气管横断入路行保喉食管切除治疗颈段食管癌

目的：分析气管横断入路行保喉食管切除治疗颈段食管癌的疗效。方法：回顾性分析2017-2019年温州医科大学附属第一医院耳鼻咽喉科行保喉颈段食管癌切除的5例患者的病例资料，分析手术疗效。结果：所有患者均行颈部及胸、腹腔镜联合入路下颈段食管癌切除。1例患者术后出现单侧声带麻痹，2例患者出现左侧胸腔积液及肺不张，5例患者术后均有胃酸反流，经药物治疗后明显改善。所有患者在院期间无重大并发症，无院内死亡。术后4例患者接受了放、化疗，1例患者因个人原因未行放化疗。随访时间2～36个月，1例患者术后1年因肿瘤复发死亡，其余4例均健在，言语和吞咽功能恢复良好，气管套管已拔除，无呛咳，无吻合口瘘，无吸入性肺炎。结论：颈段食管癌可在胸、腹腔镜切除食管并制作管状胃的基础上，经气管横断入路行颈部病灶切除同时行喉功能保全，术后辅以放、化疗，可获得良好的临床效果。

Surgical treatment of cervical esophageal carcinoma: larynx-preserving esophagectomy via tracheal transection approach

Objective: To study the results of larynx-preserving esophagectomy via tracheal transection approach for cervical esophageal carcinoma. Methods: A total of 5 patients with cervical esophageal carcinoma undergoing larynx-preserving esophagectomy in our hospital from 2017 to 2019 were selected. Results: All patients underwent combined thoracic and laparoscopic larynx-preserving esophagectomy via tracheal transection approach. Only one patient developed unilateral vocal cord paralysis after surgery. Two patients developed left pleural effusion and atelectasis after surgery. Gastric acid reflux was observed in all patients, which was significantly improved after drug treatment. No patients had major complications and no deaths during their stay in the hospital. After surgery, 4 patients received radiotherapy or chemotherapy, and 1 patient refused chemoradiotherapy for personal reason. The follow-up time was 2-36 months. Only 1 patient died of tumor recurrence 1 year after surgery. The other 4 cases were all alive, with good recovery of speech and swallowing function. With tracheostomy tube removed, they had no choke, no anastomotic fistula or aspiration pneumonia. Conclusion: The larynx-preserving esophagectomy for cervical esophageal carcinoma via tracheal transection approach, combined with adjuvant chemotherapy or radiotherapy, can obtain safe perioperative recovery