胃大部切除术后食管癌的手术治疗

Surgical treatment of esophageal carcinoma in patients after subtotal gastrectomy

目的探讨胃大部切除术后食管癌的手术治疗方式和效果。方法对1972年至1998年间20例胃切除术后食管癌的手术治疗进行分析。结果左、右后外开胸、上腹正中开腹及左颈3切口,食管癌切除、移植结肠至颈部与食管吻合,腹腔结肠与残胃吻合7例;胸腹联合切口,食管癌切除,将残胃、脾、胰体尾移入左胸内,行食管残胃弓上吻合,空肠RouxenY重建消化道3例;食管残胃弓上吻合,空肠RouxenY重建消化道4例;食管空肠RouxenY重建消化道4例探查并行小肠造瘘术2例。本组食管癌切除率为90.0%18/20。总并发症为30.0%6/20。1、3、5年生存率分别为90.0%、64.3%和36.4%。结论胃大部切除术后食管癌的手术治疗需根据病变部位和病情选择手术方式。胸上段癌采用移植结肠代食管术,胸中、下段癌采用残胃及小肠代食管术,胸下段癌采用选择性小肠代食管术,其方法较为合理。残胃、脾、胰体尾移植入左胸内、食管癌切除、食管残胃吻合、空肠RouxenY重建消化道可供临床作为一种新术式,值得推荐。

Objective To evaluate the surgical treatment f or esophageal carcinoma after subto tal gastrectomy and its outcome.Methods Twenty patients developed esophage al carcinoma after subtotal gastrectomy from 1972to 1998were an alyzed.Results In seven patients,the lesions were r esected,and transverse and descending colon were brought to neck as substitute for esophagus through left or right postero-lateral thoracotomy,upper abdominal and left-neck incision.In three patients,the lesions were removed,the residual stomach together with spleen and caudal portion of pancrea were moved into the left thorax,and anastomosis of esophagu s with the residual stomach above the arotic arch and Roux-en-Y jejunojejunostomy were performed t hrough thoraco-abdominal incision.Esophagogastretomy above the arotic arch and Roux-en-Y jejunojejunosto my were performed in four patients,Roux-en-Y esophagojejunostomy in four patients and laparotomy and jejunostomy in two patients.The resection rate of patients with esophageal carcinoma after subtotal gastrecto my was 90.0%(18/20).The morbidity was 30.0%(6/20).The 1-,3-,5-year survival rates were 90.0%,64.3%and 36.4%respectively.Conclusions The surgical procedures for the patients with eso phageal carcinoma after subtotal gastrectomy should be adopted accordi ng to lesion location and patientscon dition.Colonic substitute should b e choosen for lesion located at upper thoracic segment,residual stomach and jejunal substitute for lesions a t middle thoracic and lower thoracic segment,and jejunal substitute for lesions at lower thoracic segment.I t is a new procedure and should be recommended as an ideal procedure to transplant the residual stomach tog ether with spleen and caudal portion of pancrea into left thoracic cavity,and perform esophagogastrectomy a nd Roux-en-Y jejunjejunostomy.