食管癌、贲门癌手术入路的探讨

A study on operative approach for carcinoma of esophagus and gastric cardia

为了评估食管癌、贲门癌各种手术入路的优缺点，我们总结食管贲门癌手术2120例，其中病变位于食管颈、胸上、中、下段及贲门者分别为26、280、936、408、470例。经左后外侧剖胸，包括左胸、左颈两切口者1995例，并发症6．6％（133／l955）；经右胸一腹正中一颈三切口者58例，并发症24．1％（14／58）；颈腹二切口者20例；胸腹联合切口者39例，并发症7．6％（3／39）：经上腹正中切口者8例。认为左后外侧剖胸因切除肿瘤彻底、暴露良好、操作方便、创伤小利于恢复，能满足大多数食管癌根治术；对食管中上段癌尤其病变位于主动脉右侧者以右胸三切口更符合肿瘤切除原则，更安全方便。

To evaluate the operative approach for cancers of esophagus and gastric cardia.Method: Summarized the operative experince of 2 120 cases with these two cancers, and reviewed litera-ture on this problem. Results: 26, 280, 936, 408, and 470 cancers located in neck, upper-, middle-,lower thorax of esophagus, and gastric cardia respectively. Operations included 1995 operations via left- thoracotomy with complications in 6. 6%, 58 via lvor Lewis procedure with complications in 24. 1 %, 20via non-thoracotomy, 39 via left thoracotomy combined laparotomy with 7. 6% complications, and 8 viasole middle laparotomy. Conclusion: We held that left thoracotomy is the most suitable access for distalesophagus and gastric cardia cancer due to total cancer resection, better operative field, and slight trauma,and that lvor Lewis operation is one of the more reasonable approach for most of cancers located in middleand upper third esophagus of thorax.