结肠上徙代食管在下咽、食管疾病中的治疗体会

目的 :探讨在保留喉功能的基础上结肠上徙代食管治疗晚期下咽癌、颈段食管癌及严重食管狭窄的可行性及疗效。方法 :1989～ 1996年共进行结肠上徙代食管手术 2 5例 ,晚期下咽癌 9例 ,其中 T3期 7例 ( N0 1例 ,N1 4例 ,N2 2例 ) ,T4 N1 M0 2例 ( U ICC1997) ;颈段食管癌 13例 ,其中 T1 N0 M0 2例 ,T2 期 11例 ( N0 4例 ,N1 7例 ) ;严重食管狭窄 3例 (狭窄长度 3～ 5 cm)。术后肿瘤患者给予放疗。结果 :2 5例患者 3、5年生存率分别为5 4 .5 % ( 12 / 2 2 )和 4 2 .9% ( 6/ 14 ) ,其中晚期下咽癌、颈段食管癌 3年生存率分别为 4 4 .4 % ( 4 / 9)和 61.5 % ( 8/ 13 )。结论 :结肠上徙代食管符合生理功能 ,只要手术适应证选择合适 ,术中精细操作 ,可以减少并发症 ,提高患者的生存质量。

Substituting esophagus with colon in the treatment of hypopharyngeal and esophageal disease

OBJECTIVE: To study the feasibility and effect of substituting esophagus with colon in the treatment of advanced stage hypopharyngeal carcinoma, cervical esophagus cancer and serious esophageal stenosis on the basis of laryngeal function preservation. METHODS: From 1989 to 1996. 25 patients in our department were retrospectively reviewed among them, nine were hypopharyngeal carcinoma, T3 (No1, N1 4, N2 2), T4 N1 M0 2 (UICC 1997), thirteen were cervical esophagus cancer, T1N0M0 2, T2 (N0 4, N1 7), there were serious esophageal stenosis, length was 3-5 cm. The patients with carcinoma were given postoperation radiotherapy. RESULT: The total survival rates in 3, 5 years are 54.5%, 42.9% respectively. The 3-year survival rates are 44.4% in the cases with advanced stage hypopharyngeal carcinoma, and 61.5% with cervical esophagus cancer, respectively. CONCLUSION: Substituting esophagus with colon is in conformity with physical demand, can reduce complication and improve life quality.