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中下段食管癌三种术式探讨
引用本文:许咏冬,林霞,章响艳,涂韶松,赵纯,吴志军.中下段食管癌三种术式探讨[J].中国肿瘤临床,2009,36(1):51-54.
作者姓名:许咏冬  林霞  章响艳  涂韶松  赵纯  吴志军
作者单位:温州医学院附属第五医院 浙江省丽水市中心医院胸外科(浙江省丽水市323000 )
摘    要:目的:探讨中下段食管癌三种术式的优缺点。方法:2000年1 月至2007年12月共300 例中下段食管癌患者分别采用左胸左颈切口手工吻合(G1 组)、左胸切口经食管床行左胸顶机械吻合(G2 组)、左胸切口经主动脉旁行左胸顶机械吻合(G3 组)三种手术方式(各100 例),观察手术时间、术后胸液量、胃液引流总量、肠蠕动恢复时间、心律失常、术后吻合口瘘、术前及术后3 个月肺功能变化、术后3 个月进食梗阻及反流等指标。结果:三组均无手术死亡。术后病理示食管鳞癌289 例,小细胞癌4 例,类癌4 例,腺癌3 例。上、下切缘无癌残留。G1 组发生3 例吻合口瘘,经保守治疗治愈。G1 组手术时间比G2、G3 组长,费用较低,术后吻合口瘘发生率相对较高,术后3 个月吻合口狭窄发生率较低;G2 组与G1、G3 组相比术后胸液引流总量少,术后早期心律失常发生率相对较低,术后3 个月肺功能减退及食管反流症状较轻;三组术后胃液引流总量/肠蠕动恢复时间无差别。结论:中下段食管癌的三种术式各有优缺点,应该根据患者肿瘤位置高低、术前肺功能状况、经济条件以及术者的熟练程度等因素综合考虑选择合适的术式。在条件允许的情况下,选择左胸切口经食管床行左胸顶机械吻合具有一定优势。 

关 键 词:食管癌    外科    吻合器    食管床
收稿时间:2008-07-29

Effects of Three Different Surgical-Procedures on Esophageal Carcinoma in the Middle-Lower Section
XU Yongdong,LIN Xia,ZHANG Xiangyan,TU Shaosong,ZHAO Chun,WU Zhijun.Effects of Three Different Surgical-Procedures on Esophageal Carcinoma in the Middle-Lower Section[J].Chinese Journal of Clinical Oncology,2009,36(1):51-54.
Authors:XU Yongdong  LIN Xia  ZHANG Xiangyan  TU Shaosong  ZHAO Chun  WU Zhijun
Institution:Department of Thoracic Surgery, Lishui Central Hospital, Lishui 323000, China
Abstract:Objective: To compare the effects of three different surgical procedures on middle-lower sec -tion esophageal cancer. Methods:From January 2000 to December 2007, data from 300 patients with mid -dle-lower section esophageal carcinoma who underwent three different surgical procedures were reviewed. Patients in Group 1 had manual anastomosis in the left neck. Patients in Group 2 had staple anastomosis in the left chest cavity through the esophageal bed. Patients in Group 3 had staple anastomosis in the left chest cavity beside the esophageal bed. Each group included 100 patients. We evaluated indices including surgical duration, chest and gastric tube drainage volume, intestinal movement, cardiac arrhythmia, anastomotic leak-age, pulmonary function before and 3 months after surgery, and esophageal stricture and regurgitation 3 months after surgery. Results: There was no surgery-related death. Pathological detection showed 289 cases of squamous carcinoma,4 cases of small cell carcinoma, 4 cases of carcinoid tumor, and 3 cases of adeno -carcinoma. Group1 had lower surgical expenses, a higher rate of morbidity, longer surgical duration, and a lower rate of postoperative esophageal stricture. Group 2 had shorter surgical duration, less chest tube drain -age, a lower cardiac arrhythmia rate, milder esophageal regurgitation, and less pulmonary function damage. Conclusion:Staple anastomosis in the left chest cavity through the esophageal bed can achieve better results than the other two surgical procedures. The treatment decision should be made considering tumor location, patients’economic situation, pulmonary function, and the surgeon’s technique. 
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