食管癌切除结肠代食管术44例

Esophagectomy and Colonic Interposition in Treatment of Esophageal Carcinoma: Report of 44 Cases

我们于１９８９年３月至１９９３年８月间，为４４例食管癌病人行食管癌切除、结肠代食管术。包括上段癌２３例，中段癌１８例，下段癌３例；其中上段癌病变长于７ｃｍ者６例，中段癌病变长于８ｃｍ者５例及下段癌中２例既往曾行胃大部切除术且病变长于９ｃｍ者均先行术前放疗，放疗剂量为３０～４０Ｇｙ。４０例（９０．９％）以结肠左动脉升支供血的横结肠行顺蠕动方向吻合，结果手术死亡１例，颈部吻合口瘘９例（２０．４５％）。我们认为本术式对中、上段癌病人疗效较满意，建议多采用以结肠左动脉为血供的横结肠作为移植段行顺蠕动方向吻合，为减少术后并发症，应注意加强病人围手术期的处置和护理。

Forty-four patients with carcinoma of the esophagus were treated with esophagectomy and colonic interposition in our hospital between 1989￣1993.Among them, 23 were upper segment carcinoma, 18 middle segment and 3 lower segment (of which 2 received gastrectomy more than 25 years ago).11 patients received preoperative radiotherapy since the tumors were longer than 7cm (6 in upper segment,5 in lower segment),40 patients (90. 90%) received reconstruction operation with the isoperistaltic transverse colon.There was one operative death and nine cervical anastomotic leakage (20.45%).We consider this type of operation with routine use of the transverse colon for reconstruction is more suitable for patients with esophageal carcinoma in the upper or middle segment.The left colonic arterial blood supply should be preserved and the interposition of the transverse colon should be isoperistaltic.More attention should be paid to enhancing the perioperative treatment and care of the patient in order to reduce the postoperative complications.