食管癌切除胃代食管三种术式比较分析

Esophagectomy with gastric replacement for esophageal carcinoma:a comparison of three approaches

为明确食管癌术后胃代食管三种不同术式的术后近期并发症发生率和死亡率，对446例食管癌外科治疗患者进行回顾性分析。经左胸食管癌切除胸内吻合268例（Ⅰ组）；经左胸食管癌切除左颈部吻合49例（Ⅱ组）；经右胸腹食管癌切除颈部吻合129例（Ⅲ组）。结论：经左胸食管癌切除胸内吻合适于多数胸中下段食管癌。使用吻合器能显著降低吻合口瘘的发生率及手术死亡率。胸段食管全切加颈部吻合较胸内吻合更能达到根治目的。虽然其并发症发生率较高，但手术死亡率并未随之而升高。

To determine the roles of differen approaches of esophagectom with gastric replacement for esophageal cancer. Method: 446 patients who underwent such resechtions in our department from september 1975 to October 1996 were studied retrospetively. Group Ⅰ (n = 268): left esophago-gashectomy with intrnthoracic anastomosis; Group Ⅱ (n = 49): left esophagectomy with left cervical anastomsis;GrouP Ⅲ (n = 129): right thoracotomy and laparotomy with cervical anastomsis. Conclusion: Subtotal esophagectomy with cervical anastomsis is more radical than intrathoracic procedure, and its higher morbidity does not translate into a higher mortality. Left esophagectomy with introthoracic anastomosis is still an ideal procedure for lower esophgeal carcinoma in most cases, and a stapler is recommended because it is very effective in reducing the incidence of anastomotic leak as well as the mortality.