36例食管癌穿孔的手术治疗

Surgical Treatment of Perforation in Esophageal Carcinoma:A Report of 36 Cases

目的:探讨手术治疗食管癌穿孔的理想手术方法及围术期治疗特点。方法:对36例食管癌穿孔(其中穿入右肺14例,穿入纵隔17例,穿入气管5例)患者进行手术治疗。开胸手术34例,其中右胸三切口术式16例,分期手术15例。34例中经胸骨后间隙胃或结肠代食管26例。结果:31例患者获得手术成功,手术死亡3例。术后随访3～72个月,其中生存7～12个月15例,24个月2例,72个月1例,疗效较为满意。结论:手术治疗食管癌穿孔效果较为明显,优于一般保守治疗。手术方式以右胸三切口术式(胸骨后胃或结肠代食管)或分期手术为佳。

Objective： To study the ideal method for esophageal carcinoma and the characteristics of perioperative surgical treatment of perforation in treatment. Methods： Thirty-six cases with perforation in esophageal carcinoma were treated surgically in this series, among which 14 occurred at the right lung, 17 in the mediastinum and 5 in trachea. Open thoracic surgery was performed in 34 cases, in which the method of right thoracic approach with 3 incisions was applied in 16 cases, and staging-operation in 15. Of the 34 cases, retrosternal substitution of esophagus with stomach or colon was conducted in 26 cases. Results： Surgery was successful in 31 cases and intraoperative death occurred in 3 cases. The postoperative follow-up study was from 3 to 72 months, among which 15 cases alive in 7 to12 months, 2 in 24 months, and 1 cases 72 months. The results can be considerd satisfactory. Conclusions： The therapeutic result of surgical treatment of perforation in esophageal carcinoma is markedly superior to that of conventional conservative treatment. The authors suggest that surgical intervention without delay should be undertaken for patients with perforation in carcinoma of the esophagus using the method of right thoracic approach with 3 incisions （retrosternal replacement of esophagus with stomach or colon） and the staging operation is preferable.