摘要
目的 探讨应用新术式治疗食管中段癌及部分中上段癌的疗效。方法 回顾性总结行主动脉弓后胸膜顶吻合的食管癌根治术 6 8例的疗效。其中食管中段癌 4 9例 ,中上段癌 19例。鳞状细胞癌 5 0例 ,腺癌 16例 ,未分化癌 2例 ;双原发癌 8例。Ⅰ期 9例 ,Ⅱ～Ⅲ期 5 9例。结果 全部食管切缘均阴性。无术后吻合口瘘 ,无手术近期死亡。主动脉弓后胸膜顶吻合的食管癌根治术可经胸单切口最大限度地切除食管 ,尤其适用于部分食管中上段癌。该术式对游离胃长度的要求较颈胸腹三切口手术为低 ,而游离胃位于主动脉弓后食管床内 ,故胸胃对术后呼吸功能影响较小 ,加之有主动脉弓的阻挡作用 ,在一定程度上可预防并降低术后反流性食管炎的发生 ,改善患者术后生存质量。结论 经食管床主动脉弓后胸膜顶吻合的食管癌根治术是治疗食管中段癌的一种新术式 。
Objective To evaluate the result of surgical treatment of the middle and upper middle eso phageal carcinoma with a new operation, performing the anastomosis posterior to the aortic arch at the apex of the thoracic cavity . Methods From April 1996 to May . 2000, 179 patients with esophageal carcinoma were tr eated. Sixty eight of these patients (49 in the middle and 19 in the upper mid dle segment) were treated by esophogogastrostomy at the top of the chest, poster ior to the aortic arch . There were squamous cell carcinoma 50, adenocarcinoma 1 6, undifferentiated carcimoma 2, including 8 double primaries. The lesions wer e stage I 9 and stage Ⅱ Ⅲ 59. Results All patients have been alive after follow up of 2 months to 3 y ears. Without an y positive margins, anastomotic leaK or perioperative death, this new method has merits: 1. Length of esophagus resected was maximal through one sin gle incision. It would be especially useful for some of the upper middle lesio ns. 2. This new method requires a shorter transposed stomach than that required by the combined triple cervico thoraco a bdominal approach. 3. As the site of thoracic stomach was on the bed of esophagu s, there was less chance of post operative embarrasement in respiration due to the dilatation of the transpositioned stomach and py lorostenosis, etc. 4. There w ould be less chance of reflux esophagitis because of the 'blocKing' by the aorti c arch, thereby , the patients life is improved. Conclusion This radical operation for esophageal carcinoma with anastomosis at top of the t horacic cavity posterior to the aortic arch, being a newly designed surgical met hod, is especially useful for carcinoma in the middle and upper middle esophage al segment. [
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2002年第2期197-199,共3页
Chinese Journal of Oncology
