One-stage surgery for esophageal cancer.

Of 102 patients operated on from 1985 to 1989, 75 patients had esophageal cancer, 21 had cancer of the cardia involving the thoracic portion of the esophagus, 3 had gastroesophageal cancer, 2 had leiomyosarcoma, and 1 had an epidermoid lesion of the middle third of the esophagus and cardial adenocarcinoma. All of them underwent extirpation of the esophagus with one-stage esophagoplasty and the establishment of a cervical anastomosis. The esophagus was replaced by an isoperistaltic tube made from the greater curvature of the stomach in 95 patients, from the colon in 4, and from the small intestine in 3 patients. The abdominocervical approach was employed in 86 patients and with additional right-side thoracotomy in 16 patients. The gastric graft was formed using a laser scalpel and suture instruments. Postoperative mortality was 4.9% (i.e., 5 deaths). A number of surgical approaches through the abdomen are suggested, permitting visual exposure of the esophagus up to the aortic arch.     

经食管床全胃重建食管术的临床应用(附100例报告)

1985年9月至1991年1月间,我院应用经食管床全胃重建食管术治疗高位食管癌100例,获得较好的近期疗效。本术式的重点是经右胸游离并切除全胸段食管;行上腹正中切口经腹游离全胃,常规行幽门成形及沿小弯的管状胃缝缩术;将制备的管状全胃组织经食管裂孔,送于后纵隔食管床之中,再于左颈部将管状胃递出;最后于左颈部与食管(咽)行Gambee氏单层吻合术。本组胸内(心、肺)未发生术后并发症,颈部吻合瘘为2％。     

食管中段癌切除吻合口部位的选择

作者对１６４例食管中段癌作了切除术，其中颈部食管胃吻合术３９例，上下切缘无残留癌，发生吻合口瘘４例，均治愈，胸内食管胃弓上吻合１２５例，发生吻合口瘘６例死亡１例，上切缘残留癌１０例，作者对颈部和胸内两种部位吻合作了比较和分析，认为食管中段癌苇除颈部吻合利弊少，切除长度足够，无残留癌组织，即使发生了吻合口瘘，治疗也容易，大多能痊出院。     

The completely mobilized remnant stomach: A new choice to reconstruct the esophagus in lower thoracic esophageal carcinoma with a history of distal gastrectomy

Objective

It is a significant surgical challenge to reconstruct esophagus for the patients following distal gastrectomy (DGE). Remnant stomach seems to be a better choice compared with colon or jejunal. But many complicated surgical methods were performed because of limitation of feeding vessels. We found the remnant stomach remained viable when all the feeding vessels were dissected. We used the completely mobilized stomach to reconstruct esophagus successfully in 29 lower thoracic esophageal carcinoma patients with a history of DGE.

Intussusception anastomosis of the esophagus: a new method of anastomosis after resection of esophageal or cardiac carcinoma

A new method of anastomosis after resection of esophageal or cardiac carcinoma was carried out in 141 patients in Anyang Cancer Hospital from February 1983 to September 1985. After resection of the tumor, the proximal end of the esophagus was intussuscepted into the stomach lumen and extroversion sutures were applied on the esophageal mucosa to prevent bleeding and stenosis. In this series, the operative mortality was 0.7% (1/141) and no anastomotic leakage was found. We consider that this modified operative procedure is fairly easy, simple, and beneficial in reducing surgical complications.     

Gastric esophagoplasty for esophageal carcinoma.

The 30 years experience includes 293 esophageal resections for carcinoma, completed with esophagogastrostomy at the thoracic or cervical level. Resections were performed according to the method of Garlock (73), Lewis (178), and Dobromyslov-Torek (36). This paper compares isoperistaltic esophagoplasty with whole or resected stomach (257) and antiperistaltic esophagoplasty with a tube from the greater gastric curvature (36). We will assess the choice of an esophageal substitute, the creation of esophagogastric anastomosis, and the functional consequences of surgical intervention.     

Surgical aspects in the treatment of esophageal cancer.

In operation for esophageal cancer the authors distinguish amputation and rehabilitation stages. Analysis of survival rate has shown that extended esophageal resections are preferable to typical resections. The differences are significant both in locally limited cancer and cancer with lymphogenous metastases. One-stage esophagoplasty is advisable, since after Dobromyslov-Torek's operation multistage esophagoplasty could be completed only in one-third of the patients due to recurrence of the disease and their general weakness. In Lewis' and Garlock's one-stage operations it is preferable to perform an "end-to-side" anastomosis with immersion of the first line of anastomotic sutures and the adjacent esophageal part into the anterior gastric wall. Postoperative mortality for Lewis' and Garlock's operations was 14.7% and 8.3%, respectively. Combined operations are justified only when one-stage esophagoplasty is performed.     

胃大部分切除术后食管癌的手术治疗和远期疗效

 目的　探讨胃大部分切除术后食管癌的手术治疗方法和远期疗效。方法　 85例胃大部分切除术后的食管癌患者均采用剖左胸食管癌切除 ,保留胃短血管 ,将残胃、脾脏及胰尾移入左侧胸腔 ,行食管、残胃吻合术重建消化道。结果　手术切除率 91.8% ,术后并发症率 10 .3% ,无手术死亡 ,1,3,5 ,10年生存率分别为 85 .7% ,5 0 .7% ,30 .6 %和 18.8%。结论　手术为胃大部分切除术后食管癌患者最有效的治疗手段。采用食管残胃吻合重建消化道 ,方法简单 ,既能够达到较好的治疗效果 ,也有利于提高患者的消化功能及生存质量。     

双成形术在食管胃手术中的应用

目的评价双成形术对食管胃术后胃排空障碍、吻合口瘘、狭窄及反流性食管炎的预防作用。方法按食管胃弓上、弓下及颈部吻合口部位将所有患者随机分为对照组和研究组,两组均采用手术切除的方法进行治疗,两组患者切除病灶后均应用国产管状吻合器将食管胃吻合在一起。对照组采用常规的食管贲门癌根治术;研究组患者在施行食管贲门癌根治术的同时,附加双成形术。结果研究组患者出现胃排空障碍1例,占0.43%,反流性食管炎1例,占0.43%,吻合口瘘1例,占0.43%,吻合口狭窄9例,占3.90%;对照组患者出现胃排空障碍8例,占3.57%,反流性食管炎7例,占3.13%,吻合口瘘9例,占4.02%,吻合口狭窄10例,占4.46%。两组胃排空障碍、反流性食管炎及吻合口瘘的发生率比较差异有统计学意义（P<0.05）,吻合口狭窄的发生率比较差异无统计学意义(P>0.05)。结论采用双成形术可有效预防食管胃吻合后胃排空障碍,减少食管胃吻合口瘘及反流性食管炎的发生,不增加吻合口狭窄的发生率。     

结肠段间置胸内吻合术在食管外科中的应用

目的　研究结肠间置胸内吻合术在食管外科中的应用。方法　对 2 8例食管胸中段、下段癌切除并用GF I型消化道吻合器将带蒂横结肠段与食管进行食管结肠、结肠食管的胸内顺行吻合。结果　保留了食管、胃的迷走神经及完整的食管裂孔和贲门、胃的正常解剖位置。结论　结肠间置胸内吻合术后无胸胃症状 ,消化功能良好 ,无返流性食管炎的发生。 1,3,5年生存率明显提高 ,分别为 96 .4%、92 .8%和 71.4%。     

缩缝管胃弓后上提颈部吻合治疗食管癌

One hundred and twelve esophageal cancer patients underwent esophagus resection with neck anastomosis of esophagus and reduced tubular stomach raised from the stomach bed and back of the aortic arc. Twelve (10.8%) cases developed early complications and 2 (1.8%) died. The 3 and 5 year survival rates were 48.7% (19/39) and 33.3% (3/9), respectively. The operative procedure, its advantages and points to be noted are discussed.     

A comparative study of immediate and long-term results of the treatment in cancer of the distal part of the stomach

Treatment results were studied in 117 cases of cancer of the distal part of the stomach; the patients had undergone subtotal resection. Postoperative lethality after Hofmeister-Finsterer's resection was 15.1%, after valve anastomosis-5.9% (overall lethality-8.3%). Postoperatively, patients with valve anastomosis did better and suffered surgery-related functional disorders less frequently than those treated after Hofmeister-Finsterer. 104 (97.2%) patients were followed up. Five-year survival was 45.2%; ten-year-32.2%.     

2005例食管和贲门癌切除一层吻合术的临·论著·床运用

目的食管和贲门癌切除术后吻合瘘口是常见的并发症之一,为了降低吻合口瘘的发生率,我院心胸外科对食管与胃或肠的吻合方法进行了改进。方法食管与胃空肠结肠吻合采用一层吻合法,共手术２００５例,其中食管与全胃吻合１０４１例,与残胃吻合８６９例,与空肠吻合８５例,与结肠吻合１０例。结果全组术后发生吻合口瘘４１例（２．０％）,死亡１５例（３６．６％）。结论经临床运用证明一层吻合术具有对合整齐血供好,肿瘤切除率高,吻合口瘘发生率低等优点。改进吻合技术,保护吻合口血供,减少术中污染,降低吻合口张力是预防吻合口瘘的重要措施。     

食管胃颈部单层吻合术治疗食管癌方法探讨

目的探讨食管胃颈部单层吻合术治疗食管癌的方法及疗效。方法回顾分析612例食管癌患者采用左侧开胸胃经食管床、主动脉弓后至颈部行食管胃单层吻合的临床资料。结果根治性切除599例,姑息性切除13例,切除率100%;术后出现颈部吻合口瘘12例,肺不张3例,肺部感染8例,返流性食管炎10例,乳糜胸1例,并发症的发生率为5.7%(35/612),无吻合口狭窄及喉返神经损伤发生。结论颈部单层吻合愈合好,对心肺功能影响小,吻合口瘘及狭窄发生率较低,有利于患者恢复和提高术后生活质量。     

Omentoplasty versus no omentoplasty for esophagogastrostomy after surgery for cancer of cardia and esophagus

BACKGROUND: The standard of care of patients with cancer of cardia and esophagus still remains surgery in early stage. One of the most feared complications after such procedure is anastomotic leak. AIM: We present our experience with omental wrapping of anastomosis (omentoplasty) to decrease the anastomotic leak. SETTINGS AND DESIGN: Retrospective study. MATERIALS AND METHODS: An analysis of 50 consecutive patients, who underwent surgical resection for cancer of cardia and esophagus at BPKMCH, is done. For cancer of esophagus, a 10 cm proximal tumor free margin and for lesions of cardia, at least 5 cm margin was achieved. A 5 cm distal tumor free margin was achieved in each case. A subset of patients was considered for omentoplasty after completion of anastomosis. RESULTS: There were 29 male and 21 female with a mean age of 56.3 years. The average postoperative stay was 13.14 days. The stomach was the organ of substitute in 48 and jejunum in 2 cases. Omentoplasty was done in 37 cases, whereas in 13 cases, no omental wrapping was done. The rate of anastomotic leak was 6%. There was no leak from anastomosis placed at chest, whereas three cases of leak was observed in the anastomosis at the level of neck (P=.013). Overall, there was no leak in omentoplasty group, whereas there were three cases with leak in the group without omentoplasty (P=0.003). CONCLUSION: Omentoplasty should be considered in every case after surgical resection for cancer of cardia and esophagus.     

左胸全胃食管床移植颈部吻合治疗胸段食管癌

目的：报告左胸后外侧切口全胃移植颈部吻合手术治疗胸段食管癌的临床经验。方法：全组１１２４例,男７４９例,女３７５例;平均年龄５８．５岁。肿瘤分布：上段癌７２例,中段癌８８３例,下段癌１６９例。临床病理分期（ＴＮＭ）Ⅰ期４８例,Ⅱａ期２６３例,Ⅱｂ期３０４例,Ⅲ期４２５例,Ⅳ期７９例。全部经左胸后外侧切口行食管次全切除,全胃食管床移植颈部吻合。结果：全组手术治疗愈１１１８例,死亡６例（０．５３％）,     

Safety of EEA staplers for anastomosis between upper esophagus and the gastric tube

The EEA stapling devices used for intrathoracic anastomosis between the upper esophagus and the gastric tube in patients with carcinoma of the thoracic esophagus were evaluated, and the results were compared with those of an antesternally reconstructed esophagus. These approaches were both used by the same surgical team. An intrathoracic anastomosis using the EEA stapler was made in 53 patients with carcinoma of the thoracic esophagus. Minor anastomotic leakage occurred in five patients (9.4%). Good results were obtained with total parenteral nutrition for 2 weeks. Intrathoracic anastomotic complications were never fatal. Among another 106 patients with antesternally reconstructed esophagus, with the EEA stapler there were 28 patients with anastomotic leakage (26.4%) and two operative mortalities (1.9%). Intrathoracic anastomosis with the EEA stapler is recommended because it is secure and the operative procedure is simple and time-saving. For successful use of the instrument, proper technical procedures must be followed.     

单一右胸入路行跨主动脉弓的食管癌切除术

目的：研究经单一右胸入路行跨主动脉弓的食管癌切除术的可行性。方法：对２５例中晚期食管癌患者采用经右胸后外侧切口入胸,将胃向上拖出膈裂孔,行食管胃胸顶吻合术。结果：切除率达１００％,其中２４例两切端无癌残留,病灶旁淋巴结癌转移１０例;术后吻合口瘘１例,肺部感染４例;术中胃左血管滑脱１例;２例生存期８月,８例生存期３年,７例生存期４年,其余８例存活５年以上。结论：单一右胸入路适用于中晚期跨主动脉弓的食     

Radical surgical treatment of cancer of the stomach in surgical hospitals]

Results of treatment of 571 patients with gastric cancer as well as errors committed during palliative and radical surgery were analysed. General surgeons not infrequently performed distal resection of the stomach for cancer of its proximal part whereas in cases of gastrectomy the distal part of the esophagus was not removed when indicated. On the contrary, in patients with cancer of the distal part of the stomach, surgeons aspired to save as much of the organ as possible, as would be done for the treatment of gastric ulcer. Principles of radical surgery for cancer were violated in those cases.     

A reflux-free Y-shaped gastroenteroanastomosis in the surgery of cancer of the distal portion of the stomach]

A procedure for formation of jejunal valve in addition to Y-shaped gastroenteroanastomosis following subtotal resection of the stomach is described. Surgery was performed in 44 patients with cancer of the distal part of the stomach. No anastomosis-related complications were observed. One (2.3%) patient died. Function of the anastomosis was studied early and at later periods following surgery. The valve proved reliably free from reflux. Partial return of the reservoir function of the gastric stump was observed.