不开胸食管剥脱术在颈段食管癌中的治疗价值

目的探讨不开胸食管剥脱术治疗颈段食管癌的效果。方法自1995年7月至2004年12月对21例颈段食管癌患者行不开胸食管剥脱术并Ⅰ期行胃咽吻合或胃食管端侧吻合术。结果本组病人的手术切除率100%。手术后发生各类并发症8例,其中吻合口瘘3例,肺部感染3例,伤口裂开1例,气胸1例。18例患者术后有不同程度的胃液反流。1例住院期间因胃大出血死亡。除2例失访外其余患者获得随访27个月～12年,13例存活超过1年,6例存活超过3年,3例存活超过5年。结论不开胸食管剥脱术手术简单,效果满意,适用于颈段食管癌。食管剥脱术后行胃代食管者胃液反流严重,手术方式有待进一步改善。

Therapeutic value of esophageal strpping without thoracotomy for carcinoma of cervical esophagus

Objective To investigate the curative effects on the esophageal stripping without thoracotomy for carcinoma of cervical esophagus. Methods From July 1995 to December 2004,21 cases with carcinoma of cervical esophagus underwent esophageal stripping without thoracotomy and gastropharyngostomy or gastroesophagostomy in one stage were analyzed retrospectively. Results The operations were performed successfully in all cases,and the tumor resection rate was 100%. Postoperative complications were found in 8 cases,including anastomotic leakage 3 cases,pulmonary infection 3 cases,dehiscence of the abdominal wound 1 case and pneumothorax 1 case. Gastric juice regurgitation in different degree was found in 18 cases. One case died from massive bleeding of stomach during hospitalization. The rest cases were followed-up from 27 months to 12 years except for 2 cases of lost follow-up. 13 cases survived over 1 year,6 cases survived over 3 years,and 3 cases survived over 5 years. Conclusion Esophageal stripping without thoracotomy possesses simple manipulation and satisfactory efficacy,and it is suitable for the operation of cervical esophageal carcinoma. After stripping of esophagus received stomach replacing esophagus,the patients have a severe gastric juice regurgitation. So this surgical procedure has necessity tofurther improvement.