195例中上段食管癌手术分析

目的总结195例中上段食管癌手术经验，探讨中上段食管癌合理手术方式。方法195例中上段食管癌患者，根据采用的手术方式不同分为两组，左颈部吻合组：左胸径路、胃由食管床提至左颈部与近端食管行手工单层、宽边吻合；胸内器械吻合组：左胸径路、食管癌切除术后采用国产常州WGWB-26型吻合器行左胸膜顶胃食管吻合。比较两种手术方式的吻合时间、总手术时间；吻合口瘘、吻合口狭窄、乳糜胸、呼吸循环并发症的发生率及近端食管癌组织残留的阳性率。结果全组无手术死亡。胸内器械吻合组吻合时间、总手术时间较颈部吻合组缩短（P〈0．05）；吻合口瘘、吻合口狭窄、呼吸循环并发症的发生率较左颈部吻合组低（0％vs7．5％，0％vs5．8％，2．7％vs16．7％，P〈0．05，0．05，0．01），但其近端食管癌组织残留阳性率明显高于颈部吻合组（0％vs6．7％，P〈0．01）；两组患者乳糜胸的发生率相比，差异无统计学意义（P〉0．05）。结论中上段食管癌采用左胸顶部器械吻合可明显缩短手术时间，有效降低术后并发症的发生率，但易发生癌组织残留，术中快速切片检查是必要的。

Clinical study on operation for middle-upper esophageal carcinoma(195 cases reports)

Objective To summarize the experience of operation of middle -upper esophageal carcinoma in 195 cases, and to explore the reasonable operation mode. Methods 195 patients were divided into two groups according to different operation methods, the left neck anastomosis group ： from the left thoracic route, the stomach was lifted to the left neck for a wide one layer anastomosis to the proximal esophagus; intratharocic mechanical anastomosis group ： left tharocic group, from the left thoracic route, the stomach - esophagus anastomosis at the apical pleura using home - made anastomosis stapler WGWB - 26. The time for anastomosis, total operation time, the incidence of anastomosis leakage or sticture, chylothorax, respiratory system complications and the positive rate of the proximal esophageal cutting edge were compared between the two groups. Results There was no mortality in both of the two groups. Compared with those in left tharocic group, the time for anastomosis, total operation time were significantly shorter（ P 〈 0. 05） ; the incidence of anastomosis leakage, respirato/y system complications were lower（0% vs 7. 5%, ,0% vs 5.8% ,2. 7% vs 16. 7% ,P 〈 0. 05,0. 05,0. 01）, but the positive rate of the proximal esophageal cutting edge was higher in mechanical anastomosis group（0% vs 6. 7% ,P 〈 0. O1 ） ;the incident rate of chylothorax between the two groups was not significantly different （P 〉 0. 05 ）. Conclusions The mechanical anastomosis at left apical pleura can significantly reduce the operation time and effectively reduce the postoperative complications, but there is a potentiality of remnant tumor tissue, so the intraoperative pathologic examination is necessary.