颈胸骨部分劈开径路治疗上胸段食管癌的几个问题探讨

Discussion on the problems in resection of carcinoma in the upper segment of the esophagus through cervicosternal splitting approach

目的 总结颈胸骨劈开径路切除上胸段食管癌的经验 ,并探讨上段食管癌手术切口选择、淋巴结清扫及术后并发症的防治等问题。方法 左胸锁乳突肌前缘及部分胸骨劈开切口 ,显露食管并游离肿瘤 ,经腹游离胃 ,胸段食管内翻拔脱 ,胃经食管床送至颈部与食管吻合。结果 76例切除 69例 (90 7% ) ,并发颈部吻合口瘘 1 2例 ,声嘶 5例 ,切口感染 2例 ,全组无术后死亡。结论 颈胸骨劈开径路对上胸段食管癌切除显露好 ,切除率高 ,术后并发症少 ,可作为上段食管癌手术径路的选择。

Objective To summarize the experience in resection of carcinoma in the upper segment of the esophagus through cervicosternal splitting approach and to discuss surgical approach, clearance of lymph node, prophylaxis and treatment of postoperative complications.Methods A partial cervicosternotomy was performed, the tumor of the upper esophagus was freed and the segment of the thoracic esophagus was stripped by inversion.The stomach was taken up to the neck through the bed of esophagus and anastomoted between the stomach and esophagus.Results The esophageal carcinoma was resect in 69 cases(90.7%).Postoperative complications included anastomotic fistula in 12 cases, hoarseness in 5 and wound infection in 2. There was no operative death.Conclusion The cervicosternal splitting approach can offer good exposure and high rate of resectability for the carcinoma of the upper segment of esophagus. The postoperative complications are few It′s a good surgical approach for the upper segment esophageal carcinoma.