌先平卧位开腹游离胃、清扫腹腔淋巴结关腹后 ,重摆左侧 90°卧位 ,右后外侧切口开胸 ,游离胸内食管 ,清扫胸内淋巴结 ,吻合器主动脉弓上吻合。淋巴结转移以术后病理检查为依据。结果 本组病人全部治愈 ,无吻合口瘘、无死亡 ;胸腔内淋巴结转移率 5 0 % ( 2 2 /4 4) ,腹腔淋巴结转移率 2 7.3 % ( 12 /4 4) ,声嘶 8例 ,胰腹腔瘘 1例 ,肺部感染 3例 ,胃穿孔 1例。结论 Lewis手术治疗胸段食管癌 ,切除范围较广泛 ,吻合部位不受主动脉弓的影响 ,并能保证胸腹腔淋巴结的清扫 ,是安全、有临床价值的手术方法。

Objective To study the clinical value of Lewis esophagogastrectomy for carcinoma of thoracic esophagus.Methods Forty four patients with carcinoma of thoracic esophagus rewived lewis esophagogastrectomy from March 2000 to Suptember.Clearance of abdoment lymph nodes and pyloroplasty were perfomed via an upper midline abdominal incision.The patients were turned to left to lateral position.Though a fifth intercostals incision the esophagus was freed to the apex of the right pleural cavity,complete mediastinal nodes clearance was performed whenever possible.Pathological examination for lymph nodes were performed and results were analyzed.Postoperative complications were also observed.Results The rectuble rate was 100%.and there was no postoperative esophagogastric anastomic leakage and operative death.The common complications were pneumonia (3 cases),hoarseness(8 cases),gastric perforation(1 case),abdomen-pancreas fistula(1 case)50% of mediastinal lymph nodes metastasis and 27.3% of abdomen lymph nodes metastasis were found. Conclusion This was better exposure of operation field which made through dissection of lymph nodes possible,especially those along the right recurrens larynheal nerve.Better operation exposure also provided chances for verdict dissection with less interference from the aortic arch.It made anastomosis easier to perform so that stenosis and leakage were less likely to occur.Lewis esophagogastrectomy is a superior surgical procedure of choice for the treatment of cancer of thoracic esophagus.