高位食管癌手术方式的探讨

目的总结高位食管癌不同术式及食管替代器官的临床疗效.方法总结1992年至2001年在我院手术治疗的104例高位食管癌患者的临床资料,根据肿瘤的部位、范围及淋巴结转移情况选取不同的手术术式和不同的器官替代,观察手术治疗的远期效果及并发症发生情况.结果手术切除率为95.2%,手术死亡率为3.8%,5年生存率为27.7%.手术切除的99例中,65例(65.6%)应用胃代食管,20例(20.2%)结肠代食管,14例(14.2%)喉气管瓣代下咽及颈段食管.高位食管癌手术主要并发症为吻合口瘘、喉返神经损伤、吻合口狭窄和反流等.结论高位食管癌外科手术治疗需根据肿瘤所在的部位、侵及的范围及淋巴结转移情况等选取具体的手术术式;胃、结肠及气管替代食管各有其利弊,需根据患者具体病情和术者的自身情况而定.

Study of various resective techniques in the treatment of carcinoma of the upper esophagus

Objective To review our treatment strategy and outcomes of carcinoma of the upper esophagus. Methods 104 consecutive patients treated between 1992 and 2001 were analysed retrospectively. Various resective techniques had been used in the management of patients with carcinoma of the esophagus. These techniques included esophagogastrectomy and esophagogastrostomy, or interposition of the large bowel and the use of laryngoplasty replacing cervical esophagus. Results The respectability was 95.2%,the hospital mortality was 3.8%,and the 5-year survival rate was 27.7%?There were 65.6% of patients experiencing esophagogastrostomy, 20.2% with interposition of the large bowel and 14.2% with laryngoplasty replacing cervical esophagus. The main complications after resection were anastomotic leakage, recurrent laryngeal nerve injury, dysplasia and reflux et al. Conclusions According to the location of the tumors, local extension and lymph node metastasis, the different approaches to treat carcinoma of the upper esophagus have been selected. The selection of each approaches should base on the patients'physical condition and the skillfulness of surgeons.