全胸段食管切除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：我院胸外科自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。结果：本组手术死亡率１．８％（１５／８３１）；断端癌发生率１．４％（１２／８３１）；术后并发症发生率２１．８％（１８１／８３１），其中颈部吻合口瘘的发生率６．０％（５０／８３１）．全部病例中１８４倒采用了带蒂舌骨下肌群肌瓣覆盖吻合口术，颈部瘘的发生率降至１．１％（２／１８４）。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、胸、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。

Panthoracic Esophagectomy with Cervical Esophageal Reconstruction through Esophageal Bed - A Report of 831 Cases

A analysis of 831 cases of esophageal cancer treated with subtotal esophagectomy and re-construction in the neck during the period from January 1992 to May 1997 was made. The operative mortali-ty rate, the frequency of residual cancer and the postoperative complication rate were 1 . 8% ( 15 /83l ) .1. 4% ( 12/831 ) and 21 . 8 % ( 181 /831) respectively. Anastomotic fistula formation occurred in 6. 0%(50/831). The cervical leakage rate in 184 cases who undernent cervical esophago - gastric anastomosisencircled with an infrahyoid musculocutanneous flap dropped to 1 . 1 % (2/ 184) . The authors suggest thatthe resection must be thorough including extensive removal of the tumor and the cervical, thoracic and ab-dominal lymph nodes. The advantages of this operation and its complications i. e. the Neck - stomach Syn-drome, anastomotic leakage etc. were discussed and the preventive measures for the above complicationswere presented.