胃大部切除术后再发食管癌的外科治疗

The surgical treatment for esophageal cancer of postoperative gastrectomy

目的总结胃大部切除术后再发食管癌的外科治疗体会。方法1995年1月至2010年6月，我院收治胃大部切除术后再发食管癌并且有详细随访资料的患者42例，对本组患者的手术方式、治疗结果、并发症发生情况、胃肠功能恢复情况等进行回顾性分析。结果术后住院时间9～35天，随访5年以上，术后1年生存比例88．10％（37／42），术后3年生存比例为54．76％（23／42），术后5年生存比例为21．43％（9／42）。结肠间置术患者术后1、3、5年的生存比例与残胃代食管和残胃切除、Roux-en-Y食管-空肠吻合消化道重建术的患者比较，差异均无统计学意义（P〉0．05）；但在结肠间置术中，顺蠕动间置者术后1、3、5年的生存比例均明显高于逆蠕动间置者（P〈0．05）。生存质量调查显示结肠间置术患者的总满意度与残胃代食管术、食管-空肠吻合消化道重建术组比较，差异均无统计学意义（P〉0．05）；但结肠顺蠕动间置患者的总满意度显著高于逆蠕动患者（P〈0．05）。结论结肠间置术、残胃代食管和残胃切除、Roux—en-Y食管-空肠吻合消化道重建术都是临床治疗胃癌术后再发食管癌的理想术式，临床应根据患者的具体情况选择相应的术式，以提高患者术后的生活质量和生存比例。

Objective To summarize the surgical treatment for esophageal cancer of postoperative Gastrectomy. Methods From January 1995 to June 2010, 42 postoperative gastrectomy patients with esophageal cancer who have detailed follow-up data for the study. Retrospective research was used to analyse the surgical methods, treatment outcome, post-operative complications and the recovery of gastrointestinal function. Results Days of hospitalization were 9 - 35. The follow-up time were more than five years. The results showed that 37 patients were survived after one year,and the survival rate was 88.10%. 23 patients were survived after 3 years, and the survival rate was 54.76%. 9 patients were survived after 5 years, the survival rate was 21.43%. The survival rates of one, three and five years of colon interposition for esophageal cancer had no significant difference with residual stomach esophagus and remnant gastrectomy with Roux-en-Y esophagns-jejunal anastomosis patients （ P 〉 0.05 ） ; However, the survival rates of one, three and five years of who were opposed set along peristalsis was significantly higher than who were opposed reverse peristalsis（ P 〈 0.05 ）. Quality Survey showed that overall satisfaction rate of colon interposition reconstruction had no significant difference with that of gastric remnant esophagus and remnant gastrectomy with Roux-en-Y esophagns-jejunal anastomosis. But the overall satisfaction rate between colon set along was significantly higher than the reverse peristalsis（ P 〈 0.05 ）. Conclusion Colon interposition reconstruction, residual stomach esophagus and remnant gastrectomy with Roux-en-Y esophagns-jejunal anastomosis are suitable treatment for esophageal cancer of postoperative gastrectomy. According to different circumstances, patients select the appropriate surgical methods in order to improve the postoperative quality of life and survival.