经裂孔食管切除术在食管癌外科治疗中的评价

Evaluation of transhiatus esophagectomy for patients with esophageal cancer

目的评价经裂孔食管切除术在食管癌外科治疗中的作用。方法总结分析2000年5月至2007年7月单一外科医生组对46例食管癌患者实施经裂孔食管切除术的病例资料。结果本组患者食管鳞癌44例，食管腺癌1例，食管类癌1例。位于颈段者11例，胸上段者21例．胸中段者5例，胸下段者9例。行术前化疗者6例。按国际TNM分期：0期者3例；Ⅰ期者6例：Ⅱa期者17例；Ⅱb期者2例；Ⅲ期者16例；2例为化疗后病理完全缓解。胃代食管者42例，结肠代食管者4例。术前肺功能FEV1低于0．8L或FEV1／FVC低于50％者29例。46例均获切除,切缘阴性，无手术死亡。术后声音嘶哑2例，心律失常3例，双侧胸腔积液1例，6例出现小的颈部吻合口瘘。结论经裂孔食管切除术在食管癌的外科治疗中对高龄、心肺功能差而不能耐受剖胸手术患者是理想的选择。

Objective To evaluate the transhiatus esophagectomy for patients with esophageal cancer. Methods Clinicopathological data of 46 patients with esophageal cancer undergone transhiatus esophagectomy by single surgeon team from May 2000 to July 2007 were analyzed retrospectively. Results These 46 patients included 44 esophageal squamous cell carcinomas,1 esophageal adenocarcinoma and 1 esophageal careinoid. The lesions of 11 patients located at neck segment, 21 at upper segment, 5 at middle segment, and 9 at lower segment. All the patients were classilqed according to UICC TNM stage classification：3 cases as stage 0, 6 cases as stage Ⅰ , 17 cases as stage Ⅱ a, 2 cases as stage Ⅱ b,16 cases as stage Ⅲ. Six patients received preoperative chemotherapy and pathological complete response was seen in 2 cases. Reconstruction with stomach was performed in 42 cases and with colon interposition in 4 cases.All the tumors were resected, and there was no perioperative death. All the resected margins were pathologically clear. Postoperative complications occurred in 12 cases and were successfully treated, including 2 cases of hoarseness, 3 cases of cardiac arrhythmia, 1 case of bilateral pleural effusion, and 6 cases of small anastomotic leakage at neck. Conclusion Transhiatus esophagectomy is an ideal choice in surgical treatment for patients with esophageal cancer, especially for the ones of aged, poor cardiac or pulmonary function, who can not afford the thoracotomy.