晚期食管癌联合气管部分切除术式探讨

Advanced esophageal cancer surgical resection combined trachea method is discussed.

目的探讨晚期食管上、中段癌外侵至胸段主气管或左、右主支气管膜部及侧壁,联合气管部分膜部及侧壁切除,气管纵形缝合或自体心包片气管修补术的适应证和治疗效果。方法选择26例食管癌外侵至气管膜部及侧壁患者(其中食管胸中段鳞癌16例,食管胸上段鳞癌患者10例),食管胸上段癌经右胸-颈-腹三切口联合胸段气管侧壁及膜部窗形切除,气管纵行缝合术或自体心包片气管膜部及侧壁修补,食管胃颈部吻合术;胸中段食管癌经左胸后外侧切口,联合左或右侧主支气管膜部、侧壁开窗切除,自体游离心包补片气管修补术,食管胃胸内吻合术。结果26例患者无气管瘘发生,3例气管轻度狭窄,4例术后咳痰困难,经纤支镜吸痰,痊愈出院。结论食管癌联合气管部分切除,可明显提高食管癌的切除率和远期生存率,避免食管-气管瘘发生。

Objective To explore the advanced esophageal cancer in the middle, and the trachea thoracic segments or left and right mainstem membrane and wall part of membrane, joint trachea and wall resection, tracheal longitudinal shape or autogenous pericardial slice tracheal repair indication and therapeutic effect. Methods the eases of esophageal carcinomas and trachea membrane and wall to patients （including esophageal squamous cell carcinoma in 16 cases for breast, breast esophageal squamous cell carcinoma patients in 10 cases）, esophageal cancer on the chest for the right chest - neck - abdominal incision combined three thoracic segments tracheal wall and window form of membrane, tracheal longitudinal sewing or autogenous pericardial slice trachea and wall repairing, membrane stomach esophagus anastomosis of neck, In the left breast esophageal posterolateral incision, joint left or right mainstem membrane, lateral window resection, autologous free perlcardial patch tracheal repair within the chest and stomach esophagus anastomosis. Results 26 patients without tracheal fistula, 3 eases of tracheal stenosis, 4 cases mild, sputum by bronchoscopy sucking phlegm, motality. Conclusion Combined resection, esophageal trachea can obviously increase the resection and long-term surial esophageal fistula, avoid esophageal - tracheal.