弓上纵隔胸膜完整并左侧颈部吻合的食管癌根治术

Integrated mediastinal pleura upon aortic arch and left cervical anastomosis in radical operation for esophageal carcinoma

目的:探讨保持弓上纵隔胸膜完整并左侧颈部吻合术在治疗食管癌中的疗效。方法:回顾性分析98例保持弓上纵隔胸膜完整行左侧颈吻合的食管癌根治术的临床资料,其中食管中段癌56例,中上段癌12例,中下段癌24例,双原发癌6例,癌灶长度(5.2±2.4)cm,TNM分期,I期6例,II～III期92例,病理报告均为鳞癌。结果:全部病例采用改良前外侧切口保持弓上纵隔胸膜完整并左颈部吻合术进行手术,手术顺利,无近期死亡、乳糜胸、呼吸困难、胃潴留、切口感染、严重的返流性食管炎等并发症,改善了患者术后生存质量。结论:保持弓上纵隔胸膜完整行左颈部吻合的食管癌根治术式,可有效地减小手术创伤,降低手术并发症,值得推广。

Objective To evaluate the therapeutic effect of remaining integrated mediastinal pleura upon the aortic arch and performing the anastomosis at the left cervix in radical operation for esophageal carcinoma. Methods Ninety-eight patients with esophageal carcinoma were treated with the operation mentioned above. Among them, 56 patients had cancer in the middle, 12 in the upper-middle, 24 in the lower-middle segments, and 6 had double-primary tumors, with carcinoma length of （5.2±2.4） cm. The TNM stages were 6 of Stage Ⅰ and 92 of Stages Ⅱ-Ⅲ. All cases were squamous cell carcinomas. Results All patients had satisfactory operation processes, without perioperative death, chylothorax, dyspnea, gastric retention, incision infection, and severe gastroesophageal reflux. The life quality of the patients was improved. Conclusion The radical operation with remaining integrated mediastimal pleura upon the aortic arch and anastomosis at the cervix for treating esophageal carcinomas is of minimal invasion with fewer complications, and may be used in clinical practice.