摘要
目的 评价左开胸治疗中段食管癌。方法 自１９９２年１ 月至１９９８年１２月采用单纯左胸入路治疗中段食管癌８９ 例。全组病人均行食管钡餐造影检查。病变上缘均位于气管分叉以下长３～８ｃｍ 。右侧卧位。左后外侧切口，先经第七肋间进胸。游离主动脉弓下食管，若肿瘤外侵明显，尽量连同外侵组织整块切除。游离弓下食管至主动脉弓上。清扫纵隔淋巴结。打开膈肌游离胃，低位结扎胸导管。在贲门处切断下端食管，封闭贲门，修整胃小弯侧，将胃制成“管状”。将开胸器移至第五肋间，暴露主动脉弓水平。将食管、“管状”胃经主动脉弓后食管床及主动脉弓上三角处拉出，距胸顶３ｃｍ 处切断上端食管。食管－ 胃－ 层吻合法吻合。吻合口套入胃内３ｃｍ ，纵隔胸膜包埋。结果 ８９例中，１ 例术后病理为食管残端阳性，二周后给予放疗。２例肺感染经抗炎治疗治愈。１例术后二周出现吻合口狭窄给予球囊扩张改善。全组无手术死亡。无吻合口瘘及反流。无乳糜胸。结论 单纯左胸入路具有一个切口同时完成胸、腹手术，术后并发症发生率低的优点。但因不能行全胸段食管切除与颈部吻合，故残端阳性发生率高。
? Objective To evaluate the left sided approach for esophagectomy for middie third esophageal carcimoma.Methods Between January 1992 to Decmber 1998,89 cases (63 male and 19 female)with mean age of 55.6 years (38-4) were diagnosed by barium meal examination of esophagus.The lengths of lesion were 3 to 8 cm under the bifurcation of trachea.A left thoracic incision was made through the seventh intercostal space.The esophagus and tumor were dissected from below aortic arch to the left cavity apex.The diaphragm was cut and the stomach was then mobilized.The right gastric artery and the right gastroepiploic vessel were remained.Mediastinal and abdominal lymph nodes were cleared.Thoracic duct was routinely divided and ligatured.The stump was placed 3 cm proximal to transection from the left carity apex.Distal resection may localized at cardia.Esophagogastro anastomsis was performed on the apex of the left pleural cavity.Results There was no death.One patient having proximal spread of tumor was given postoperative radiotherapy.Two patients with pneumonia were cured.1 patient with anastomotic stenosis that pastoperative saccuie dilation improvement.There was no postoperative esophagogastric anastomotic leakage and reflux.Conclusion Advantages of the left sided thoracic approach were that one incision could performe abdominal and thoracic operation,there was less complications,but the rate of proximal spread of tumor was higher than that of cervical esophagogastro anastomosis. 〔
出处
《中国肿瘤临床与康复》
1999年第4期74-75,共2页
Chinese Journal of Clinical Oncology and Rehabilitation
关键词
食管癌、食管-胃吻合
外科手术
Esophageal carcinama
Esophagogastro anastomsis
Surgical treatment.
