经主动脉外膜下分离切除食管癌

Separating and excising aortic adventitia in treatment of esophageal carcinoma

目的探索经主动脉外膜下分离切除食管癌的可行性。方法距肿瘤0.5～1.0cm处剪开主动脉外膜,并经主动脉外膜下分离并完整切除肿瘤已累及主动脉壁的食管癌。结果1993年12月～2004年3月,共有8例累及主动脉壁的食管癌采用本项技术完整切除肿瘤,其中7例结扎切除受累的胸导管。手术顺利,无手术死亡,无术后并发症。食管鳞癌7例,腺癌1例,术中所见和术后病理均证实肿瘤没有穿透主动脉外膜。结论主动脉外膜对食管癌的侵入性生长具有很强的阻挡限制能力,经主动脉外膜下分离切除食管癌的手术方法是可行的,手术相对简便、安全、有效。

Objective To investigate the feasibility of separation and excision of aortic adventitia to treat esophageal carcinoma. Methods The aortic adventitia was incised by the edge of tumor about 0.5～1.0cm and the esophageal carcinoma that had invaded the aortic wall was excised completely by separating and excising the aortic adventitia. Results From December,1993 to March ,2004, the esophageal carcinoma that had invaded the aortic wall in 8 patiens was excised completely by this surgical technique. The invaded thoracic duct of 7 patients was ligated and cut. Squamous cell carcinoma was in 7and adenocarcinoma was in 1. There was lymph node metastasis of mediastinum in 5 cases and of peri-stomach in 3 cases. Intraoperative finding and postoperative pathology evidence that the tumor had not passed through the aortic adventitia. Operation was smooth and successful. There was no operative mortality and no postoperative complication. Conclusion The aortic adventitia possess a very strong capacity to restrict the invading of esophageal carcinoma.This surgical technique by separating and excising aortic adventitia to treat esophageal carcinoma is feasibility,safe, simple and convenient.