经右胸入路结合管状胃在食管癌手术中的应用

Right Chest Approach Combined with Application of Tubular Stomach in Surgery of Esophageal Carcinoma

目的探讨经右胸入路结合管状胃在食管癌手术中的应用价值和手术要点。方法 106例食管癌患者均采用经右胸二或三切口,并结合管状胃重建消化道,对其临床资料进行回顾性分析,探讨经右胸切口的优势及管状胃的应用价值。结果 106例病人手术顺利,术后恢复良好。术后发生颈部吻合口瘘1例,吻合口狭窄1例,单侧喉返神经损伤致声嘶12例。全组系统性淋巴结清扫彻底,无严重胃排空障碍及胸胃综合征发生。结论经右胸二或三切口行食管癌手术更有利于肿瘤彻底切除和淋巴结清扫,管状胃重建消化道更符合生理解剖学的要求,又可明显减少手术风险及术后并发症。

Objective To discuss the application value and its mean operative points in the right chest approach combined with tubular stomach in surgery of esophageal carcinoma. Methods The di-incision or tri-incision esophageal resection was undergone by the right chest approach in 106 patients. And the tubular stomach was used for the reconstruction of the digestive tract. The clinical data of the patients was analyzed retrospectively. Results After operation, all the cases recovered well except 1 of cervical anastomotic fistula, 1 of anastomotic stricture and 12 of recurrent laryngeal nerve injury. No serious chest stomach syndrome, nor gastric emptying disorder. The systematic lymph node got dissected completely. Conclusions It is more suitable for the complete excision of tumor and lymph node dissection of the di-incision or tri-incision esophageal resection by the right chest approach. And the tubular stomach is more conformable to the physiology and anatomy of digestive tract reconstruction requirements, and can significantly reduce the risks and complications after operation.