保留喉功能的非开胸食管拔脱颈段食管癌切除术

Substitution of esophagus with stomach or colon without thoracotomy in the treatment of cervical esophageal carcinoma with laryngeal function preserved

目的 探讨保留喉功能的非开胸食管拔脱切除颈段食管癌及胃上提、结肠上徙代食管的治疗方法。方法 非开胸食管拔脱切除颈段食管癌 2 4例 ,17例保留喉功能。重建食管用胃上提(19例 )或结肠上徙 (5例 )。术前或术后给予放疗。结果 T2期生存 3年者 3例 ,生存 5年者 1例 ;T3和T4期生存 3年者 8例 ,生存 5年者 3例。 17例保留喉功能 ,喉功能保留率 77.3% (17/2 2 ) ,术后拔管率 75 .0 % (12 /16 )。并发症发生率为 2 9.2 %。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、结肠上徙重建食管 ,联合放射治疗 ,可以提高患者的术后生存率和生存质量。

ObjectiveTo study the feasibility and effect of substituting esophagus with stomach or colon without thoracotomy in the treatment of cervical esophageal carcinoma with laryngeal function preserved. MethodsTwenty-four patients with cervical esophageal carcinoma were retrospectively reviewed. The esophagus was resected and substituted with 19 gastric pull-up and 5 colon interposition. Nineteen patients received radiotherapy postoperatively(dose 50-70 Gy). ResultsTwenty two patients were follow up over 3 years. The 3- and 5- year survival rates for T2 were 3 and 1, for T3,T4 8 and 3, respectively. The laryngeal function preservation rate was 77%(17/24) and the decannulation rate was 75%(12/16). The complication rate was 29%. ConclusionSurgical resection of cervical esophageal carcinoma with removal of the extraesophageal invaded tissues while preserving the laryngeal function is possible. The continuity of the esophagus is restored by stomach transposition and colon interposition. Combined with radiotherapy, the survival rate and life quality of the patient might be improved.