颈段食管癌的外科治疗16例临床分析

目的：探讨颈段食管癌的外科治疗方法及保留喉功能手术治疗的意义及可行性。方法：回顾性分析手术治疗颈段食管癌患者16例的临床资料，手术方式中，喉及喉咽全部切除食管内翻拔脱管状胃代食管术12例；喉及喉咽全部切除＋颈段食管切除气管代食管术1例；部分下咽＋颈段食管切除喉气管瓣代食管术1例；保留喉的食管内翻拔脱管状胃代食管术2例。均同期行双侧颈廓清术。结果：无手术死亡，手术切除率100％。术后并发肺部感染2例，吻合口瘘2例，吻合口狭窄2例，心功能衰竭1例，失访3例。喉功能保留率12．5％。3年生存率30．7％，5年生存率23．1％。结论：颈段食管癌可行非开胸食管内翻拔脱术切除肿瘤，以管状胃、喉气管瓣修复食管缺损，根据肿瘤所在部位及侵及范围，尽可能保留喉功能。

Surgical management of cervical esophageal carcinoma in 16 cases

To investigate the method of surgical management for cervical esophageal carcinoma and the feasibility of the operation with preservation of laryngeal function. Method：Sixteen patients with cervical esoph- ageal carcinoma who received surgical treatment were reviewed in our retrospective study. Removal of total hypo- pharynx and larynx and the inversion stripping esophagectomy were conducted in thirteen patients, of which one underwent the reconstraction with residual larynx and tracheal flap and the other twelve patients underwent the re- constraction with gastric-pharyngeal anastomosis. One patient received the cervical esophageetomy and partial hy- popharyngectomy with laryngotracheal flap. The inversion stripping esophagectomy with laryngeal function preser- vation were conducted in two patients, who received the reconstraction with gastric-pharyngeal anastomosis and preserved total laryngx. All the patients were carried out the bilateral neck dissections. Result：The surgical resec- tion rate was 100 % and no operative death occured. The postoperative complications included pulmonary infection in two eases,anastomotic fistula in two cases,anastomotic stenosis in two cases and congestive heart failure in one case. The retained rate of the larygeal function is 12.5%. The 3-year survival rate is 30.7~//0, and the S-year sur- vival rate is 23.1%. Conclusion.. The surgical treatment of cervical esophageal carcinoma is possible. The inversion stripping esophagectomy without thoracotomy is performed to resect the tumor. The esophageal defect could be re- constracted by laryngotracheal flap or gastric-pharyngeal anastomosis. The laryngeal function should be remained as far as possible according to the location and extension of the tumor.