“三切口”切除食管癌经胸骨后代食管16例

目的：评估食管中段癌经右胸、颈、上腹三切口切除后胃经过胸骨后隧道与颈部残留食管吻合术的实用价值。方法：将病变长度大于5cm的食管中段癌，右侧进胸将胸段食管及区域淋巴结切除后，进腹游离胃并清除胃周淋巴结，将胃经胸骨后隧道上提至颈部与颈段残留食管吻合，然后再清扫下颈部淋巴结。结果：16例中，10例行根治性切除，其余6例为姑息性切除；吻合口瘘发生率为37．5％，但均经洽当的引流后治愈；无心肺并发症发生。结果：“三切口”术式切除食管中段癌符合肿瘤外科的治疗原则，而食管中段癌切除后胃经胸骨后上提至颈残留食管吻合是可行的，对中晚期食管中段癌估计术后需辅助性放疗的病例可选择此术式。

16 Cases Report about Stomach Substitute Esophagus via Substernal Route after Resecting Esophageal Carcinoma by＂Three Incision＂ Approach

Purpose：To appraise the practical value of surgical managment for middle third esophageai carcinomas：after resection of the carcinoma by right chest,neck and upper abdominal ＂three incisions＂,pulling up stomach substemally to anastomose with the residual neck esophagus. Methids： 16cases of middle third esophageal carcinonas of which the leaions were more than 5cm in length treated surgically as follwowing：right thoracotomy for disection of the carcinoma and regional lymph nodes.Laparotomy to mobilize the stomach and dissect the oaragastric lymph nodes, then pulling he stomach up through the substernal canal to anastomose with the residual esophagus in the neck,Lower neck lymph node dissection was done afterward. Results： Among the 16 cases.10 were resected radically,and the others were resected palliatively.Anastomotic leak occurred in 37.5 % ,but all the leakages were cured by proper drainage.No cardic and pulmonary complication occurred.Conclusions：＂three incision＂approach for resection of middle third esophageal carcinomas accords with the therapeutic principle of oncological surgery,and the substernal route by which the stomach is pulled up to anastomose with the residual esophagus in the neck is feasible.This procedure can be applied for advanced middle third esophageal carcinoma for which adjuvant radiotherapy probably be used postooeratively.