非开胸食管拔脱胃上提治疗颈段食管癌(附19例报告)

Substituting esophagus with stomach without chest break in the treatment of cervical esophagus carcinoma

目的 探讨非开胸食管拔脱切除颈段食管癌及胃上提食管重建的治疗经验。方法 共行非开胸食管拔脱切除颈段食管癌胃上提食管重建 19例 ( T2 N0 2例 ,T2 N1 1例 ,T3N0 4例 ,T3N1 4例 ,T4 N0 4例 ,T4 N1 4例 ) ,均为鳞状细胞癌。19例均清扫颈部及上纵隔气管食管旁淋巴结 ,7例喉侵犯严重者作全喉切除 ,甲状腺叶切除术 12例。术前或术后肿瘤患者给予放疗。结果 T2 期 3、 5年生存者分别为 3/ 3例、 1/ 1例 ,T3、 T4 期患者 3、 5年生存者分别为 6 / 14例和 3/ 8例。喉功能保留率 6 3.16 % ( 12 / 19) ,术后拔管率 72 .73% ( 8/ 11,1例未做气管切开术 )。并发症发生率为 2 6 .32 % ( 5 / 19) ,包括咽瘘 2例次 ,颈部吻合口狭窄 1例次 ,吻合口瘘 1例次 ,腹壁切口裂开 1例次。结论 颈段食管癌可以行非开胸食管拔脱一期切除肿瘤及周围受侵组织 ,并尽可能保留喉功能。利用胃上提重建食管 ,联合放射治疗 。

Objective To study the feasibility and effect of substituting esophagus with stomach without chest break in the treatment of cervical esophagus carcinoma Methods Nineteen patients with cervical esopha geal carcinoma were retrospetive studied,including 2 patients in T 2N 0,1 in T 2N 1,4 in T 3N 0,4 in T 3N 1,4 in T 4N 0,4 in T 4N 1 The esophaguses were resected and substituted with stomach pulling up 2 patients recived radiotherapy before operation while 15 patients did postoperatively(dose50～70Gy) Results 3 and 1 patient in T 2 survived 3 and 5 years 3 and 5 year survival rates for T 3 4 were 6/14 and 3/8 The laryngeal function preservation rate was 63 16% and the decannulation rate was 72 73% The incidence of complication was 26 32% Conclusions Surgical resection of cervical esopphageal carcinoma and resolvation of the extraesophage al invasion is possible The continuity of the esophagus is restored by stomach transposition Two third of the patients'laryngeal function can be preserved Combined with radio therapy,the resectability,survival rate of the cervical esophageal carcinoma can be improved Cervical esophageal cancer must be managed by otolaryngeal head and neck surgeons under the support of thoracic and abdominal surgeons and radiotherapists