摘要
目的 应用右胸腹二切口治疗中、下段食管癌。方法 自 1992年 12月至 1999年 6月 ,应用上腹、右胸二切口治疗中、下段食管癌 87例。全组病人均行食管钡餐检查 ,病变上缘均位于距门齿 2 8cm以下、长 2～ 9cm。先平卧位上腹正中切口开腹 ,游离胃大小网膜 ,清扫腹腔淋巴结。扩大膈食管裂孔 ,行幽门成形。改左侧卧位 ,右后外侧切口 ,经第五肋进胸。游离胸腔食管。结扎、切断奇静脉弓。整块切除食管周围组织 ,距胸顶 3cm处切断上端食管 ,在贲门处切断下端食管 ,封闭贲门。清扫纵隔淋巴结。低位结扎胸导管 ,食管 胃右胸顶吻合。结果 87例中 1例术后病理残端阳性。 1例术后 2 4小时发生ARDS经呼吸机辅助呼吸等辅助治疗治愈。 1例术后 72小时出现急性心肌梗塞经抢救治愈。全组无手术死亡。无吻合口瘘、狭窄及胃食管返流。结论 上腹 右胸二切口适于中、下断食管癌的手术治疗。
Objective To evaluate abdominal and right chest approaches for middle and low esophageal carcinoma.Methods Between December 1992 to June 1999,57 cases (58 male and 29 female )with mean age of 57.9 years (41～73) were diagnosed with esophagogastroscopy.The lengths of lesion were 2 to 9cm,28cm under the incisor teeth.Clearance of abdomen lymph nodes and pyloroplasty were performed via an upper midline abdominal incision,The patients were turned to lefto lateral position.Through a fifth intercostal incision the esophagus was freed to the apex of the right pleural cavity,complete mediastinal nodes clearance was performed whenever possible.Thoracic duct was routinely divided and ligatured.3cm proximal to the right cavity apex.Distal resecion may localized at cardia.Esophagogastro anastomosis was performed on the apex of the right pleural cavity.Results There was no death.l patient with pathologically positive stump received postoperative radiotherapy.1 patient with ARDS and lpatient with AMI were cured.there was no postoperative esophagogastric anastomotic leakage、stenosis and reflux.Conclusions Abdominal and right chest approach for middle and low esophageal carcinoma is effective and safe to improve lymphatic clearance and diminish the re occurence. [
出处
《中国肿瘤临床与康复》
2000年第5期58-59,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
治疗
esophageal carcimoma
surgical treatment
esophagogastric anastomsis
