摘要
〔目的］评估食管中段癌经右胸、颈、上腹三切口切除后胃经胸骨后隧道与颈部残留食管吻合术的实用价值。（方法）将病变长度大于5cm的食管中段癌16例，右侧进胸将购段食管及区域淋巴结切除后，进腹游离胃并清除胃周淋巴结，将胃经胸骨后隧道上提至颈部与颈段残留食管吻合，然后再清扫下颈部淋巴结。（结果）16例中，10例行根治性切除，其余6例为姑息性切除；吻合口瘘发生率为37.5％，但均经恰当的引流后治愈；无心肺并发症发生。（结论）“三切口”术式切除食管中段癌符合肿瘤外科的治疗原则，而食管中段癌切除后胸胃经胸骨后上提至颈部与颈段残留食管吻合是可行的，对中晚期食管中段癌估计术后需辅助性放疗的病例可选择此术式。
(Purpose) To appraise the pratical value of surgied managment for midddle third esophageal carcinomas: after resection of the carrinoma by right cbest, neck and upper abdominal 'three indsions', pulling up stomach substemally to anastomose with the residual neck esophagus, (Methods) 16 cases of middle third esophageal carcinomas of which the lesions were more than 5cm in length treated surgically as following: right thoracotomy for dissection of the carcinoma and regional lymph nodes. Laparotomy to mobilize the stomach and dissect the paragastric lymph nodes, then pulling the stomach up through the subsernal canal to anastomose with the residual esophagus in the neck. Lower neck lymph node dissection was done afterward. (Results) Among the 16 cases, 10 were resected radically, and the others wer resected palliatively- Anastomotic leak occurred in 37. 5%, but all the leakages were cured by prope drainage No cardic and pulmonary complication occurred. (Conclusions) 'Three incision' approah for resection of midddle third esophageal carcinomas aocords with the therapeutic principle of oncological surgery, and the substernal route by which the stomach is pulled up to anastomose with the residual esophagus in the neck is feasible. This procedure can be applied for advanced middle third esophageal carcinoma for which adjuvant radiotherapy probahly be used postoperatively.
