非开胸食管内翻拔脱术治疗食管癌105例

目的探讨非开胸食管内翻拔脱术治疗食管癌的适应证、手术技巧及并发症处理。方法回顾性分析2002年7月至2010年7月南京医科大学第一附属医院105例食管癌患者行食管内翻拔脱术(其中28例辅助使用电视纵隔镜)的临床资料,其中男59例,女46例;年龄63(48～81)岁。食管上段癌51例,中段癌18例,下段癌36例;分析手术效果和安全性。结果手术时间153(140～210)min,术中出血量150(100～250)ml,住院时间15(10～35)d。全组无手术死亡,残端未见肿瘤细胞残留。27例术后发生并发症,其中3例吻合口瘘,4例喉返神经损伤,5例胸腔积液,2例气胸,3例合并肺部感染,3例心律失常,1例乳糜胸,2例切口感染,2例胃排空障碍,2例吻合口狭窄,经治疗后均痊愈。术后随访16个月～5年,随访97例,失访8例,已生存1年以上患者94例,生存3年以上67例,生存5年以上34例,部分患者待进一步随访。结论食管内翻拔脱术损伤小、恢复快,可使不能耐受经胸或不宜经胸手术的Ⅱ期及更早的食管癌患者获益。     

食管内翻拔脱术治疗食管癌贲门癌19例分析

目的　探讨食管内翻拔脱术在食管癌、贲门癌外科治疗中的地位。方法　 19例食管癌、贲门癌病人接受了食管内翻拔脱术 ,其中食管鳞癌 15例 ,颈段 3例 ,胸中段 6例 ,胸下段 6例 ;贲门腺癌 4例。 0期 1例 ;Ⅰ期 4例 ;Ⅱa期 4例 ;Ⅱb期 1例 ;Ⅲ期 9例。 3例因有上消化道手术史行结肠代食管。结果　 19例均获切除 ,食管切缘阴性 ,无手术死亡。术后声音嘶哑 1例 ,心律失常1例 ,双侧胸腔积液 1例 ,左侧气胸伴左膈下脓肿 1例 ,5例出现小的颈部吻合口瘘。结论　食管内翻拔脱术扩大了食管癌、贲门癌的手术适应证 ,使某些常规手术高危患者重新获得手术机会。     

食管、贲门、膈

220例右胸腹部二切口治疗胸段食管癌的疗效分析；镍钛合金组合式人工食管替代食管术后新生食管的形成与重构；结肠代食管术后远期并发症的观察；串列式食管内翻拔脱术；低位结扎胸导管预防食管癌术后乳糜胸的适应证探讨     

非开胸食管内翻拔脱治疗颈段食管癌19例

食管颈段是指食管入口至胸骨柄上缘,由于颈段食管癌术后并发症和病死率较其他部位高,手术效果不如胸段,传统的方法选择放射治疗,近年来趋向于手术治疗.1997年至今,我院采用非开胸食管内翻拔脱术治疗颈段食管癌19例,取得良好的效果,现报告如下.     

腹腔镜下经食管裂孔顺行食管拔脱术治疗上段食管癌1例

本文报道1例腹腔镜下顺行食管内翻拔脱术治疗食管癌。患者女,72岁,吞咽不畅1个月,经胃镜和活检病理诊断为上胸段食管鳞状细胞癌。术前分期T1N0M0。2014年12月31日行腹腔镜下顺行食管内翻拔脱术。腹腔镜下用超声刀游离胃、膈食管裂孔和下胸段食管,左颈部切口顺行拔脱食管,经上腹部切口制做管状胃,将管状胃牵至颈部与食管残端吻合。手术过程顺利,手术时间200 min,术中出血量150 ml。术后恢复顺利,第9天进清流食,无呕吐,无反酸,第12天出院。住院期间未发生吻合口漏、声音嘶哑等并发症。术后病理食管鳞癌,淋巴结无转移。术后3个月复诊,进食可,无呕吐,胃酸反流2~3次/d。     

新辅助化疗后腹腔镜辅助食管内翻拔脱术治疗颈段食管癌1例报告

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.     

高位食管癌的外科治疗

目的:为减少高位食管癌颈部吻合术后并发症,尤其是吻合口三大并发症。方法:采用经食管床胃重建食管术治疗高位食管癌91例。结果:2例吻合口瘘(2.2％)均经换药治愈,无吻合口瘘死亡。结论:经食管床全胃重建食管术治疗高位食管癌可采用左侧开胸、右侧开胸或上腹正中内翻拔脱术三种切口,各有利弊,应合理掌握。采用食管黏膜延长胃浆肌层包套吻合术疗效满意,值得推广。     

经颈、胸骨上段劈开径路手术治疗上胸段食管癌

目的总结经颈、胸骨上段劈开径路手术治疗上胸段食管癌的临床经验,并探讨食管癌外科治疗手术径路的选择以及术后并发症等问题。方法采用左颈部胸锁乳突肌前缘切口以游离颈部食管,将胸骨上段部分劈开,充分显露及游离上胸段食管及肿瘤;经腹部切口游离胃后行胸段食管内翻拔脱,将胃经食管床上提后行食管胃吻合。颈部吻合23例,纵隔内吻合14例。结果37例上胸段食管癌患者的癌肿全部切除,切除率100%,无手术死亡。术后发生颈部吻合口瘘3例,经保守治疗后痊愈;发生声音嘶哑12例,7例声带功能逐步恢复。结论经颈、胸骨上段劈开径路对上胸段食管的显露满意,可在直视下完成食管及肿瘤的游离。手术切除率高,术后发生危重并发症较少。     

电视胸腔镜食管切除术在食管癌外科治疗中的应用

目的分析电视胸腔镜食管切除术对于食管癌患者的手术安全性和有效性。方法2004年6月至2007年10月。共有36例食管癌患者行胸腔镜食管切除术。食管上段癌5例，食管中段癌25例，食管下段癌6例。其中2例患者既往有胃大部切除手术史，1例患者行术前化疗。手术采用胸腔镜游离胸段食管并清扫纵隔淋巴结，开腹游离胃行食管胃颈部吻合。结果平均手术时间250（190-330）min。其中胸部手术时间平均为70（50-150）min，术中出血量165（100～350）ml，术后胸腔引流管放置时间平均2．9d，平均住院时间8．7d。平均清扫淋巴结14．3枚，其中胸部淋巴结8．2枚。无围手术期死亡，共有11例（30．6％）患者出现术后并发症。结论电视胸腔镜食管切除术治疗食管癌在技术上是安全可行的，有望减少手术创伤，降低肺部并发症的发生。     

非经胸食管内翻剥脱治疗食管癌

目的总结非经胸食管内翻剥脱治疗食管癌的体会。方法对41例患者应用非经胸食管内翻剥腹术治疗食管癌进行回顾性分析。结果本组1例术后第4天死于心衰，其余40例治愈出院。术中发生并发症12例．其中颈咽吻合瘘3例，气胸、液气胸3例，肺部感染4例，腹部伤口感染2例，经非手治疗均治愈。结论早期食管癌．有剖胸禁忌的患者，食管内翻剥脱为最佳手术治疗选择。     

不开胸食管剥脱术在颈段食管癌中的治疗价值

目的探讨不开胸食管剥脱术治疗颈段食管癌的效果。方法自1995年7月至2004年12月对21例颈段食管癌患者行不开胸食管剥脱术并Ⅰ期行胃咽吻合或胃食管端侧吻合术。结果本组病人的手术切除率100%。手术后发生各类并发症8例,其中吻合口瘘3例,肺部感染3例,伤口裂开1例,气胸1例。18例患者术后有不同程度的胃液反流。1例住院期间因胃大出血死亡。除2例失访外其余患者获得随访27个月～12年,13例存活超过1年,6例存活超过3年,3例存活超过5年。结论不开胸食管剥脱术手术简单,效果满意,适用于颈段食管癌。食管剥脱术后行胃代食管者胃液反流严重,手术方式有待进一步改善。     

Prevention and treatment of pleuropulmonary complications after simultaneous reconstructive operations on the esophagus in esophageal cancer]

Pleuropulmonary complications in 50 patients who underwent operation for esophageal carcinoma with simultaneous esophagogastroplasty were most frequent (59%) and serious and accounted for up to 60% of all causes of early postoperative mortality. In operations through a transthoracic approach these complications occur more frequently (75%) than in operations without thoracotomy (48%). The possible causes and measures for the prevention of pleuropulmonary complications in the pre-, intra-, and postoperative periods are discussed. Particular attention is focused on the acute respiratory insufficiency syndrome during resection of the esophagus without thoracotomy. It is concluded that this serious pathological condition can be avoided by a complex of preventive and therapeutic measures carried out in all stages of treatment.     

食管胃套接术与器械吻合术治疗食管、贲门癌的对比研究

目的对比食管胃套接术与器械吻合术的临床治疗效果,以减少食管、贲门癌根治术后并发症的发生率. 方法将285例诊断明确的食管、贲门癌住院患者按入院顺序随机分为两组,食管胃套接组(套接组)134例,采用食管癌切除食管瓣片成形-食管胃套接术;器械吻合组(吻合组)151例,采用食管癌切除器械吻合术.术后观察吻合口瘘、吻合口狭窄和胃食管反流并发症的发生率,并随访观察3年. 结果套接组术后吻合口瘘、吻合口狭窄和胃食管反流的发生率分别为0%、2.2%和1.5%,而吻合组为1.3%、13.9%和21.2%(P<0.01). 结论食管瓣片成形-食管胃套接术术后并发症少、操作简单,较器械吻合具有一定的优越性.     

胃大部切除术后食管癌手术方法分析

目的探讨胃大部切除术后食管癌患者手术治疗方式的选择。方法自2006年1月至2010年6月,我院收治8例有胃大部切除术史的食管癌患者,对其治疗方法进行分析。食管癌切除,结肠代食管4例;3例腹腔粘连,结肠无法游离,将残胃连同脾脏及胰体尾移入胸腔,残胃代食管完成食管癌根治手术;1例腹腔广泛粘连无法分离放弃手术。术后给予抗感染、抑酸、空肠营养支持等处理。结果3例残胃代食管手术后恢复快,无并发症;4例结肠代食管患者中,2例恢复良好,1例术后肠粘连梗阻并出现下消化道出血,1例术后第5天出现吻合口瘘,给予对症支持治疗后均治愈出院。结论胃大部切除术后食管癌患者,结肠代食管是常见术式,腹腔粘连较重时,将残胃连同脾脏及胰体尾移入胸腔,在弓下或弓上与食管吻合,残胃代食管完成食管癌根治手术是一种安全、有效的手术方法,并发症少,术后恢复快。     

Total esophageal reconstruction after extraction of the esophagus.

During the period between 1971 and 1974, 25 cases of carcinoma of the hypopharynx and cervical esophagus underwent esophageal extraction and total esophageal reconstruction without operative mortality. The operative methods used for this series were blunt dissection, or everting stripping of the thoracic esophagus without thoractomy followed by pharyngogastro or -colostomy as a one stage procedure via a posterior mediastinal route created by esophageal extraction. The operative technique of esophageal extraction without thoracotomy is described. It is obvious that mediastinal tunnel is the shortest route through which to put the chosen organ for esophageal substitution. This operation is to be recommended for lesion of the hypopharynx and cervical esophagus as well as some esophageal stricture because of its operative simplicity, ease, safety and rare postoperative complications.     

SiewertⅠ型和Ⅱ型食管胃结合部癌不同手术方式的近期疗效分析

目的分析SiewertⅠ型、Ⅱ型食管胃结合部癌患者不同手术方式的近期疗效。方法纳入2015年3月至2018年3月西安交通大学第一附属医院胸外科接受手术治疗的SiewertⅠ型、Ⅱ型食管胃结合部癌患者共82例,其中男53例、女29例,年龄48~72(61±6)岁。根据手术方法将患者分为4组,左开胸组(n=14),腹腔镜左胸小切口组(n=33):胸腹腔镜Ivor-Lewis组(n=17)和胸腹腔镜McKeown组(n=18)。对比分析不同手术组的近期疗效和生存率。结果左开胸组手术时间最短,随后为腹腔镜左胸小切口组、胸腹腔镜McKeown组和胸腹腔镜Ivor-Lewis组;胸腹腔镜McKeown组/腹腔镜左胸小切口组术中出血量最少;左开胸组淋巴结清扫数量最少,胸腹腔镜McKeown组最多。腹腔镜左胸小切口组总并发症发生率低于其它3组(P<0.05),肺炎及心律失常发生率在4组中最低(P<0.05)。4组近期生存率差异无统计学意义(P>0.05)。结论胸腹腔镜联合手术治疗SiewertⅠ型、Ⅱ型食管胃结合部癌安全、可靠。腹腔镜左胸小切口手术方式具有微创优势,淋巴结清扫较为彻底,尤其对于心肺储备功能欠佳的高龄患者,能明显缩短手术时间、减少术后并发症,具有一定的可推广性。     

食管插入吻合法在二次开胸处理胸内食管吻合口瘘中的应用

本文报告5例食管癌手术后胸内吻合口瘘采用二次开胸,拆除原吻合口,以食管插入法重新吻合并附加空肠造瘘的方法进行处理的经验。5例均获治愈。作者等认为,该方法具有迅速净化胸腔,防止吻合口再瘘和打开营养通道及时的优点。作者还比较了运用其它方法进行处理的结果,认为本方法是治疗胸内食管吻合口瘘的一种较好方法。     

电视胸腔镜与小切口开胸手术治疗食管良性疾病的比较

目的比较电视胸腔镜手术与小切口开胸手术治疗食管良性疾病的临床效果和适应证。方法1995年1月至2007年1月我院胸外科应用微创手术治疗食管良性疾病患者52例。其中贲门失弛缓17例,食管平滑肌瘤24例,食管憩室7例,食管脂肪瘤1例,食管囊肿1例,贲门失弛缓合并食管憩室1例,贲门失弛缓球囊扩张食管破裂1例。根据手术方式分为电视胸腔镜手术组25例,小切口开胸手术组27例。结果两组患者手术治疗效果均良好,无术后并发症,无手术死亡。电视胸腔镜手术组有2例因胸腔内广泛粘连和食管黏膜损伤中转开胸。两组患者手术时间、术后胸腔闭式引流时间、胃肠减压时间以及术后住院时间均无明显差异。结论电视胸腔镜手术和小切口开胸手术治疗食管良性疾病安全有效,术后恢复快。电视胸腔镜手术切口符合美观要求,可作为治疗食管良性疾病的常规术式。小切口开胸手术更适合于病情较复杂的患者。     

Limited operation for patients with T1 esophageal cancer

BACKGROUND/AIMS: Transhiatal esophagectomy without thoracotomy has been introduced as a minimally invasive operation to prevent postoperative complications in patients with relatively early-stage esophageal cancer who have preoperative pulmonary or cardiovascular complications or who are in a high age bracket. However, this procedure for patients with esophageal cancer remains controversial, especially as regards curative surgery because complete intrathoracic lymphadenectomy cannot be performed in this operation. Thus, cancer recurrence after this operation has been considered to be high. To evaluate the benefits of this less invasive surgery for patients with T1 esophageal cancer, the prognoses of patients who underwent transhiatal esophagectomy without thoracotomy were compared with those of patients who underwent traditional esophagectomy with thoracotomy. METHODS: Between 1989 and 1998, 33 patients with T1 esophageal cancer were operated on in our hospital. We introduced transhiatal esophagectomy without thoracotomy in 19 patients who were over 70 years old or who had preoperative complications (transhiatal group). The remaining 14 patients were treated with the transthoracic procedure (transthoracic group). These 33 patients were followed up at our hospital until the end of 1999. The postoperative complications and prognoses in the two groups were compared. RESULTS: We were able to reduce the operation time using the transhiatal procedure. Even though no significant difference was detected, there were fewer postoperative pulmonary complications with this procedure (11%) than with the transthoracic procedure (21%). The incidences of in-hospital mortality did not differ between the two groups. Cancer recurrence was detected in 5 of 19 patients (26%) in the transhiatal group and in 5 of 14 patients (36%) in the transthoracic group; no difference was observed (P=0.562). The 5-year survival rate (58%) of the transhiatal group was no different from that of the transthoracic group (62%, P=0.69). CONCLUSIONS: Complete intrathoracic lymphadenectomy cannot be performed along with transhiatal esophagectomy; however, the prognoses of patients who were treated with this procedure were no different from those of patients who were treated with transthoracic esophagectomy. Thus, transhiatal esophagectomy without thoracotomy might be a justifiable operation for compromised patients with T1 esophageal cancer.