胃大部切除术后食管癌的外科治疗

目的：探讨胃切除术后食管癌的外科手术治疗。方法：通过我科的39例手术,结合文献分析胃大部切除术后食管癌手术切除重建的各种术式方法及优缺点。结果：上段食管癌切除应以横结肠代食管重建为佳,中下段食管癌以残胃代食管重建最理想,也可以用空肠代食管重建。结论：胃大部切除术后食管癌是可以通过手术再根治的,食管的重建以残胃最接近生理及解剖学,术式简单,安全,易行。     

胃切除后食管癌手术方法选择

 目的　探讨胃大部切除或全胃切除后再患食管癌手术治疗术式。方法　回顾分析 1990年 1月至 2 0 0 1年 12月收治胃切除术后再患食管癌 2 9例资料。食管癌切除后的消化道重建方式 :残胃代食管术 2 0例、空肠代食管术 3例、结肠代食管术 6例。结果　 2 9例除 1例颈部食管结肠吻合口瘘、1例胸部食管残胃吻合口瘘、1例吻合口狭窄、3例肺部感染、其余均Ⅰ期愈合。结论　胃大部切除术后食管中下段癌采用残胃代食管术 ,食管中上段癌行结肠代食管术更为合理     

外科治疗胃大部切除术后食管癌12例报告

目的　探讨胃大部切除术后食管癌的手术方式。方法　对 10例单纯胃大部切除术后食管癌和 2例胃大部切除 +脾切除术后食管癌采用两种不同术式。结果　两种术式均取得成功 ,无吻合口瘘及切缘癌残留发生。结论　残胃与脾胰体尾联合移入胸腔与食管吻合治疗单纯胃大部切除术后食管癌是一种可靠、实用的手术方法 ;以回结肠动脉为供血管 ,末段回肠 +右半结肠代食管术 ,治疗胃大部切除 +脾切除术后食管癌有其临床可行性     

外科治疗胃大部切除术后食管癌12例报告

目的：探讨胃大部切除术后食管癌的手术方式。方法：对10例单纯胃大部切除术后食管癌和2例胃大部切除 脾切除术后食管癌采用两种不同术式。结果：两种术式均取得成功，无吻合口瘘及切缘癌残留发生。结论：残胃与脾胰体尾联合移入胸腔与食管吻合治疗单纯胃大部切除术后食管癌是一种可靠、实用的手术方法；以回结肠动脉为供血管，末段回肠 右半结肠代食管术，治疗胃大部切除 脾切除术后食管癌有其临床可行性。     

空肠P袢代胃术在胃大部切除术后食管下段、贲门癌手术中的临床应用

[目的]探讨空肠P袢代胃术在胃大部切除术后食管下段、贲门癌手术治疗的可行性及临床疗效。[方法]对12例胃大部切除术后食管下段、贲门癌患者，手术切除病灶后，采用空肠P袢代胃。[结果]全组无手术死亡发生，无吻合口瘘及狭窄。术后生存5年以上2例。患者对术后生活质量感到满意。[结论]运用空肠P袢主动脉弓下食管空肠吻合代胃，对胃大部切除术后发生的食管下段、贲门癌进行手术切除，重建消化道，是一种安全、实用、疗效满意的手术方法。     

残胃食管吻合治疗贲门食管癌

自１９８３年１０月至今 ,对７例因溃疡病胃大部切除术后残胃发生贲门及食管癌患者进行了手术治疗。其中贲门癌５例 ,腹段食管癌１例 ,胸内上段食管癌１例。平均年龄６５．１岁。距胃大部切除时间平均２４．７年。首次手术均采用毕２式结肠前顺蠕动胃空肠端侧吻合 ,空肠输入输出段间未行侧侧吻合。手术方法 :经胸部左后外侧切口切开膈肌观察残胃容积平均约５００～７００ｍｌ,游离残胃及食管 ,距肿物上、下缘３～５ｃｍ处切断食管及胃体 ,切除肿瘤后残胃体积约２５０～３００ｍｌ,吻合完成后约１５０～２００ｍｌ。于靠近腹腔动脉起始部切断…     

106例结肠代食管术的经验分析

目的:评价结肠代食管术在食管重建外科的地位。方法:回顾分析1979年4月-2004年10月106例结肠代食管术的临床资料,随访治疗结果。结果:本组无住院死亡。72例良性狭窄者,术后长期生存,进食正常。食管癌34例,28例获得随访,术后1、3、5年生存率分别为85.7%、57.1%及28.6%。结论:结肠代食管术对颈段食管良性狭窄者,特别适合已行胃大部切除术后食管癌患者的食管重建;选用左结肠动脉为蒂部滋养血管,降结肠及部分横结肠经胸骨后顺蠕动移植至颈部吻合是最常用的术式;改进手术操作和减少并发症,对扩大此术式的应用范围尤为重要。     

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。     

食管癌残胃食管弓上吻合术7例报告

对7例远端胃大部切除术后食管癌，采用左胸、上腹两切口行食管癌根治，残胃食管弓上吻合术。术后无吻合口瘘及狭窄发生，无输入、输出襻梗阻表现。对远端B-Ⅱ式胃大部切除术后的中下段食管癌，特别是年老体弱的患者宜采用本术式。     

胃大部分切除术后食管癌的手术治疗—食管残胃吻合术

胃十二指肠溃疡病在我国是极为常见的疾病、在手术治疗中以胃大部分切除为最常用方法,近年来发现又患食管癌者并不少见。我们为了能在满足食管癌肿切除范围而又保留残胃,使术后能有较好的消化功能,保持或接近术前水平。故此,我们设计了将残胃、脾脏及部分胰尾移入左胸内,并以食管残胃吻合术重建消化道的手术方法。从1982年2月至1983年8月共施行7例,计有食管上、中段癌切除,食管残胃颈部吻合1例。食管中段及下段癌各3例,分别行食管残胃主动脉弓上及弓下吻合各3例,全部成功。本文主要介绍了手术方法及随访结果。其手术方法简单,术后恢复满意。     

胃大部切除术后食管癌的手术治疗

目的：探讨胃切除术后食管癌（Ｅｃａ）的手术治疗方式和效果。方法：对１９８７年～１９９６年间手术治疗８１５例Ｅｃａ中４１例胃切除后Ｅｃａ的手术治疗进行分析。１例胸下段Ｅｃａ行切除并残胃食管弓下吻合术，４０例右胸入路行右半结肠代食管术合并颈、胸、腹淋巴结清除术。结果：４１例胃切除术后Ｅｃａ颈、上纵隔、中下纵隔和腹部淋巴转移率分别为３４．１％、２１．９％和１９．６％。并发症发生率４８．７％。颈部吻合口瘘发生率３４．１％，无手术死亡。全组３、５年生存率４１．６％和１５．４％。根治性手术３、５年生存率４６．６％和２２．２％。姑息手术无１例生存超过５年。３年生存率１４．３％。结论：对胃切除术后Ｅｃａ颈、上纵隔和腹部淋巴结清扫很重要。结肠代食管术为安全有效办法。右半结肠经胸骨前、后径路代食管术是胃切除后Ｅｃａ手术的最好方法之一     

Treatment for synchronous and metachronous carcinomas of the head and neck and esophagus

In the past 27 years, 75 patients were found to have separate primary carcinomas of the head and neck and the esophagus. Head and neck tumor was discovered first in 41 patients, synchronously with esophageal tumors in 17 patients, and esophageal tumors were recognized first in 17 patients. Reconstruction by graft after resection of head and neck cancer was necessary in 18 patients and esophagectomy was performed in 62 patients. In eight patients, pharyngeal and esophageal reconstruction was necessary after resection of synchronous and metachronous pharyngeal and esophageal carcinoma. The combined procedure with free tissue transfer was useful for surgical treatment for synchronous or metachronous carcinomas of the head and neck and the esophagus.     

胸段食管鳞癌淋巴结转移特点及临床意义

目的 了解胸段食管鳞癌淋巴结转移特点及对预后的影响,探讨合理的淋巴结清扫范围。方法 对２４３例单纯技术切除胸段食管鳞癌患者的临床资料进行回顾性分析。结果 淋巴结转移率４５．３％,转移度１０．５％,表现为沿食管周上的上下“双向性”转移。影响淋巴结转移的因素为肿瘤浸润深度和肿瘤分化,肿瘤长度则影响不大。有淋巴结转移的患者５年生存率为１６．４％,明显低于无淋巴结转移患者的５１．９％（Ｐ〈０．０１）,。淋     

食管癌219例根治性切除的淋巴结的转移规律

目的研究淋巴结在食管癌转移的规律。方法根治性切除２１９例食管癌患者的癌组织及廓淋巴结１８７９枚并作区域分布的病理分析。结果２１９例根治性切除食管癌患者中６５例有淋巴结转移。其中胸上段食管癌８例中有２例颈深淋巴结转移。胸中段食管癌１８６例中５２例有淋巴结转移,其中伴有隆突淋巴结转移２６例,伴有食管旁、贲门区和胃左动脉旁、左下肺静脉及左下肺韧带淋巴结转移分别为１５、１２、２２、４、５例。胸下段食管癌２５例中有淋巴结转移者１１例,其中伴有食管旁、左下肺韧带、贲门区和胃左动脉旁淋巴结转移分别为１、２、５、８例。左肺动脉淋巴结无１例转移。结论淋巴结在食管癌转移的共性规律是：上段癌向上转移大于向下,下段癌向下转移大于向上,中段癌转移依次隆突区、胃左动脉旁、胸上食管旁、胸下食管旁和贲门区。左肺动脉淋巴结甚少转移。     

胃大部切除后食管癌和贲门癌的外科治疗——附24 例报告

目的：探讨胃大部切除术后食管癌和贲门癌的手术方式、处理要点和预后。方法：１９８９ 年１ 月～１９９７ 年１２ 月２４ 例胃大部切除术后食管癌和贲门癌患者实行手术治疗,其中食管癌１５ 例,贲门癌９例。残胃代食管３ 例,空肠代食管胃７ 例,回结肠代食管胃５ 例,结肠代食管胃经胸骨后颈部吻合９ 例。结果：胸腔内吻合１５ 例,１ 例发生吻合漏（６ ．７ ％ ） ,第１９ 天死亡,颈部吻合９ 例,２ 例发生吻合口漏（２２ ．２ ％ ） ,无死亡。１ 年生存率为８６ ．７ ％ ,３ 年生存率为５３ ．３ ％ 。结论：结肠经胸骨后代食管胃是颈部吻合较理想的选择,胸腔内吻合可视具体情况选择残胃、空肠、回结肠代食管胃。     

Palliative and curative surgical therapy of malignant stenoses of the esophagus and cardia

Between January 1967 and July 1986, 171 patients with malignant stenosis of the esophagus and cardia were subjected to curative or palliative surgical treatment. Specifically, there were 84 primary esophageal carcinomas, 5 cases of malignant esophageal stenosis caused by an extra-esophageal malignant tumor (inter alia bronchial carcinoma), and 82 primary carcinomas of the cardia. The average age of the patients as a whole was 63.7 years, and the sex ratio (male:female) was 4.0:1. In 18 esophageal carcinoma patients and 21 patients with carcinoma of the cardia curative resection was possible, but in 132 patients merely palliative surgery was performed, most frequently esophageal intubation and gastrostomy. The specific operations with a curative objective performed upon the esophageal carcinoma patients were abdominothoracic esophageal resection with upward displacement of the stomach (n = 16) or interposition of a colonic segment (n = 2), whereas in the patients with carcinoma of the cardia, proximal resection was performed in 13 cases, either subtotally or as a cardiofundectomy, and total gastrectomy in 8 cases. For the subsequent reconstruction of the passage the interposition of a jejunal segment was most frequently used. The clinical mortality for the curative resections was 33% for the 18 esophageal carcinoma patients and 9.5% for the 20 patients with carcinoma of the cardia. The long-term survival rates are depressing: of the patients who underwent curative resection 47.6% were still alive after one year, 28.6% after 2 years and 14.3% after 5 years. Of the patients treated only palliatively on account of an already advanced stage of the tumor, 91.5% died within the first year; only 4.9% of patients from this group were still alive after 2 years.     

Pathology of early invasive adenocarcinoma of the esophagus or esophagogastric junction: implications for therapeutic decision making

BACKGROUND: As an alternative to surgical resection, endoscopic treatment modalities are being explored for the treatment of patients with early esophageal carcinoma. This study aimed to evaluate patterns of local growth and regional dissemination of early adenocarcinoma of the esophagus or esophagogastric junction, as these pathologic features may contribute to rational therapeutic decision making. METHODS: Among 173 patients who underwent esophageal resection for invasive adenocarcinoma (1993-1998), 32 (19%) had early stage cancer (pT1). Clinical records, pathology reports, and original slides of the surgically resected esophagus were reviewed in each case. RESULTS: In 12 patients tumor invasion was limited to the mucosa, whereas in 20 patients the tumor showed infiltration of the submucosa. All cancers were associated with intestinal metaplasia. Areas of high grade dysplasia accompanied 27 of the 32 cancers (84%). Intramucosal cancer had no lymph node metastasis but presented as multifocal disease in 42% of cases and extended under preexisting squamous mucosa in 17% of cases. In submucosal cancer, lymph node metastases were present in 30% of cases. Disease specific 3-year survival for patients with intramucosal cancer was 100% and for those with submucosal cancer 82% (P = not significant). CONCLUSIONS: Based on the local growth pattern of intramucosal adenocarcinoma of the esophagus or esophagogastric junction, endoscopic treatment of patients with this disease should be applied with caution. For submucosal carcinoma, surgery is the mainstay of treatment, as lymph node metastasis is frequently present. Both subclassifications of early cancer show a favorable outcome after esophagectomy.     

Cervical anastomosis of the stomach transposed through the esophageal bed--report of 536 cases

Cervical anastomosis of the stomach transposed through the esophageal bed after subtotal resection of esophagus was performed in 536 patients with esophageal cancer during the past 15 years. It comprised 41.2% of all esophagotomy. This operation can be used for lesion at every segment of the esophagus except carcinoma of gastric cardia. Its advantages are: 1. The lesions can be radically resected; 2. The distance of transposition is short; 3. The patient's position need not be changed during the whole course of the operation, and the operative trauma is smaller than the conventional method with three incisions; 4. The stomach lying in the esophageal bed is more physiological; and 5. The procedure of cervical anastomosis is easy and safe. The authors recommend that the cervical anastomosis be adopted instead of anastomosis above the arch of aorta, and be performed through the esophageal bed.     

The integration of 18-fluoro-deoxy-glucose positron emission tomography and endoscopic ultrasound in the treatment-planning process for esophageal carcinoma

PURPOSE: Accurate delineation of the gross tumor volume (GTV) is important in radiation therapy treatment planning. We evaluated the impact of PET and endoscopic ultrasound (EUS) compared with CT simulation in the planning of radiation fields for patients with esophageal carcinoma. MATERIAL AND METHODS: Twenty-five patients presenting with esophageal carcinoma for radiation therapy underwent PET scans in the treatment position after conventional CT simulation. Patients underwent PET/CT scanning after being injected with 10 to 20 mCi of [F-18]-2-deoxy-2-fluro-D-glucose. The length of the abnormality seen on the CT portion of the PET/CT scan vs. the PET scan alone was determined independently by 2 separate investigators. The length of the GTV and detection of regional adenopathy by PET was also correlated with EUS in 18 patients. Of the 18 patients who had EUS, 2 had T2 tumors and 16 had T3 tumors. Eighteen patients had adenocarcinoma and 7 had squamous cell carcinoma. Nine tumors were located at the gastroesophageal junction, 8 at the lower esophagus, 7 in the middle esophagus, and 1 in the cervical esophagus. The PET scans were reviewed to determine the length of the abnormality by use of a standard uptake value (SUV) of 2.5 to delineate the tumor extent. RESULTS: The mean length of the cancer was 5.4 cm (95% CI 4.4-6.4 cm) as determined by PET scan, 6.77 cm (95% CI, 5.6-7.9 cm) as determined by CT scan, and 5.1 cm (95% CI, 4.0-6.1 cm) for the 22 patients who had endoscopy. The length of the tumors was significantly longer as measured by CT scans compared with PET scans (p = 0.0063). EUS detected significantly more patients with periesophageal and celiac lymphadenopathy compared to PET and CT. The SUV of the esophageal tumors was higher in patients with peri-esophageal lymphadenopathy identified on PET scans. CONCLUSION: Endoscopic ultrasound and PET scans can add additional information to aid the radiation oncologist's ability to precisely identify the GTV in patients with esophageal carcinoma.