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贲门失驰缓症食管压力与诊断分类和手术方法的选择 总被引:3,自引:0,他引:3
手术治疗贲门失驰缓症87例,其中31例接受术前食管压力和/或24小时食管PH检查,26例兼行术食管压力监护,结果显示食管下括约肌(LES)有接近正常吞咽松弛反应者占13%,无吞咽松弛反应者87%,食管体有原发吞咽运动者13%,无吞咽蠕动87%,高压区(highpressurezone,HPZ)值在正常范围者4/9例(44.4%)呈高张力改变者5/9例(55.6%),揭示EA的运动紊乱类型存在明显差 相似文献
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目的评价经裂孔食管切除术在食管癌外科治疗中的作用。方法总结分析2000年5月至2007年7月单一外科医生组对46例食管癌患者实施经裂孔食管切除术的病例资料。结果本组患者食管鳞癌44例,食管腺癌1例,食管类癌1例。位于颈段者11例,胸上段者21例.胸中段者5例,胸下段者9例。行术前化疗者6例。按国际TNM分期:0期者3例;Ⅰ期者6例:Ⅱa期者17例;Ⅱb期者2例;Ⅲ期者16例;2例为化疗后病理完全缓解。胃代食管者42例,结肠代食管者4例。术前肺功能FEV1低于0.8L或FEV1/FVC低于50%者29例。46例均获切除,切缘阴性,无手术死亡。术后声音嘶哑2例,心律失常3例,双侧胸腔积液1例,6例出现小的颈部吻合口瘘。结论经裂孔食管切除术在食管癌的外科治疗中对高龄、心肺功能差而不能耐受剖胸手术患者是理想的选择。 相似文献
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目的 评价经膈肌裂孔食管切除术(THE)治疗食管癌及食管胃交界癌的远期疗效.方法 北京大学肿瘤医院单一手术组于2000年3月至2009年12月间共计手术治疗食管癌和食管胃交界癌患者544例,其中实施THE 者63例(THE组),经胸或经腹手术者481例(非THE组),比较分析两组患者的远期生存.结果 THE组58例、非THE组427例患者的临床资料能用于生存分析.THE组1、3、5、8年累计生存率分别为91.0%、60.5%、44.6%和44.6%;非THE组则分别为84.5%、49.2%、37.2%和28.7%,差异无统计学意义(P=0.67).结论 THE可作为治疗特定食管癌及食管胃交界癌除经胸途径以外的另一重要可选方法,其疗效不逊于传统的经胸食管切除术. 相似文献
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目的探讨治疗贲门失驰缓症的理想术式。方法回顾性分析1998年3月至2007年3月手术治疗的贲门失驰缓症28例:经胸Heller术9例,经腹Heller术附加胃底折叠并幽门成形术19例。分析两种手术方式疗效间的差异。结果经胸Heller术9例中,治愈5例,好转1例,差3例。经腹Heller术附加胃底折叠并幽门成形术19例中,治愈18例,好转1例。两种手术方式疗效间的差异有统计学意义(P0.01)。结论经腹Heller术附加胃底折叠并幽门成形术是治疗贲门失驰缓症的较理想术式。 相似文献
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Esophagectomy without opening the thoracic cavity — transhiatal esophagectomy — (THE) were performed in 47 patients with malignant tumors localized at various levels of the esophagus. Pulmonary function studies were performed in all patients and they are categorized as low, moderate, or high risk for probable postoperative pulmonary complications according to the risk category system. Nine of these patients were classified as high risk, seven as moderate risk, and the rest as low risk. In all patients but four, reconstruction was accomplished by using their stomachs as a substitute. In the remaining patient, intestinal continuity was established by a left and right colonic interposition. Three patients were lost in the early postoperative period. Two patients categorized as low risk died from pulmonary thromboembolism and cardiac failure, respectively. One patient categorized in the high risk group died of coronary thrombosis. Postoperative complications included transient hoarseness due to recurrent laryngeal nerve paresis in one patient, right pleural effusion in one patient, pneumothorax in two patients, and thrombophlebitis in one patient. In the high risk patient group, there were no pulmonary complications. This clinical study demonstrated the protective effect of THE in patients with serious pulmonary problems. 相似文献
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本文报道2012年8月29日1例新辅助化疗后腹腔镜辅助食管内翻拔脱术治疗食管癌.患者男,58岁,吞咽困难进行性加重半年.经胃镜和活检病理诊断为颈段食管鳞状细胞癌.化疗3周期后,分期从T3N1M0降为T2N0M0,行腹腔镜辅助食管内翻拔脱术:腹腔镜下用超声刀游离胃、下段食管和膈食管裂孔,利用腔镜切割缝合器制成管状胃.同时,经颈部游离食管和清理颈部各组淋巴结.腹部悬吊,腹腔镜辅助食管内翻拔脱后,将管状胃牵至颈部,与食管残端吻合.手术时间2 h 50 min.术中出血量约210 ml.术后第7天进清流食,逐渐加量.术后第12天出院.住院期间未发生声嘶等并发症.术后病理:颈部各组淋巴结15枚,未见癌转移.术后3个月,酸反流4~6次/d,多在夜间. 相似文献
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Purpose: Mediastinal adhesions, caused by the transerosal spread of disease, inflammatory diseases, or preoperative chemoradiotherapy,
can result in diffi-culties and major complications during transhiatal esophagectomy (THE). However, few studies have specifically
addressed the incidence and management of inflammatory adhesions encountered during THE.
Methods: We retrospectively analyzed the operative details and postoperative outcome of 70 patients who underwent THE between 1998
and 2000. Patients with inflammatory tracheoesophageal adhesions were identified and their operative records were reviewed
for operative findings, intraoperative management, morbidity, and mortality. Patients with upper thoracic esophageal tumors
and direct tumor spread to the airways were excluded from the analysis.
Results: Eight (11.4%) of the 70 patients had inflammatory adhesions and esophagectomy was possible in 7 of these 8 patients. Due
to poor pulmonary status, one patient required conversion to the trnsthoracic approach, but the other six were managed transhiatally.
Three patients underwent subtotal esophagectomy, the esophagectomy was completed by the inversion extraction technique in
two, one required extended transhiatal dissection, and esophagectomy could not be completed in one due to dense inseparable
adhesions between the trachea and esophagus. There was no major airway injury or bleeding.
Conclusions: Inflammatory tracheoesophageal adhesions may be encountered in patients undergoing THE in developing countries. Thus, an
awareness of the possibility of these adhesions and suitable modifications of the operating procedures are necessary to prevent
major complications.
Received: November 5, 2001 / Accepted: September 3, 2002
Reprint requests to: N.K. Shukla 相似文献
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BACKGROUND: Experience with transhiatal esophagectomy (THE) for both benign and malignant diseases of the esophagus as practiced over an 18-year period is presented. METHODS: Between 1982 and 2000, 411 consecutive patients underwent THE for both benign (n = 44) and malignant (n = 367) diseases of esophagus. Surviving patients were followed up for a mean of 30.4 months. RESULTS: The overall operative mortality was 11% which had reduced to 6% for the last 111 patients. Operative mortality in the benign group was less than 5%. Respiratory complications were the most frequent cause of morbidity and mortality. Nonfatal anastomotic leaks occurred in 14%. The overall actuarial survival rates at 2, 5, and 10 years for carcinoma patients were 54%, 38%, and 18% respectively. The 2- and 5-year actuarial survival rates for postcricoid cancers were 83% and 64%, respectively. CONCLUSIONS: Transhiatal esophagectomy is safe and effective, and its results including long-term outcome are comparable with most published series. 相似文献
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Toshiro Konishi Ken-ichi Mafune Toru Hirata Masakazu Takagi Yoshio Ushirokoji Yasuo Idezuki Kiyonori Harii Masao Asai 《Surgery today》1989,19(5):570-575
We report herein, a rare case of a patient who, having undergone resection of a thoracic esophageal cancer, underwent removal
of a cervical esophageal cancer, for which a free jejunal graft with microvascular anastomoses was utilized. The tumor in
the cervical esophagus had originated from a second primary squamous cell cancer, which had occurred synchronously but had
unfortunately escaped detection before the first operation. Due to the high incidence of other multicentric neoplasma or metastatic
skip lesions accompanying esophageal carcinoma, careful evaluation during preoperative examinations in order to avoid overlooking
another lesion, especially in the cervical portion of the esophagus is imperative. 相似文献
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The conventional treatment for an epiphrenic diverticulum consists of diverticulectomy with or without myotomy via a left
thoracic approach. We describe the resection of an epiphrenic esophageal diverticulum using a laparoscopic transhiatal approach
after observing its rate of enlargement on routine chest X-rays done over a number of years. This approach eliminates the
need for thoracotomy and pleural drainage, and permits a complete laparoscopic procedure, including diverticulectomy, myotomy,
and antireflex surgery. 相似文献
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Although there are no differences worth mentioning between esophageal cancer in Japan and in Europe regarding epidemiology,
tumor stages at the beginning of therapy and surgical selection. In Japan, early esophageal squamous cell carcinoma is more
often diagnosed than in Europe where esophageal adenocarcinoma, especially that of the endobrachyesophagus, is becoming more
and more relevant. For a long time, the limiting factor for the prognosis of esophageal cancer was the postoperative lethality.
However, by carefully analysing the factors influencing this operative lethality over the last few years, the lethality following
esophagectomy has been decreased to approximately 15 per cent. In fact, in some specialized centers, the lethality is now
less than 10 per cent and in selected patient groups even 3 per cent has been reached. It is only through this achievement
that the prognosis for esophageal cancer has been able to be markedly improved. The results of this analysis can be detailed
as follows: 1) The preoperative definition of tumor stage by CT or MRI is not reliable, the validity being between 45 per
cent and 73 per cent. Therefore, no therapeutical decisions can be made on the basis of these diagnostic procedures. Hopefully
the intraluminal ultrasound will improve this situation in the future. 2) The analysis of preoperative nutritional status
did not allow a definition of risk groups. 3) Decisive improvements were able to be achieved by the standardising of surgical
procedures and indications. Enbloc resection is indicated for all intrathoracic squamous cell carcinomas and accounts for
a high percentage of RO-resections. The blunt dissection is especially appropriate for distal adenocarcinomas. 4) Endobronchial
onesided ventilation during the operation and prophylatic assisted ventilation have both decreased the pulmonary risk considerably.
A further improvement in the prognosis of esophageal carcinoma can possibly be achieved by the preoperative identification
of advanced tumors (T3/T4) and preoperatively treating these tumor types accordingly. From our own experience, we believe combined radio-chemotherapy
could be successful. 相似文献
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Early experience with totally robotic esophagectomy for malignancy. Surgical and oncological outcomes
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