高位颈段食管癌的外科手术治疗探讨

The probe into the therapy of the surgical operation of the esophageal carcinoma of perch segment of neck.

目的探讨胃—咽吻合术治疗颈段食管癌的新途径。方法手术的关键是食管重建,胃的游离要充分,尽量避免对胃的挤压,吻合时将胃由食管床上提至颈部,这样可减少胃的张力,符合生理通道,食物下咽时可顺利通过,同时胃在食管床中,对心肺功能的影响亦小,有利于心肺并发症防治。结果术后一例死于多脏器功能衰竭,二例因胃壁坏死形成瘘口感染,经治疗而愈。其余35例恢复顺利,进食情况良好。结论凡高位颈段食管癌患者,如无手术禁忌,即使有颈部淋巴结转移,都应考虑外科手术治疗,术后再辅以化疗及放疗,这样可巩固手术疗效,提高治愈率及改善病人的生活质量。

Objective To evaluate a new treatment for the esophageal carcinoma of perch segment of neck by fitting the stomach and pharynx together. Methods The key of the surgical operation was the reconstruction of esophagus. The dissociation of the stomach must be plenty to avoid extruding the stomach, lifting the stom- ach from the esophagus bed up to the neck while fitting together, that could reduce the tensility of the stomech and coincide with the physiology passage, food could pass easily when swallowed. At the same time, the stomach was in the esophagus bed and had no influence on the function of heart and lung as well, which could cured the complication of heart and lung with advangtage. Results A case died of the multiple system organ failure, two cases were infected because of the stomach was mortified and formed fistula, which were cured after treatment, The rest of 35 cases recovered and took food well. Conclusions Any patients of the esophageal carcinoma of perch segment of neck without the surgical operation taboo must be cured by surgical operation, even if the cervix lymph had diverted, then carried out the chemotherapy and radiherapy after opertion, which could consolidate the curative effect of the surgical operation, raise the cure rate and improve the patient＇s living quantity.