下咽及颈段食管癌不同修复方法的经验

Prognosis of Hypopha ryngeal and Esopkageal Caucers Treated witb Different Surgical Procedu res

自１９８１年４月～１９９１年４月用不同术式和不同修复材料对３９例下咽癌和２１例颈段食管癌行手术治疗。其中胃代食管术３３例，结肠代食管术２０例，肌皮瓣修复４例，胃大弯“胃管”代食管３例。下咽及颈段食管癌三年生存率分别为５８．８％（２０／３４）及６６．６％（１０／１５），五年生存率分别为３６．８％（７／１９）及４０％（４／１０）。死于局部复发的占４０．５％，死于颈淋巴结转移的占３５．１％。术前颈淋巴结阴性术后病理阳性率４２．１％；气管食管沟及上纵隔淋巴结阳性率２７．２％。对５例局部复发和８例颈淋巴结转移的患者再手术切除率分别是２／５和３／８。认为结肠代食管、结肠－咽吻合术更符合生理功能，成功率高，局部复发率低，生活质量好。

Thirty-nine cases of hypopharyngeal and 21 cases of cervical esophageal carcinomas were resected and different organs and tissues were used for reconstruction,Among them,the stomach was used as substitute for the esophagus in 33 cases the colon in 20,the myocutaneous flap in 4 and the gas-tric tube in 3. Three-year and 5-year survival rates were 61.2%and 37.9%respectively. Of the post-operative deaths within 5 years,40.5%was due to local recurrence and 35.1%due to metastasis to cer-vical lymphnode. In patients who had negative lymphnOde findings before operation, positive results were obtained in 42.1%of the cerical lymphnOdes and in 27.2%of the tracheoesophageal groove and superior mediastinal lymhnedes resected.Reoperation was performed in 5 cases with local recurrence and 8cases with cervical lymphnode metastasis and the resectabilities were 40. 1%and 37.0%respectively. The authors consider that among these operative procedures, the colonic interposition with pharyngo-colonic anastomosis had the following advantages:(1) excellent physiological function;(2)higher suc-cessful rate; 3)lower local recurrence incidence;and (4)gcod living quality.