胸上段食管癌根治性放疗后复发的外科治疗

目的:探讨胸上段食管癌根治性放疗后复发的外科治疗方法和并发症防治。方法:回顾分析25例患者临床资料。根据患者术中探查结果，采取不同的外科干预措施。其中经颈右胸腹三切口食管癌根治、一期胃代食管颈部吻合术9例，单纯食管癌切除、颈部食管外置4例，食管癌切除、颈部食管外置、二期胸骨后径路消化道重建12例（其中胃代食管11例，结肠带食管1例）。结果:围手术期无死亡病例。二期消化道重建后颈部吻合口瘘发生2例，经换药后治愈。喉返神经损伤1例。肺部并发症发生4例，其中肺部感染2例，肺不张1例，呼吸衰竭1例，均治愈。心律失常3例，其中快速房颤2例，频发室早1例，均治愈。随访期间，2例出现吻合口狭窄，经扩张后缓解。随访1年存活率为68%（17/25），3年存活率为44%（11/25）。结论:选择合适的外科治疗方式和有效防治心肺并发症，能改善上段食管癌根治性放疗后复发患者预后，取得较好的临床效果。

Surgical treatment of recurrent upper thoracic esophageal carcinoma after radical radiotherapy

Objective:To explore the effect of surgical treatment and perioperative management of recurrent upper thoracic esophageal carcinoma after radical radiotherapy.Methods:Clinical data of 25 cases of acquired benign tracheoesophageal fistula were retrospectively studied and the related literature was reviewed.All of the patients were operated.16 patients received operation through triple incisions in the right thorax，superior belly and neck.12 cases in two phases(a line of resection of esophageal cancer，esophageal left neck external，gastmstomy；elective surgery that is，two chest stomach esophagus，left cervical esophagogastric anastomosis).The remain 4 patients underwent palliative operation.Results:No patient died during the perioperative period.Anastomotic fistula occurred in 2 cases who received two-stage operation.Injury of recurrent laryngeal nerve in 1,postoperative pulmonary complications in 4.1 case of cardiac arrhythmia.Anastomotic stenosis were observed in 2 cases during follow-up.The 1,3 year survival rates were 68%(17/25),44%(11/25),respectively.Conclusion:Choosing a suitable surgical procedure and effective prevention of cardiopulmonary complications were crucial in the treatment of the deseases mentioned above.