食管次全切除在食管癌外科治疗中的价值

The Value of the Subtotal_esophagectomy in the Surgery of Esophageal Carcinoma

１９８５～１９９５年共为１２１例食管癌患者施行了外科手术，其中食管切除术１００例，转流术１２例，单纯探查９例。切除组中食管次全切除、胃（８３／１００）或结肠（２／１００）＿残食管颈部吻合术８５例；食管部分切除、食管胃胸内吻合１５例（弓上７例、弓下８例）。８２％（７／８５）伴发颈部吻合口瘘，均行保守治疗治愈。１５例胸内吻合者术后均有消化道症状，而颈部吻合者只有２４７％（２１／８５）有消化道症状。作者认为：食管次全切除、颈部食管重建更符合肿瘤广泛切除的治疗原则，也接近食管的生理功能与解剖要求，减轻了术后以反流为主的消化道症状。手术操作方便，便于处理与吻合口有关的并发症。

From 1985 through 1995 a total of 121 patients underwent surgery for esophageal carcinoma in our department. Among them 100 resections, 12 by_pass operations, and 9 sole_explosion were performed, for a overall resectability of 83%, of the resections 85(85%) were subtotal_ esophagectomy with cervical anastomeses and 15 (15%) partial_esophagectomy with intrathoracic anastomeses. The stomach was used as substitute for the esophagus in 98% compared with 2% colon transplants The clinical results and information from docunments support the surgical oplicy we have persued thus far: subtolal esophagectomy with cervical reconstruction having more advantages than partial esophagectomy with intrathoracic anastomoses.