食管癌贲门癌伴门脉高压症16例外科治疗分析

目的：分析16例食管癌贲门癌伴门脉高压症的围术期处理及外科治疗体会。方法：16例中根据肝功能Child分级A级11例，B级5例，其中3例行食管癌贲门癌根治同时行脾切除术。16例中6例行食管癌根治颈胃吻合术，3例行左侧副胸弓上食管胃吻合术，7例行弓下食管胃吻合术。结果：16例中1例死于肝性脑病，15例痊愈出院。术后并发症7例。其中3例同时行脾切除，病情改善明显。随访7个月至5年，失访3例；术后1、3、5年生存率分别是81.2％、56．2％及33．3％，无1例死于消化道出血。结论：对于食管癌贲门癌伴门脉高压症患者手术是首选方法；改善肝功能、纠正低蛋白血症及脾功能亢进是关键，合并脾亢患者应同时行脾切除术。

Surgical Treatment of Esophageal or Cardiac Carcinoma with Portal Hypertension in 16 Patients

Objective: To evaluate the surgical treatment of esophageal or cardiac carcinoma with portal hypertension in 16 patients. Methods: The sixteen patients were classified as grade A(11 patients) or B (5 patients) by Child gradation. Three patients underwent splenectomy during the operation. The esophagogastric anastomotic sites were above aortic arch in 3 patients and below aortic arch in 7 patients and others in the neck. Results: Fifteen patients recovered smoothly, 1 patient died and 3 patients who underwent splenectomy during the operation recovered quite well. There was a postoperative complication in 7 patients. After following 7 to 60 months, 3 cases have lost. The survival rates of 1 year, 3 years and 5 years were 81. 2%, 56. 2% and 33. 3% respectively after operation. Conclusion: The surgical treatment for esophageal or cardiac carcinoma with portal hypertension is first choice. Keeping supporting liver function, correcting hypoproleinemia and hypersplenism may do patients good and hold the key of treatment. Patient with hy-persplenism should undergo splenectomy at operation.