颈段、胸上段食管癌的外科治疗

Surgical Treatment of the Cervical and Upper Thoracic Esophageal Carcinoma

目的总结外科手术治疗颈段、胸上段食管癌(肿瘤上极距胸廓入口下方≤3cm)的临床经验,以提高手术疗效,减少术后并发症的发生。方法回顾性分析我院收治的142例颈段、胸上段食管癌患者的临床资料,其中行食管癌根治术122例,姑息切除术15例,总手术切除率为96.5%,探查术5例。主要重建手术术式包括:单纯剥脱胃代食管术、结肠代食管术、空肠代食管术、胸大肌皮瓣重建术;右胸-上腹-颈三切口胃代食管术、全喉切除+胃代食管术、管胃代食管术,左胸-颈两切口、胃代食管术。结果住院死亡5例,其中2例死于肺部感染,1例结肠坏死致严重感染,1例姑息切除后胃气管漏致肺部感染,1例胃大量反流误吸。9例患者食管上切端发现癌残留。8例颈段食管癌和21例胸上段食管癌患者术后发生并发症,主要包括空肠坏死、结肠坏死、喉返神经损伤、肺部感染、吞咽功能障碍、食管反流。随访117例,随访率85.4%(117/137),随访时间1～5年;失访20例。术后1、3、5年生存率分别为72%,48%和31%。Ⅰ、Ⅱ、Ⅲ、Ⅳa期患者的5年生存率分别为82.3%,61.2%,25.0%和5.0%。结论颈段和肿瘤上极距胸廓入口下方≤3cm的胸上段食管癌患者的手术治疗在手术方式、切除范围、术后并发症的防治、术后功能保留和恢复等方面尚需进一步探讨。

Objective To summarize the clinical experience of surgical treatment ior cervtcal and upper tnoracic esophageal cancer （the distance between the upper margin of tumor and the inlet of chest is/or less than 3cm）, so as to enhance the surgery curative effect and reduce the occurrence of complications. Methods Clinical material of 142 patients with esophageal carcinoma in the neck and upper thorax in this hospital were retrospectively analyzed. Radical excision were taken for 122 patients, palliative excision were taken for 15 patients and exploration were taken for 5 patients, total excision rate was 96.5%. The main type of surgical reconstruction technique includes： simple died of suffocation due to massive regurgitations. Tumor cells were discovered on the cancer edge of esophagus by pathology in 9 patients. Eight patients with carcinoma of the cervical and 21 patients with carcinoma of the upper thoracic esophagus were suffered from one or more kind of postoperative complications. Mainly complications consisted of the jejunum necrosis, the colon necrosis, the recurrent nerve damage, the lungs infection, the swallow {unction barrier, esophageal regurgitation. The total of 117 （85.4 %） survivals were followed up from 1 to 5 years, 20 patients were missed follow-up. The 1, 3, 5 years survival rate after surgical treatment were 72% ,48% and 31% respectively. The 5 year survival rate of the patients in Ⅰ,Ⅱ ,Ⅲ ,Ⅳa stage were 82. 3%, 61.2%, 25.0% and 5.0% respectively. Conclusion Further studies about operation mode, excision area, prevention for postoperative complication, preservation and reconstruction of normal function for patients suffering from the cervical and upper thoracic esophageal cancer （the distance between the upper margin of tumor and the inlet of chest is/or less than 3cm） is still expected.