食管癌565例手术治疗体会

Experience in 565 cases of oesophagus cancer treated by surgical operation

目的总结手术治疗食管癌的诊治经验和教训。方法回顾性分析我院肿瘤外科及胸外科自2001年3月-2007年3月手术治疗食管癌565例的病历资料。结果565例手术,手术切除504例,切除率89.2%,术后并发心血管疾病22例,死亡3例;并发肺部感染18例,死亡1例;并发吻合口瘘17例(颈部13例,胸内4例),死亡3例;并发乳糜胸2例,均保守治疗治愈。结论术前全面了解病情,掌握肿瘤外侵及转移情况可提高手术切除率,正确的无张力吻合技术和良好的吻合口血运是防止吻合口瘘的关键,对于并存心血管疾病、慢性肺部疾病、糖尿病,加强监测和围术期处理可减少和避免其并发症的发生率和病死率,对于严重的慢性肺部疾病,尤其应注意加强支持和预防继发感染。

Objective Summary experience of oesophagus cancer treated by surgical operation.Methods Data of oesophagus cancer treated by surgical operation were retrospectively analyzed in department of tumor surgery and chest surgery in 565 cases of Nan Yang Medical College from 2001 March to 2007 March.Results Among 565 cases of surgical operation,Surgery excision were 504 cases,resection rate was 89.2%,there were 22 cases of cardiovascular disease after operation, including 3 death,there were 18 cases of lung infection,1death,concurrent anastomotic in 17 cases（13 cases were in the neck,4 case were inside the chest）,there were 3 death,Chylothorax was 2 cases,all were cure after conservative treatment.Conclusion Comprehensive understanding of the preoperative condition,grasping tumor outside invasion and metastasis could improved surgical operation resection rate.Good tension-free line anastomotic technology and good blood supply, which were key to prevent anastomotic leakage.Strengthen monitoring and perioperative management could reduce complications and to avoid its incidence and mortality for the patients complicated by cardiovascular disease,chronic lung department disease,diabetes.With particular attention paid to support and to prevent secondary infection for the patients with severious chronic lung disease.