经裂孔食管切除食管-胃颈部半机械侧侧吻合治疗食管癌

Transhiatal esophagectomy and cervical side-to-side stapled esophagogastric anastomosis for esophageal carcinoma

目的:探讨经裂孔食管切除、食管-胃颈部半机械侧侧吻合术在食管癌外科治疗中的应用价值。方法:>60岁合并低肺功能的食管癌患者114例,观察组41例行经裂孔食管切除、食管-胃颈部半机械侧侧吻合术;对照组73例,行经左胸后外侧切口食管切除、食管-胃颈部手工端侧吻合术。观察患者术前术后肺功能变化,术后并发症等。结果:114例均完整切除,无术中死亡;术后30d内对照组1例死于肺部感染呼吸衰竭。术后吻合口瘘、反流性食管炎、术后肺部并发症的发生率及手术时间、肺功能、动脉血氧分压、术后住院天数等方面,观察组与对照组比较,差异有统计学意义(P<0.05);声带麻痹发生率和淋巴结清扫数目2组比较差异无统计学意义(P>0.05)。观察组的吻合口面积显著大于对照组。结论:经裂孔食管切除、食管-胃颈部半机械吻合术是一种安全快速的手术方式,为高龄低肺功能食管癌患者理想的选择。

Objective To evaluate the application value of transhiatal esophagectomy and cervical side-to-side stapled esophagogastric anastomosis to esophageal carcinoma. Methods One hundred and fourteen patients over 60 years old were divided into observation group and control group. The patients with impaired pulmonary function and esophageal carcinoma received transhiatal esophagectomy and cervical side-to-side stapled esophagogastric anastomosis,and control group received the classic transthoracic esophagectomy and manual end-to-side esophagogastric anastomosis. The changes in pulmonary function before and after surgery and postoperative complications were observed. Results All the 114 cases were successfully operated. There was no intraoperative death. One patient in control group died of respiratory failure in 30 days. There were statistic differences in the operating duration,pulmonary function,arterial blood partial pressure of oxygen,postoperative hospital days,the incidence of postoperative anastomotic leakage,reflux esophagitis,and postoperative pulmonary complications between these two groups （P〈0.05）. There was no statistic difference between the two groups in the number of lymph node dissection and the incidence of vocal cord paralysis. The anastomotic area was significantly larger in the observation group than that in control group. Conclusion Transhiatal esophagectomy and cervical side-to-side stapled esophagogastric anastomosis are safe and effective for esophageal carcinoma with impaired pulmonary function.