摘要
目的 分析颈段食管癌手术的特点，增加切除率，减少并发症，延长生存期。方法 对４１ 例颈段食管癌外科治疗，以不同的切口切除肿瘤，周围汇集的淋巴结及附着的脂肪组织，以胃、结肠代替食管，经不同途径，行颈部吻合。经颈—右胸—腹，胃代食管２０ 例，右半结肠代食管２ 例。经颈—左胸，胃代食管１５ 例（ 主动脉弓后９ 例） 。经颈—胸骨后—腹，右半结肠２ 例，左半结肠２ 例。结果 有９ 例（２２ ％ ） 发生并发症，２ 例死亡，其余多经治疗恢复。１ 例术后全喉切除，气管造口，死于吻合口瘘纵隔感染。吻合口瘘３ 例，１ 例死亡，２ 例经换药、胃小肠造瘘供应营养后治愈。有３５例随访（８５ ％ ） ，６ 例失访。２ 例生存７ 月，４ 例生存１０ 月，４ 例生存１ 年，５ 例生存１－５ 年，４ 例生存２ 年，７ 例生存３ 年，９例生存５ 年。结论 颈部食管癌周围解剖结构复杂，与中下段食管癌手术相比，切除率低，并发症发生率高。术中必须注意局部解剖结构，尽可能廓清淋巴结，避免上切端阳性率，精细吻合，术后加强护理，减少并发症，提高生活质量，必能延长生存期。
Objcetive To analyze the operative characters of cervical part of esophageal cancer,increase the resection rate ,decrease the complications and extend the survival stage.Methods From Jan.1978 to Dec.1998,41 cases (male 31,female 10)of cervical esophageal cancer underwent surgical treatment.Carcinoma,lymph nodes and sticking adipose tissue were eliminated by different approaches.By the way of neck right thoracic abdomen,the esophagus was reconstructed with stomach in 20 cases,and with right colon in 2 cases.By the way of neck left thoracic,the esophagus was reconstructed with stomach in 15 cases(in 9 cases behind arch of aorta).By the way of neck substermum abdomen,it was reconstructed with right colon in 2 cases and with left colon in 2 cases respectively.Results Nine cases got complications at all.Two of the patients died.All of the others recovered by correct treatment.One patient who underwent excision of whole larynx died of infection of mediastum.Three patients got fistula of anastomosis;one died of it and the other two recovered by dressing exchange and fistulafion of stomach and intestine.35 cases (85%) were followed up and 6 cases were not.The lengths of their survival were:2 cases,7 months;4 cases,10 months;4 cases,1year;5 cases,1 and a half years;4 cases,2 years;7 cases,3 years;9 cases,5 year.Conclusion The local anatomic structure of cervical esophageal cancer is so complicated that it has lower resection rate and higher complication rate,compared with the middle lower part of esophageal cancer.Surgeons must pay attention to the and perform anastomoses carefully.Intensive care post operation is essential for the local anatomic structure,try their utmost to eliminate the lymph nodes prevention of complications,improvement of survival quality and extension of survival stage.
出处
《四川医学》
CAS
2000年第1期26-29,共4页
Sichuan Medical Journal
关键词
颈段食管癌
并发症
食管肿瘤
外科手术
Cervical part of esophageal cancer Operative method Complication
