经上腹右胸两切口治疗胸段食管癌676例分析

目的：探讨应用上腹右胸两切口治疗胸段食管癌的临床经验。方法：回顾分析1990年1月-2005年12月采用经上腹右胸两切口（Ivor—Lewis术式）治疗676例胸段食管癌患者的临床资料。结果：全组并发率为12．7％，肺部并发症占第1位（占30．2％），吻合口瘘4例，其中1例为胃壁坏死或者穿孔，均经保守治愈。死亡1例，系胸穿致严重窒性心律失常致死。本组1、3、5年生存率分别为86．1％、61．2％和45．2％，无淋巴结转移的5年生存率为62．2％；有淋巴结转移的5年生存率为30．2％。结论：上腹、右胸两切口食管癌切除术具有良好的胸腹腔显露。淋巴结清扫彻底，尤其对右侧最上纵隔喉返神经旁淋巴结清扫方便有利。且操作方便，吻合可靠，故此术式为治疗胸段食管癌较为理想的术式。

Surgical Treatment in Patients with Thoracic Esophageal Carcinoma: a Report of 676 Cases

Objective:To summarize the clinical experience of treating thoracic esophageal cancer using Ivor-Lesis operation. Methods:Clinical data of 676 cases of thoracic esophageal cancer were retrospectively analyzed.Results:Total incidence of post- operational complication was 12.7%,among which lung complication ranked top(occurred in 30.2%of the patients).4 cases suffered anastomotic leakage,including 1 case of gastric wall perforation or necrosis.All the patients recovered after non-surgi- cal treatment.1 case died of severe ventricular arrythmia.1,3 and 5 year survival rate were 86.1%,61.2% and 45.2% re- spectively.5 year survival rate with lymph node metastasis was 30.2%.Conclusion:Ivor-Lewis operation exposed the operation fields clearly and make radical lymphadenectomy easier,especially the lymph nodes in the upper right mediastimun.Therefore, Ivor-Lewis operation proves to be a ,safe and ideal operation procedure for thoracic esophageal carcinoma.