三种术式重建食管治疗食管癌和贲门癌的临床研究  

Clinical Study on Three Methods of Esophageal Reestablishment in Treating Esophageal and Cardiac Carcinoma

作　　者：禹亮[1,2] 王巨[1,2] 禹志正 张庆华[1,2] 孙树林 张明文[1,2] 王胜发 

机构地区：[1]哈尔滨医科大学第一附属医院心胸外科 [2]哈尔滨市第七人民医院

出　　处：《中国冶金工业医学杂志》1997年第1期15-17,共3页Chinese Medical Journal of Metallurgical industry

摘　　要：目的：提高食管癌和贲门癌的根治切除率和临床治愈率，预防吻合口瘘。方法：设计了Ⅰ、Ⅱ、Ⅲ三种术式：上、中段食管癌采用右胸前外侧切口，经第３或４肋间开胸，左腹直肌旁或左肋弓下斜切口开腹和右颈部切口，保留２～３ｃｍ颈段食管，食管次全切除，贲门部或部分胃切除，在颈部食管胃端侧分层吻合（Ⅰ式）。中段食管癌采用左胸前外侧切口，经第４或５肋间开胸，腹部切口同前，左颈部切口，保留３～４ｃｍ颈段食管，食管次全切除，部分胃切除，在左颈部食管胃端侧分层吻合（Ⅱ式）。贲门癌采用左胸前外侧切口，经第５或４肋间开胸，腹部切口同前，中段食管和近半胃或纵半胃切除，在主动脉弓下食管胃端侧分层吻合（Ⅲ式）。尽可能清除区域淋巴结，吻合口均用大网膜包盖加固。结果：食管癌和贲门癌总切除率９２１％（１７４／１８９），其中根治性切除率为７５１％（１４２／１８９），探查率（未切除）为７９％（１５／１８９），三种术式的总吻合口瘘发生率为４０％（７／１７４），无围手术期死亡。结论：三种术式可提高根治性切除率，大网膜包盖加固吻合口可减少瘘的发生率，食管胃分层吻合法可降低吻合口狭窄的发生率，临床治愈率高，围手术期死亡率低。Objective:To increase the operative resective ratio and clinical curative ratio and prevent anastomosis fistula.Methods:(1)Right anteriolateral Ⅲ or Ⅳ intercostal incision,left lateral straight muscle of abdomen incision and right cervical incision for gastroesophageal anastomosisin upper and middle segment esophageal carcinoma;(2)Left anteriolateral Ⅳ or Ⅴ intercostal incision,left lateral straight muscle of abdomen incision and right cervical incision for the operation in middle segmental esophageal carcinoma;(3)Left anteriolateral Ⅳ or Ⅴ intercostal incision and abdomental incision for the inferior aortic arch anastomosis.Results:The anastomosic part was covered with omental in all three methods.The resective ratio of esophageal and cardiac carcinoma was 92 1%,all the anastomosis fistula of all is 4 0%.There was no dead in perioperation.Conclusions:All the methods could reduce the fistula happening with higher clinical curative ratio and lower perioperative mortality.

关 键 词：外科手术 食管肿瘤 贲门癌 食管重建 治疗 

分 类 号：R735.105[医药卫生—肿瘤]