上段食管癌的外科治疗

Surgical treatment of upper segment esophageal carcinoma

目的 探讨上段食管癌的手术治疗方法。方法 回顾性分析了 1990～ 2 0 0 2年间 2 2 5例上段食管癌的手术治疗情况。其中胸上段食管癌 16 6例 ,切除 16 3例 ,采用经右胸、上腹、左颈的三切口术式 (15 5例 )或非开胸食管外拔脱 (剥脱 )法 (8例 )切除 ,以胃 (16 1例 )或结肠 (2例 )重建食管 ;颈段食管癌 4 1例 ,切除 4 0例 ,采用非开胸食管内翻拔脱或外拔脱 (剥脱 )法切除 ,以胃 (32例 )或结肠 (8例 )重建食管 ;下咽食管癌 18例 ,切除 18例 ,分别用胸大肌肌皮瓣或联合裂层皮片、喉气管瓣、胃、结肠重建食管。结果 手术切除率分别为 98.2 %、97.6 %、10 0 %。并发症发生率为 5 .3% ,其中喉返神经损伤 1例 ,咽瘘 1例 ,颈部吻合瘘 4例 ,胃排空障碍 2例 ,胃液返流致呼衰 1例 ,吻合口狭窄 2例 ,死亡 1例。结论 对上段食管癌的术式选择及并发症的预防措施进行了讨论。

Objective To explore the experience of surgical treatment for upper segment esophageal carcinoma. Methods The clinical data of 225 patients with upper segment esophageal carcinoma from 1990～2002 were analyzed retrospectively. One hundred sixty six cases of upper thoracic esophageal carcinoma,163 cases were resected,esophagectomy was carried out by three-incision operation (155 cases) or esophagectomy without thoracotomy (8 cases),stomach (161 cases) or colon (2 cases) was used to reconstruct the esophagus;41 cases of cervical esophageal carcinoma,40 cases were resected,stomach (32 cases) or colon (8 cases) was used to reconstruct the esophagus after esophagectomy without thoracotomy;18 cases of hypopharyngo-esophageal carcinoma,18 cases were resected,the esophagus was reconstructed by pectoralis major musculocutaneous flap or combined with the split graft,laryngotracheal flap,stomach or colon separately. Results The resection rates were 98.2%,97.6%,100% separately. The incidence of complication was 5.3%. Conclusion Proper method of esophageal reconstruction can reduce the incidence of postoperative complications.