食管癌和贲门癌切除术严重并发症的防治(附1238例分析)

目的：探讨食管、贲门癌切除术后严重并发症的预防和处理。方法：１９８３年４月至１９９５年６月间连续手术切除治疗食管癌，贲门癌１２３８例。其中食管癌５６３例，贲门癌６７５例。食管癌经左胸切除弓上吻合９３例，弓下吻合４５例；经上腹、右胸后外侧二切口切除３３８例；经右胸后外侧、上腹和左颈三切口切除８１例；食管内翻拔脱术５例，单一右胸切除１例。贲门癌经左胸切除３３３例，经腹切除２９９例，经胸腹斜切口切除４３例。结果：术后有１１４例发生并发症，４１例为肺部并发症，占３６％，发生率最高，术后无吻合口瘘发生，无术后３０日死亡及住院死亡。结论：笔者认为：降低手术死亡率的重点是预防吻合口瘘，根据不同的病变部位选择恰当的手术径路，以便获得充分的手术暴露，吻合方法和技术是关键，食管粘膜延长法食管胃定点一层吻合术能可靠地预防瘘的发生。此外要及时有效地处理术后并发症，发生呼吸衰竭要尽早作气管切开。

Prophylaxis and treatment of the severe complications on resection of carcinoma of the esophagus and gastric cardia (1238 cases analysis)

Purpose: To probe into the prophylaxis and treatment of the severe complications of resection of carcinoma of the esophagus and gastric cardia. Methods: From April 1983 to June 1995. We performed surgical treatment for 1238 consecutive cases of carcinoma of the esophagus and cardia. Among them 563 were carcinoma of the esophgus, the rest 675 cases was carcinoma of the cardia. 138 cases were excised from the left thorax, Ivor-Lewis esophagogastroctomy was performed in 338 cases. In 75 cases it was excised through the right thorax plus the left neck and the upper abdomen, blunt esophagoctomy was performed in 5 cases, one case was excised only from the right thorax. The carcinoma of cardia was excised from left thorax in 333 cases, from abdomen in 299 cases. Results: There were 114 cases with complications including pulmonary complications in 41 cases (36%). No postoperative (within 30 days) death and hospital death occured. Conclusions: The authors considered that the key point to reduce operative mortality is to prevent anastomotic leaking. Proper operative approaches should be chosen carefully according to the different position of the pathologic changes so as to gain better operative exposure. The technique of anastomosis is of key importance. The anastomosis with extending the esophageal mucosa may prevent leaking effectively. Besides, it is necessary to effectively manage the post-operative complications in time, especially when respiratory exhaustion happens performing tracheotomy during the early post-operative stage is neccesary.