颈段食管癌的手术治疗

Surgical management of cervical esophageal carcinoma

目的 探讨颈段食管癌手术切除及不同修复重建方法的治疗经验。方法 回顾性分析山东大学齐鲁医院 1988～ 2 0 0 0年手术治疗的颈段食管癌 33例临床资料 ,根据UICC 1997标准TNM分期 ,T1N0 2例 ,T2N0 4例 ,T2N11例 ,T3N0 6例 ,T3N16例 ,T4N0 7例 ,T4N17例 ,均无远处转移 ;病理诊断均为鳞状细胞癌。肿瘤切除及食管重建 :颈段食管切除 13例 ,分别用局部拉拢、胸大肌肌皮瓣或联合裂层皮片、喉气管瓣、结肠修复 ;不开胸全食管内翻或外翻切除 2 0例 ,用胃 (17例 )或结肠 (3例 )重建食管。 33例均清扫颈部及上纵隔气管食管旁淋巴结 ,甲状腺叶切除术 2 5例。 2例术前放射治疗量分别为 30和 4 0Gy ;2 4例术后放射治疗 ,剂量 5 0～ 70Gy。结果 手术切除率 10 0 %。随访 4个月～10年 ,T1、2期生存 3、5年者分别为 2 / 3例、1/ 1例 ,T3、4期患者 3、5年生存率分别为 7/ 16例和 3/ 8例。2 6例保留喉功能 ,术后拔管率 80 % (2 0 / 2 5 )。并发症发生率为 33 3% ,包括咽瘘 6例次 ,颈部吻合口狭窄 2例次 ,吻合口瘘 2例次 ,腹壁刀口裂开 2例次 ,胸腔积液、气胸各 1例次。结论 手术治疗颈段食管癌 ,可以一期切除肿瘤及周围受侵组织 ,利用胸大肌肌皮瓣、喉气管瓣、胃、结肠重建食管 ,联合放射治疗 。

Objective To review the experience of different surgical procedures and corresponding one stage construction methods for cervical esophageal carcinoma Methods 1 Thirty three patients with cervical esophageal carcinoma were retrospectively reviewed, including 31 males and 2 females According to UICC 1997 criteria and pathologic findings showing squamous cell carcinomas, there were 2 patients in T1N0, 4 in T2N0, 1 in T2N1, 6 in T3N0, 6 in T3N1, 7 in T4N0 and 7 in T4N1 categoris 2 Removal of cervical esophagus was conducted in 13 patients The type of cervical esophageal reconstruction included direct suturing, pectoralis major musculo cutaneous flap or combined with the split graft, laryngotracheal flap and colon interposition Total esophagectomy without thoracotomy was carried out in 20 patients Reconstruction of the esophagus consisted of 17 stomach pulling up and 3 colon interposition Twenty four patients received radiotherapy postoperatively(dose 50～70Gy) Results The resectability of cervical esophageal carcinoma was 100% The overall follow up was from 4 months to 10 years Two and one patient in T1?2 survived 3 and 5 years, respectively Three and five year survival rates for T3?4 were 7/16 and 3/8, respectively Twenty six patients had laryngeal function preserved and acquired good speech The decannulation rate was 80% (20/25) The incidence of complication was 33 3%, including pharyngeal fistulas in 6 cases, cervical stomal fistulas in 2, cervical stomal stenosis in 2 and splitting of abdominal wall in 2 Conclusion Surgical resection of cervical esophageal carcinoma and resolvation of the extraesophageal invasion is possible The continuity of the esophagus is restored by pectoralis major muculocutaneous flap, laryngotracheal flap, stomach transposition and colon interposition Combined with radiotherapy, the resectability and survival rate of the cervical esophageal carcinoma can be improved