食管切除胃代食管三种术式比较分析

为明确食管癌术后胃代食管三种不同术式的术后近期并发症发生率和死亡率，以４４６例食管癌外科治疗患者进行回顾性分析。经左胸食管癌切除胸内吻合２６８例；经左胸食管癌切除左颈部吻合４９例；经右胸腹食管癌切除颈部吻合１２９例。     

管状胃与全胃代食管术治疗食管癌的疗效比较

目的 比较管状胃代食管术与全胃代食管术治疗食管癌的临床疗效。方法 回顾性分析2007年1月至2012年1月在我院接受食管癌手术患者的病例资料;比较管状胃组（n=53）和全胃代食管组(n=48)患者在术中吻合口位置、术中出血量、手术时间、术后胃肠减压时间、胃肠减压量、胸腔闭式引流管拔除时间、胸腔引流液量、术后并发症发生情况及术后1个月的肺功能等临床指标上的差异。结果 管状胃组患者术后反流性食管炎的发生率为5.7％（3／53）,低于全胃组的25.0％（12／48）,差异具有统计学意义（P=0.01）;管状胃组无术后胸胃综合征,全胃组的发生率为8.3％（4／48）;管状胃组术后1个月的肺活量占预计值的百分比、最大通气量占预计值的百分比及第一秒用力呼气容积占预计值的百分比均显著高于全胃组,差异均有统计学意义（P＜0.01）。结论 管状胃代食管术较全胃代食管术可降低术后反流、胸胃综合征的发生率,且对患者术后呼吸功能影响较小。     

经右胸中上段食管癌切除两种术式比较

目的：探讨右后外侧剖胸切除胸中上段食管癌两种术式的优缺点。方法：全组手术切除50例，分为AB两组。A组为先开腹再行右后外侧开胸术式组25例，B组为先开胸后行颈腹三切口术式组25例。结果：切除率100％，全部治愈出院。术后并发症：先开腹组发生心肺并发症4例，声嘶2例，颈部吻合口漏2例；先开胸组发生心肺并发症3例，胃排空障碍2例，声嘶1例。结论：在胸中上段食管癌切除术中，采用先开腹再行右后外侧开胸术式具有较多优点和灵活性，对较早期及切除把握较大的病人，推荐行先开腹术式。     

中上段食管癌行两种三切口术式的比较

目的通过对两种三切口食管癌切除术的开胸时间、手术时间及术后并发症的研究,探讨三切口食管癌切除术的最佳术式.方法63例中上段食管癌患者被随机分为两组实验组39例,先开胸充分游离食管后关胸,再开腹游离胃,将肿瘤及胃经食管床递至颈部,行食管、胃吻合术(简称为先关胸手术);对照组24例,于手术开始时开胸,至肿瘤及胃均递至颈部后开始关胸(简称为后关胸手术).结果两组手术时间无显著性差异,但开胸时间及术后并发症的发生率实验组均小于对照组(P＜0.05).结论先关胸手术明显优于后关胸手术,应当大力提倡.但术前一定要充分估计到腹腔病变的情况,亦应高度重视本术式可能发生的相关并发症.     

经左胸左颈部切口胃代食管术治疗食管癌186例分析

胃代食管术是最常用的食管癌切除食管重建术式.胸内食管胃吻合术式往往食管切除长度不够,而传统颈部吻合术式吻合口瘘、吻合口狭窄、喉返神经损伤等并发症发生率较高.1998年5月～2003年5月我们采用经左胸前外侧及左颈部切口行胃代食管术治疗186例食管癌取得较好疗效,现报告如下.     

管状胃:食管癌切除后胃代食管新技术

食管癌的手术方式一般为食管部分切除与胃代食管术。传统的全胃代食管术是利用胃的良好的延展性,将游离好的胃直接上提至胸腔,在胸内或     

胃代食管途径与术后并发症相关分析

目的：探讨食管次全切除后，根据病人具体情况选择胃代食管的最佳途径。方法：对237例食管癌行食管次全切除，食管胃颈部吻合术后的病例进行回顾性总结，分析两条胃代食途径和手术后并发症的相关性。结果：经食管床的94例纵隔胃病人，术后胸胃综合征、心肺并发症最少，胸腔放置引流管时间最短。经左胸腔的143例胸腔胃病人，术后放射治疗者胃肠反应轻；术后肿瘤复发的部分病人可经2次手术治愈，或再次放疗，延长生存期。结论：对于早期食管癌，或高龄心肺功能较差的病人，预计术后不需要放射治疗者，可行胃经食管床食管纵隔胃吻合。对中晚期食管癌、或青中年、体质良好的病人，预计术后必须放射治疗者，仍应选择传统的胃经左胸腔的食管胸胃吻合。对于颈段、胸上段的中晚期食管癌、需要三切口的病人，应尽可能采取术前放疗、新辅助化疗、术中化疗和彻底清扫淋巴结，减少术后复发转移。     

经右胸后纵隔切除胸段食管癌食管床内全胃代食管术

作者采用经右胸后纵隔切除胸段食管癌,食管床内全胃代食管术50例,取得了良好效果。术后因并发症死亡1例(2％)。本文重点介绍了手术方法,注意事项及对本术式的体会等。作者认为,本术式不仅能彻底切除食管病变,而对清除食管旁,隆突下、上纵隔的淋巴结较方便、彻底、符合食管癌治疗“规范化”的要求。胸腔显露时间短,术后胸部并发症发生率低,颈部食管胃吻合的安全度高,值得推荐。     

食管癌全胸段食管切除食管胃吻合器胸顶吻合与“三切口”术式比较

评价食管胃吻合器胸顶吻合术在全胸段食管切除治疗食管癌的临床应用价值。方法：４２例病例随机分为经左胸行食管胃吻合器顶吻合组和经右胸行“三切口”手术组，并对临床资料进行分析。结果：听合器法具有手术时间短，并发症少，术后恢复快，手术适应证广等优点，其食管切除以及胸腹部淋巴结的清扫范围与“三切口”术式大致相同，但颈部淋巴结的清扫不如后者。     

食管癌手术入路探讨

目的:改进食管癌的手术入路,提高手术切除率,降低残端癌的发生率、手术死亡率,提高近期手术治疗效果。方法:我院胸外科自 1999年 1月~2002年 12月对 297例胸段食管癌患者,分别采用左胸后外侧切口 (Ⅰ组)、左胸后外侧切口+左颈切口(Ⅱ组)、右胸前外侧切口(Ⅲ组)、右胸后外侧切口(Ⅳ组)共完成食管癌食管切除术、经食管床食管重建术 293例。结果:本组手术切除率 98. 7% (293 /297),Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组分别为 98. 2%(86 /87)、98. 1% (52 /53)、98. 5% (133 /135)、100% (22 /22);手术死亡率 1. 7% (5 /297), Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组分别为 2. 3% (2 /87)、1. 9% (1 /53)、0. 75% (1 /135)、4. 5% (1 /22);断端癌发生率 3. 8% (11 /293), Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组分别为 4. 7% (4 /86)、3. 8% (2 /52)、2. 3% (3 /133)、9. 1% (2 /22);术后并发症发生率 12. 8% (38 /297), Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组分别为 17. 2% (15 /87)、9. 4% (5 /53)、11. 1% (15 /135)、13. 6% (3 /22)。Ⅲ、Ⅳ组与Ⅰ、Ⅱ组清扫的淋巴结均数相比,差异具有统计学意义(P<0. 05); Ⅰ、Ⅱ组间及Ⅲ、Ⅳ组间清扫的淋巴结均数相比,差异无统计学意义(P>0. 05)。结论:食管癌患者右胸前外侧三切口、右胸后外侧三切口全食管切除,可彻底清     

食管癌术后并发乳糜胸的诊断及治疗

目的：探讨乳糜胸的成因、诊断、治疗及再次手术的有关问题。方法：回顾分析１９９２年２月～１９９８年１１月,我院行食管癌手术１２０３例,并发乳糜胸１１例,采取保守治疗３例、手术治疗８例。结果：１０例痊愈、１例同时并发乳糜腹和胸内吻合口瘘,术后第３０天死亡。结论：乳糜胸应根据胸腔引流量合理选择保守治疗或手术治疗。     

电视胸腔镜辅助下食管癌切除（附33例报告）

目的：总结电视胸腔镜辅助下（video-assisted thoraeoscopic surgery,VATS）食管癌切除的临床经验,评价VATS食管癌切除的近期效果.方法：回顾性分析我院1998年1月至2009年12月行VATS食管癌切除的33例临床资料.男21例,女12例;年龄37-83岁,平均65岁.肿瘤平均长度4.8cm,均为鳞状细胞癌.胸上段癌7例,胸中段癌13例,胸下段癌13例;TNM分期：T1 N0M0 5例,T1N1M0 8例,T2N0M0 10例,T2N1M0 8例,T3N1M02例.手术操作分三步：经右胸VATS游离食管肿瘤清扫淋巴结;经上腹部切口游离胃;颈部食管胃吻合.结果：33例均成功经VATS切除食管肿瘤.手术时间平均2.5h,其中VATS游离时间1.0h,胸腔出血量平均120ml,清扫淋巴结平均17.1个,其中胸部淋巴结8.6个.平均住院时间11.2d.术后发生心率失常2例,肺部感染5例,无死亡.结论：完全采用VATS对Ⅰ、Ⅱ期食管癌切除是可行的,近期手术效果较好.     

Esophagectomy compared with chemoradiation for early stage esophageal cancer in the elderly

BACKGROUND:

Esophagectomy has been the traditional treatment of choice for early stage esophageal cancer. However, esophagectomy is associated with high mortality and morbidity in the elderly, and these patients often receive chemoradiation instead. The authors of this report compared outcomes of esophagectomy versus chemoradiation in a population‐based sample of elderly patients with early stage esophageal cancer.

METHODS:

The Surveillance, Epidemiology, and End Results‐Medicare database was used to identify patients aged ≥65 years who were diagnosed with stage I or II esophageal cancer from 1991 to 2002. The associations of treatment with esophagectomy or chemoradiation were assessed along with demographic and clinical variables. A survival analyses was performed to compare outcomes with treatment modality and was adjusted for potential confounders.

RESULTS:

Seven hundred thirty patients with stage I or II esophageal cancer were identified who underwent esophagectomy (n = 341; 46.7%) or chemoradiation (n = 389; 53.3%). Older age, squamous cell histology, and lower socioeconomic status were associated with increased odds of receiving chemoradiation. In multivariate analyses, chemoradiation was associated with worse disease‐specific survival (hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.64‐2.64) and overall survival (HR, 1.92; 95%CI, 1.58‐2.34). The receipt of chemoradiation was associated with worse survival for patients with adenocarcinoma (HR, 3.01; 95%CI, 2.24‐4.04), but there was no significant difference for patients with squamous cell carcinoma (HR, 1.33; 95%CI, 0.98‐1.80).

CONCLUSIONS:

Compared with chemoradiation, esophagectomy may be associated with improved survival for early stage esophageal cancer in the elderly. The current results suggest that there also may be a subset of patients with squamous cell carcinoma for whom chemoradiation is adequate therapy. A randomized trial would be useful to determine the optimal treatment for elderly patients with early stage esophageal cancer. Cancer 2009. © 2009 American Cancer Society.     

三种手术径路治疗食管癌并发症的比较

目的:比较三种不同手术径路治疗食管癌的并发症.方法:选择2012年1月-2016年1月食管癌患者117例.依手术径路分为:A组:左胸一切口,B组:右胸及腹部两切口,C组:左颈、右胸及腹部三切口入路.比较三种路径术后心律不齐、吻合口瘘、内出血(胸/腹腔)、乳糜胸、肺功能不全、肺栓塞的发生率.结果:三组间术后心律不齐、内出血、乳糜胸、肺功能不全、肺栓塞差异均无统计学意义(P＞0.05),而吻合口瘘的发生率:C组高于A、B两组(P=0.014,P=0.038),但A、B两组间差异无统计学意义(P =0.547).结论:左颈、右胸及腹部三切口入路吻合口瘘发生率较高.     

食管癌切除术后乳糜性胸水7例临床分析

目的　为探讨食管癌切除术后乳糜性胸水发生的病因、诊断和治疗手段。方法　对我院 1994年 4月～1999年 7月 480例食管癌切除术后 7例乳糜性胸水的临床资料进行回顾性分析。结果　乳糜性胸水发生率为 1.5 % ,多发生于中晚期食管中段癌的切除术后 ,尤其是术前放疗伴局部复发的食管癌。乳糜性胸水确诊后经保守治疗和再开胸行胸导管结扎术后均治愈。结论　对食管癌尤其是放疗后伴局部复发的食管癌切除术后早期发生乳糜性胸水、量持续超过 10 0 0ml/日者 ,尽早采用手术治疗。而对术后较晚发生乳糜性胸水、量低于 10 0 0ml/日的 ,可保守治疗 ,如果无效 ,再开胸行胸导管结扎术。     

Transhiatal and transthoracic esophagectomy: a comparative study.

From January 1981 to December 1990, 55 consecutive patients underwent esophageal resection by either the transhiatal (THE, 26 patients) or transthoracic (TTE, 29 patients) approach. Patient age, tumor size, and tumor stage were similar in the two groups. THE patients had a significantly worse mean preoperative American Society of Anesthesiologists (ASA) risk class assigned by the anesthesiologist. Patients who underwent THE had a significantly lower operative mortality and rate of cardiopulmonary complications, significantly shorter intensive care unit and hospital length of stay, and a significantly better postoperative survival when operative deaths are included in the analysis. Operative deaths in the TTE group were concentrated among patients > 65 years of age (4 of 9 died), in an ASA risk class > or = III (3 of 7 died) or with moderate or severe cardiac or pulmonary impairment preoperatively (4 of 6 died).     

The volume-outcome relation in the surgical treatment of esophageal cancer: a systematic review and meta-analysis

This study was undertaken to conduct a systematic review and meta-analysis of the literature on the relation between procedural volume and outcome of esophagectomies. A systematic search was carried out to identify articles investigating effects of hospital or surgeon volume on short-term and long-term outcomes published between 1995 and 2010. Articles were scrutinized for methodological quality, and after inclusion of only high-quality studies, a meta-analysis assuming a random effects model was done to estimate the effect of higher volume on patient outcome. Heterogeneity in study results was evaluated with an I(2) -test and risk of publication bias with an Egger regression intercept. Forty-three studies were found. Sixteen studies met the strict inclusion criteria for the meta-analysis on hospital volume and postoperative mortality and 4 studies on hospital volume and survival. The pooled estimated effect size was significant for high-volume providers in the analysis of postoperative mortality (odds ratio [OR], 2.30; 95% confidence interval [CI], 1.89-2.80) and in the survival analysis (OR, 1.17; 95% CI, 1.05-1.30). The meta-analysis of surgical volume and outcome showed no significant results. Studies in which the results were adjusted not only for patient characteristics but also for tumor characteristics and urgency of the operation showed a stronger correlation between hospital volume and mortality. Also, studies performed on data from the United States showed higher effect sizes. The evidence for hospital volume as an important determinant of outcome in esophageal cancer surgery is strong. Concentration of procedures in high-volume hospitals with a dedicated setting for the treatment of esophageal cancer might lead to an overall improvement in patient outcome.