18例经左胸食管次全切除及食管-胃左颈部吻合术治疗胸中上段食管癌临床分析

目的:探讨手术治疗经左胸食管次全切除及食管-胃左颈部吻合术治疗胸中上段食管癌的诊治经验和教训。方法:回顾性分析18例手术治疗胸中上段食管癌的病历资料。结果:食管中上段癌18例,根治性手术切除16例,切除率88.9%;术后并发心血管疾病2例,并发肺部感染3例,并发糖尿病1例,并发颈部吻合口瘘3例,经引流换药等治疗痊愈,未出现胸部并发症;并发乳糜胸1例,经再次手术治愈。全组无手术近期死亡病例,切缘无癌残留。出院后均随访1年以上。4例术后5个月～1年死于远处转移并发症,1年存活率77.8%(14/18),3年存活率55.6%(10/18),5年存活率27.8%(5/18),存活最长者近9年。结论:经左胸食管次全切除及食管-胃左颈部吻合手术治疗胸中上段食管癌具有肿瘤切除彻底、吻合方便、并发症少的优点,是治疗食管癌的一种既安全又能提高生活质量的手术方式,有较高的应用价值。

Analysis on the treatment through left esophageal subtotal resection and esophagogastroplasty in left neck for 18 cases with carcinoma of medium-superior esophagus

Objective To explore the surgery experience and lessons learned through left esophageal subtotal resection and esophagogastroplasty in left neck for carcinoma of medium-superior esophagus.Method Reviewed and analyzed the medical history of medium-superior esophagus cancer in thoracic surgery of Xinhua People′s Hospital from June 2003 to December 2010.Results Treated 18 patients with medium-superior esophagus cancer,16 patients had a radical treatment,the excision proportion was 88.9%;There were 2 cases with postoperation cardiovascular disease,3 cases with lung infected,1 case with diabetes,3 cases with fistula in the neck.Cured by drainage,there was no serious complications inside chest.1 case of chylothorax was cured by surgical operation and there was no died case in the next few days,and also no cancer residues remained in the cutting edge.After more than one year follow-up,4 cases died in 5 months to one year because of metastasis,1 year livability was 77.8%(14/18),3 years livability was 55.6%(10/18),5 years livability was 27.8%(5/18).The longest survivor was lived for nearly 9 years.Conclusion There are the advantages in through left esophageal subtotal resection and and esophagogastroplasty in left neck for carcinoma of medium-superior esophagus: tumor excision thoroughly,anastomosis convenient,little complications.Therefore,this method is a kind of safe type which can improve life quality,so it is valuable for application.