颈段食管癌手术方式的选择

Comparison on Surgical Methods for Cervical Esophageal Carcinoma

目的:研究颈段食管癌不同手术方式的效果。方法:分析自1993年12月至2000年12月本院头颈外科和胸外科收治的52例颈段食管癌患者住院资料,采用非开胸内翻剥脱术32例;非开胸隧道式分离术5例;开胸食管切除术15例。结果:病理诊断均为鳞癌,上下切缘无癌残留,颈淋巴结转移6例(35.3%),无胸腔淋巴结转移。术后并发症发生率23.1%。术后随访非开胸手术组3、5年生存率分别为70.3%(26/37)、48.1%(13/27),开胸手术组3、5年生存率分别为66.7%(10/15)、45.5%(5/11),两组间无显著差异(P>0.05)。颈部及上纵隔转移为主要死亡原因占40.7%,局部复发死亡为14.8%。结论:无论是否开胸均行全食管切除,原发病变手术效果均满意,非开胸手术取同一体位便于清除颈部和上纵隔淋巴结以及周围受累的组织和器官。

Objective: To compare the effects on surgical methods of cervical esophageal carcinoma. Methods: Figty-two cases with cervical esophageal carcinoma treated in Head-neck Department and Chest Department of Henan Tumor Hospital, from 1993 to 2000, were reported. There were 39 males and 19 females, ranging from 39 to71 years old. In the patients, 32 with cervical esophageal carcinoma had been treated by non-open-chest inverting avulsion operations, and 5 patients treated by non-open-chest tunnel separate operations and 15 patients treated by open-cardiac esophagectomy. Results: No death occurred in operations, and all of the cases were squamous cell carcinoma. Postoperative complication rate was 23.1%. The follow-up data showed that three-years and five-years survival rate were 70.3% (26/37) and 48.1% (13/27) respectively for patients with non-open-cardiac operations and 66.7% (10/15) and 45.5% (5/11) for patients with open-chest operations. There was no difference between the two groups (P>0.05). Conclusions: The effect of whole-esophagus resection under open-chest or non-open-chest is similar and it, is a successful procedure for the primary disease in the patients. In non-open-chest operation, it is more convenient for the patient a constant body position to fulfill cervical lymphadenectomy and upper-mediastinum lymphadenectomy.