左开胸食管癌切除食管胃颈部吻合术3169例临床分析及评价

Surgical treatment of esophageal carcinoma with cervical esophagogastrostomy by left thoracic esophagectomy

目的评价左开胸食管胃颈部吻合术治疗食管癌的疗效。方法回顾性分析河南省肿瘤医院胸外科1990年1月至2000年12月间3169例左开胸食管癌切除、食管胃颈部吻合术的临床资料。结果全组术后并发症发生率为8．6％（273例），手术病死率为0．6％（19例）。手术后的1、3和5年生存率分别为81．5％、51．6％和32．1％。对部分术后患者行消化道压力检测后发现：吻合口上方食管的静息压力值为（16±11）mmHg，明显高于正常人该处食管的压力（P〈0．01）。结果显示在吻合口上方食管产生了新的压力区。结论食管癌切除、颈部吻合的术式能够更好地保证彻底切除肿瘤，应成为治疗食管胸上、中段癌的首选术式在临床上推广和应用。此外，由于吻合位置较高和吻合口上方食管压力区的形成，故在直立及半卧位时在重力的作用下发生反流的概率要小于胸内吻合，因此具有更好的生存质量。

Objective To evaluate the effects of surgical treatment with cervical esophagogastrostomy by left thoracic esophagectomy on esophageal carcinoma. Methods The clinical data of 3169 patients with esophageal carcinoma, 2115 males and 1054 females, aged 60.9 （30-82）, that underwent cervical esophagogastrostomy by left thoracic esophagectomy from Jan. 1990 to Dec. 2000 were analyzed retrospectively. Results The incidence of complication was 8.6% （273）. The operative mortality was 0.6% （19）. The 1, 3, and 5 year survival rates were 81.5%, 51.6%, and 32.1% respectively. Manometric examination of the digestive tract showed that the post-operative resting pressure of residual esophagus above the anastomotic stoma was （16 ± 11 mm Hg）, significantly higher than that of the cervical esophagus of the normal controls [（ 4 ± 3 ） mm Hg）, P 〈 0.01 ]. Conclusion Reducing incidence of gastroesophageal reflux and improving the quality of life of patients, cervical anastomosis should be recommended as the first choice procedure in treatment of upper and middle segment esophageal carcinoma.