经口置入钉砧头系统在颈段及胸上段食管癌根治术中的应用

Application and efficacy of OrV il in radical resection of cervical and upper thoracic esophageal cancer

目的总结经口置入钉砧头系统(OrV il)在颈段及胸上段食管癌外科手术中应用的可行性及疗效。方法采用OrV il行食管胃近咽吻合技术手术治疗的颈段及胸上段食管癌病人29例,其中颈段食管癌12例,胸上段食管癌17例。术前胃镜检查提示肿瘤上缘距门齿距离17～23cm,中位20cm。1例行颈腹两切口食管拔脱,28例行Mckeown术式,所有病人行胸腹两野淋巴结清扫+选择性的单侧或双侧颈部淋巴结清扫。结果术后病理均为鳞状细胞癌,R0切除率100%。术后吻合口漏2例(6. 9%),肺部感染2例(6. 9%),声音嘶哑5例(17. 2%),饮水呛咳8例(27. 6%),经口进食时间7～22天,中位10天。全组无围术期死亡病例。随访3～36个月,声音嘶哑恢复3例,饮水呛咳均改善,吻合口狭窄1例(3. 4%),肿瘤复发率17. 2%(5/29),病死率6. 9%(2/29)。结论采用OrV il行食管胃近咽吻合的手术方法治疗颈段及胸上段食管癌,可在保喉的前提下提高肿瘤的R0切除率,安全可行,近期疗效满意。

Objective To investigate the feasibility and efficacy of transorally inserted anvil（ OrVil） in the surgical treatment of cervical and upper thoracic esophageal cancer. Methods Reviewed 29 cases of cervical and upper thoracic esophageal cancers with OrV il esophageal-gastric near-pharyngeal anastomosis. 12 cervical esophageal cancers,17 upper thoracic esophageal cancers. Preoperative gastroscopy suggested that the upper margin of the tumor was 20（ 17-23） cm from the median of the incisors. 1 case was performed with detachment of esophagus without thoracotomy and 28 cases were threated by Mckeown. All patients underwent single or bilateral selective cervical lymphadenectomy. Results Postoperative pathology was squamous cell carcinoma,R0 resection rate was 100%. 2（ 6. 9%） cases of postoperative anastomotic fistula,2（ 6. 9%） cases of pulmonary infectiont,5（ 17. 2%） cases of hoarseness,8（ 27. 6%）cases of drinking water cough. The median time for oral feeding was 10（ 7 - 22） days. No perioperative death. During the 3 - 36 months follow-up,3 cases were recovered from hoarseness,drinking water cough was improved,anastomotic stenosis occurred in 1 case（ 3. 4%）,tumor recurrence rate was 17. 2%（ 5/29）,mortality was 6. 9%（ 2/29）. Conclusion Gastro-esophageal anastomosis close to the pharynx by using the technique of OrV il in cervical and upper thoracic esophageal cancer can improve laryngeal preservation and R0 resection rate,it is safe and feasible,recent result was satisfactory.