食管癌切除颈部食管重建术的临床应用：附190例报告

自１９８９年５月－１９９５年９月，我院共施行食管癌切除颈部食管重建术１９０例，无手术死亡，亦无吻合口并发症。本文就胸段食管全切除的理论基础及颈部食管重建的优越性进行讨论。     

食管癌切除左颈部食管胃吻合术61例体会

食管癌切除左颈部食管胃吻合术６１例体会肖作珍，王彦亭，张丽１９９６年１月～１９９７年８月对６１例食管癌切除，食管氏胃代食管，左颈部吻合术。近期效果满意，分析报告如下：１材料与方法本组男４９例，女１２例。年龄４１－７３岁，平均年龄５５岁。食管中段癌４６...     

食管癌切除颈部食管胃吻合胃十二指肠过度牵拉致胸胃梗阻

食管癌切除颈部食管胃吻合胃十二指肠过度牵拉致胸胃梗阻陈古元福建省泉州市第一医院胸心外科（泉州市３６２０００）我院自１９８２年３月起采用经右胸前外侧切口切除全胸段食管，经上腹正中切口游离胃，将胃穿过膈肌食管裂孔，经右胸食管床拉至左颈部，行食管胃端侧吻合...     

食管癌颈部,胸内吻合术疗效对比观察及生活质量评价

１９７９年４月～１９８４年１２月间，作者对食管癌行食管部分切除，食管胃颈吻合术１０８例，胸内吻合术４４４例。结果表明，两组术后并发症发生率和手术死亡率基本相同，仅有颈部吻合口瘘发生率较高，但瘘致死率较低。颈吻合组术后１、３、５、１０年生存率及相同ＴＮＭ分期的５年生存率略高于胸内吻合组，但无统计学意义。两组术后生活质量尚满意，颈部吻合术未降低生活质量，而且胃食管返流低于胸内吻合术。作者认为，对食管癌病例，应选择颈部吻合术，并应进一步扩大淋巴结清除范围。     

无创可吸收缝线用于食管癌切除颈吻合术47例临床分析

目的 探讨食管癌切除食管，胃颈部吻合术后并发症的预防。方法 对47例食管癌切除病人，应用无创可吸收缝线行食管，胃颈部吻合术后进行回顾性分析。结果 本组中无手术死亡，无吻合口瘘，吻合狭窄及返流性食管炎等并发症出现。结论 该手术方法有效地预防了食管癌切除颈部吻合术后并发症的发生，明显提高了病人术后的生活质量。     

全胸段食管切降经食管床颈部吻合食管重建术：附831例报告

为改进食管癌的手术操作技术,降低残端癌的发生率,提高近期手术治疗效果。方法我院外科自１９９２年１月－１９９７年５月共完成全胸段食管切除,经食管床颈部吻合食管重建术８３１例。结论进一步证明了增加食管癌患者食管切除长度和彻底清除颈,克,腹各组区域淋巴结的重要性,同时提出了几项预防颈部瘘的有力措施。     

气管,支气管成形术的临床体会

１９７８年１０月至１９９３年１２月施行气管、支气管成形术１２例，占同期住院２５３例肺切除手术的４．７４％。其中支气管袖状肺叶切除６例，支气管楔形肺叶切除３例，气管袖状切除１例，气管袖状和食管癌切除食管胃颈部吻合１例，气管成形、隆突、左全肺和食管转移癌切除食管胃弓上吻合１例。术后并发包裹性脓胸１例，气胸１例，支气管肺炎１例。急性呼吸衰竭死亡２例，死亡率为１６．７％。     

“三切口”切除食管癌胃经胸骨后代食管16例

〔目的］评估食管中段癌经右胸、颈、上腹三切口切除后胃经胸骨后隧道与颈部残留食管吻合术的实用价值。（方法）将病变长度大于5cm的食管中段癌16例，右侧进胸将购段食管及区域淋巴结切除后，进腹游离胃并清除胃周淋巴结，将胃经胸骨后隧道上提至颈部与颈段残留食管吻合，然后再清扫下颈部淋巴结。（结果）16例中，10例行根治性切除，其余6例为姑息性切除；吻合口瘘发生率为37.5％，但均经恰当的引流后治愈；无心肺并发症发生。（结论）“三切口”术式切除食管中段癌符合肿瘤外科的治疗原则，而食管中段癌切除后胸胃经胸骨后上提至颈部与颈段残留食管吻合是可行的，对中晚期食管中段癌估计术后需辅助性放疗的病例可选择此术式。     

胃经食管床颈部吻合食管癌根治术对术后呼吸功能的影响

 目的　探讨胃经食管床颈部吻合食管癌根治术对患者术后呼吸功能的影响。方法　60例食管胸中段癌患者，30例行食管癌切除胃经食管床颈部食管胃吻合术，30例行胸内食管胃弓上吻合术，测量比较术前、术后3周、3个月肺功能主要指标变化。结果　患者均手术成功。颈部吻合组与胸内吻合组术前的肺活量（VC）、第1秒时间肺活量（FEV1）和最大通气量（MVV）差异均无统计学意义（P＞0.05）。术后3周、3个月两组相比VC、FEV1和MVV差异均有统计学意义（P＜0.05）。结论　经食管床行食管胃颈部吻合对患者呼吸功能影响小。     

改进手术径路治疗食管癌150例临床分析

改进手术径路治疗食管癌１５０例临床分析段孝凤高晓旭徐华葛来增吕军吉我院自１９９２年１月至１９９６年１２月，采用左上腹直肌、右胸后外侧和（或）右颈部切口手术径路行次全食管切除、颈部或右胸顶部食管胃吻合术，治疗不同部位食管癌１５０例，取得了较好疗效，现报...     

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.     

Esophagoplasty using modified sleeve-type intrathoracic anastomosis

Anastomotic leakage due to loosening of sutures is the frequent cause of lethality. To prevent such complication, a sleeve-type esophago-enteric and esophagogastric anastomosis was used. Its design eliminates the major cause of failure--the basic sutures running through the soft muscular wall of the esophagus. The new anastomosis was used in ca. 42 patients: Lewis operation (24), proximal resection of the stomach and distal thoracic part of the esophagus and adjuvant intrapleural esophagoplasty with the distal end of the stomach (8), gastrectomy with resection of the distal thoracic part of the esophagus and concomitant intrapleural esophagoplasty with small intestine (S.S.Yudin) (10). Postoperative complications were reported in 18 patients (42.9%); lethality--11.9%. No leaking esophageal anastomosis was registered.     

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.     

Various indices of metabolism and non-specific immunity in cancer of the thoracic region of the esophagus

Studies on protein and carbohydrate metabolism in 100 esophageal cancer patients showed a correlation between changes in metabolism, on the one hand, and stage, site and macroscopic pattern of tumor as well as degree of dysplasia, on the other. Metabolic indexes were shown to return to normal two years after resection of the esophagus and esophagoplasty using small intestine. A study involving 42 patients demonstrated that such parameters of non-specific immunity as complement activity and index of complete phagocytosis undergo maximum changes, viz. a decrease by 66.0 and 41.1%, respectively.     

胃咽吻合术在下咽癌侵及颈段食管手术修复中的应用

目的研究胃咽吻合术在下咽癌侵及颈段食管手术修复中的应用及术后并发症的预防、处理.方法回顾我院1998-2002年采用全喉、全下咽及全食管切除、胃咽吻合术治疗下咽癌侵及颈段食管的病人3例,分析其手术方式、并发症防治体会及结果.结论胃咽吻合术对于下咽癌侵及颈段食管术后缺损具有良好的修复作用,是一值得推荐的手术方式.     

胸段食管癌气管、支气管及隆凸浸润早期的CT诊断与术后病理对照研究

 目的 探讨食管癌气管、支气管、隆凸浸润早期的CT诊断和术后病理的相关性，提高术前CT食管癌T4分期的准确性。方法 49例颈段及胸上、中段食管癌患者术前行颈、胸部CT扫描，将CT扫描结果与术后病理对照，分析颈段及胸上中段食管癌气管、支气管及隆凸受侵早期术前CT诊断的敏感性、特异性、准确性及与术后病理相关性。结果 49例中，颈段21例，胸上、中段28例。术前CT显示肿瘤侵及气管、支气管及隆凸35例：颈段18例，术后病理证实14例受侵；胸上、中段17例，术后病理证实14例受侵。术前CT诊断未受侵14例：颈段3例，术后病理证实1例受侵；胸上、中段11例，术后病理证实3例受侵。CT对颈段及胸上、中段食管癌气管、支气管及隆凸浸润早期诊断的敏感性、特异性、准确性分别为93.3 %，33.3 %，76.2 %和82.4 %，72.7 %，78.6 %，术前CT诊断与术后病理对照的列联系数分别为0.52，0.77。结论 术前CT对食管癌气管、支气管及隆凸浸润早期诊断的敏感性、特异性、准确性，胸上、中段高于颈段；与术后病理有一定相关性。术前CT检查对食管癌气管、支气管、隆凸浸润早期的诊断，并不能作为放弃手术治疗的依据。     

食管黏膜延长胃浆肌层包套吻合术在颈部消化道重建中的应用

目的探讨食管黏膜延长胃浆肌层包套吻合术在颈部消化道重建中预防吻合口三大并发症的作用。方法自2007年1月至2009年1月共行左颈部食管黏膜延长胃浆肌层包套吻合术治疗食管胸中、上、颈段癌286例。结果无一例吻合口瘘、狭窄及手术死亡,返流性食管炎2例。结论食管黏膜延长胃浆肌层包套吻合术用于食管癌切除颈部消化道重建,操作简单,安全有效。     

从淋巴转移规律探讨食管癌合理根治术

1986年9月至1990年6月,按日本“食管癌规约”中食管分段,淋巴结分组、分站对175例胸段 Eca行切除合并淋巴结清除术.全组淋巴结转移(LNM)率 57.7%,颈、胸、腹分别为10.9%、40.6%、32.6%.LNM程度与肿瘤长度、浸润深度呈正相关.胸上段 Eca主要转移到上纵隔和下颈部;胸中段可有颈胸腹LNM;胸下段腹部较胸部LNM率为高.Eca合理根治术应行食管大部切除,颈部食管吻合,颈胸腹三领域淋巴结清除术.Eca病变部位不同其LN清除范围应有所侧重.