食管和贲门癌2233例手术治疗结果

Result of Operation Treatment for Esophagus and Cardia Cancer of 2233 Cases

目的：探讨食管和贲门癌（Esophagus Cardia Carcinoma,ECC）手术治疗难点的处理。方法：1973年2月~2007年2月,施行手术治疗I-III期食管癌（Esophagus cancer,EC）1690例、贲门癌（Cardia cancer,CC）543例。男1679例,女554例,年龄23~82岁,其中40岁~69岁为1986例,占88.74%。切除ECC1999年3月前应用多种路径,1999年4月后完全经左胸或左胸左颈不切除肋骨,术中不输血。2004年元月后CC常规应用左胸腋中线为中心7、8肋间隙入胸小切口。癌肿距正常组织上下各切端为≤5cm及≥6cm切除。常规清扫三野淋巴结,中上段EC结扎胸导管。食管重建选择胄、空肠、结肠,应用Sweet、吻合器、分层吻合、延长食管胄黏膜单层宽边吻合法。结果：切除EC1602例（94.79%）、CC461例（84.90%）,探查EC88例（5.21%）、CC82例（15.10%）、术后发生并发症22种388例（17.36%）,术后住院期死亡54例（2.42%）,临床治愈1954例（87.51%）,好转31例（1.39%）,病情无变化87例（8.37%）,恶化7例（0.31%）,术后住院9日~46日,平均15.6日。结论：ECC有并存疾病、癌外侵重、放宽手术适应症、手术风险难度创伤大、术后并发症多。严格掌握手术适应症、重视手术路径、质量、技巧、吻合技术、加强术后监护治疗是手术成功的关键。

Objective：The treatment of the operation difficult point is discussed to Esophagus and Cardia Carcinoma（ECC）.Methods：From February 1973 to February 2007,we performed surgical operations to treat Ⅰ-Ⅲ Cardia Cancer（CC）1,690 cases and Esophagus Cancer（EC）543 cases.Among them：male 1,679 cases,female 554 cases,age 23-82 years old,among them 40 years old-69 years old took 88.74% for 1,986 cases,excised ECC to use many kinds of routes before March 1999,did not totally excise the rib through the left chest or the left neck of left chest after April 1999 and did not transfuse blood in the operation.CC routine used the left chest armpit centre line to enter the small notch of chest as a centre for interval of rib 7 and 8 after January 2004.All cut ends excised for ≤ 5 cm and ≥ 6 cm cancerous turgescence distance normal texture from head to foot.Conventionality cleaned rankin lymph glands,middle and upper section of EC ligature chest meatus.The esophagus rebuilding chose the stomach,jejunum,colon,applying sweet,anastomosing device to delaminate anastomosing and lengthen the anastomosing method of esophagus stomach single layer mucous membrane.Results：The result excised EC 1,602 cases（94.79%）,CC 461 cases（84.90%）,ascertain EC 88 cases（5.21%）,CC 82 cases（15.10%）;happened complications 22 kinds,388 cases（17.36%）after the operation,54 cases of death（2.42%）in hospital after the operation,clinical cured 1,954 cases（87.51%）,took a favorable turn 31 cases（1.39%）,the condition had not been changed by 87 cases（8.37%）,worsened 7 cases（0.31%）,9 days-46 days in hospital after the operation,average 15.6 days.Conclusion：ECC has compatible diseases,cancer from outside was heavily invaded,the relaxed operation indication,its operation is difficult and its wound is big,many complication after the operation.Grasp the operation complication,pay attention to operation route,quality,skill,anastomosing technology and strengthen the guarding treatment after the operation is the key of operation success.