颈段食管癌外科治疗

目的：探讨颈段食管癌的外科手术方式。方法回顾性分析2005年1月至2013年12月间137例颈段食管癌手术患者的临床资料。102例患者行保喉手术，其中颈、腹二切口食管拔脱加胃食管吻合术64例，标准三切口手术26例，病灶局部切除加食管端端吻合术12例；35例患者行不保喉手术，其中行喉、全食管切除加胃下咽吻合术21例，咽、颈食管黏膜瓣成形术9例，喉、全食管切除加结肠代食管术2例，空肠间置术4例。所有病例均行单侧或双侧颈部淋巴结清扫。术后行单纯放疗42例，单纯化疗36例，放化疗31例。结果全组无围手术期死亡病例，术后吻合口瘘20例（14．6％），吻合口狭窄9例（6．6％），乳糜胸1例（0．7％），重度返流6例（4．4％）。102例保喉手术患者中，术后出现一过性声嘶者27例（26．5％），永久性声嘶18例（17．6％），严重吸入性肺炎2例（2．0％）。85例食管拔脱患者（64例保喉，21例不保喉）膜部损伤3例（3．5％），拔脱后大出血3例（3．5％）。术后1、3和5年生存率分别为73．7％、43．4％和26．8％。结论手术方式的合理选择是保证颈段食管癌治疗效果的关键。

Strategies of surgery treatment for cervical esophageal cancer

Objective To explore the methods and means of surgical treatment for cervical esophageal cancer in order to get the best efficacy. Methods Retrospective investigation and analysis were carried out in 137 patients with cervical esophageal cancer undergoing operation in our hospital from January 2005 to December 2013. According to lesion locations , these cases were divided into two groups： larynx preservation group （Group A） and laryngectomy group （Group B）. Surgery options of Group A included inversion esophagectomy without thoracotomy, three-incision esophagectomy, end to end anastomosis of cervical esophagus after local resection. Group B included gastric-pharyngeal anastomosis, pharyn-esophagus plasty, colon replacement of the esophagus or jejunal interposition. All the patients received postoperative adjuvant therapy. Results There were no perioperative deaths. The main postoperative complications included anastomotic fistula in 20 cases （14.6%）, postoperative massive bleeding after inversion esophagectomy in 3 cases, chylothorax in 1 case, anastomotic stenosis in 9 cases, severe gastroesophageal reflux in 6 cases and serious aspiration pneumonia in 2 cases. All these patients had complete resolution of disease with good postoperative quality of life. The 1-year , 3-year and 5-year survival were 73.7%, 48.4% and 26.8% respectively. The most important causes of postoperative death included local recurrence , cervical or mediastinal lymph node metastases , cachexia and multiple organic metastasis. Conclusion It is critical to select reasonable methods of operations to reduce postoperative complications and to receive proper adjuvant therapy.