食管内翻剥脱术的临床应用

目的探讨非开胸食管内翻剥脱术在治疗下咽、颈段食管及贲门癌中的应用。方法１８例中送行食管内翻剥脱１０ 例，顺行食管内翻剥脱８例；胃代食管１５例，结肠代食管３例；咽、喉切除，气管永久性造瘘２例。结果全部病例无手 术死亡；术后吻合口瘘２例，喉返神经损伤２例，肺部感染３例，切口感染１例；术后随访１５例，生存率１年以上者占 ７７％， ３年以上者占４４．５％， ５年以上者占２２％。结论该方法对心肺功能影响小，使高龄及合并心肺等重要脏器疾病的食 管癌患者获得手术机会；下咽、颈段食管癌应积极手术治疗，可提高患者的生存率；胸段食管癌应尽量避免使用该方 法。

Clinical application of esophagus invert stripping

Objective To evaluate the effect of the esophagus invert stripping without opening the thoracic cavity on carcinoma in the inferior pharynx, cervical esophagus or the cardia. Method Eighteen patients with carcinoma in the inferior pharynx, cervical esophagus or the cardia were treated surgically with invert stripping of the exophagus without opening the thoracic cavity. Ten patients received antidromic esophagus invert stripping and the other 8 underwent orthodromic esophagus invert stripping. The esophagus of these patients were replaced with either the stomach (in 15 cases) or the colon (in 3 cases), and complete removal of the pharynx and larynx were performed in 2 cases, both of Which received permanent fistulization. Result No death occurred during the operation and the complications included anastomotic leakage (2 cases), injury of the recurrent laryngeal nerve (2 cases), Pulmonary infection (3 cases), and incision infection (1 case). The follow-up survey showed that the lunar, 3-year and 5-year survival rates were 77%, 44% and 22%, respectively. Conclusions This surgical approach reduces the damage of the cardiopulmonary function, which can be meaningful for senior patients and those with cardiac or pulmonary problems. The carcinoma in the inferior pharynx or cervical part of the esophagus should be treated surgically to improve the survival rate, but this approach should be avoided in patients with carcinoma in thoracic part of the esophagus.