胃大部切除术后食管癌的手术治疗

Surgical Treatment of Esophageal Cancer in Gastrectomized Patients

目的：探讨胃切除术后食管癌（Ｅｃａ）的手术治疗方式和效果。方法：对１９８７年～１９９６年间手术治疗８１５例Ｅｃａ中４１例胃切除后Ｅｃａ的手术治疗进行分析。１例胸下段Ｅｃａ行切除并残胃食管弓下吻合术，４０例右胸入路行右半结肠代食管术合并颈、胸、腹淋巴结清除术。结果：４１例胃切除术后Ｅｃａ颈、上纵隔、中下纵隔和腹部淋巴转移率分别为３４．１％、２１．９％和１９．６％。并发症发生率４８．７％。颈部吻合口瘘发生率３４．１％，无手术死亡。全组３、５年生存率４１．６％和１５．４％。根治性手术３、５年生存率４６．６％和２２．２％。姑息手术无１例生存超过５年。３年生存率１４．３％。结论：对胃切除术后Ｅｃａ颈、上纵隔和腹部淋巴结清扫很重要。结肠代食管术为安全有效办法。右半结肠经胸骨前。

Purpose: To study the modality and effect of surgical treatment of esophageal carcinoma in patients who had had gastrectomy. Methods: Among 815 cases of esophageal cancer operated on in our hospital during the period of 1987 1996, 41 (5%) had had subtotal gastrectomy before. Thirty seven patients had esophageal cancer of upper or middle segment and 4 had lower segment cancer. One of the patient had an anastomosis of the residual stomach to the esophageal stump under the aortic arch. The other 40 cases underwent reconstruction of esophagus with colon through right thoracic approach, and radical excision of cervical, thoracic, and abdominal lymph nodes.Results:The lymph node metastatic rates of cervical and upper mediastinal, mid and lower mediastinal and abdominal cavity were 34.1%,21.9% and 19.6% respectively. Complications occurred in 48.7%, and the rate of cervical anastomotic leakage was 34. 1%, but no operative death occurred. The overall 3 ,5 year survival rates were 41 .6% and 15.4% and those in the radical resection group were 46.6% and 22. 2% respectively.None of the patients who underwent palliative surgery survived more than 5 years with 3 year survival rate being 14.3%. Conclusion:Extensive radical resection of the tumor and drained lymph nodes is of utmost importance for the post gastrectomy esophageal cancer patients. Reconstruction of esophagus with colon is safe and effective, and use of right hemicolon ria the pre or post sternal approach is the one of choice.