食管癌穿孔的外科治疗分析  

Surgical treatment of perforation in esophageal carcinoma

作　　者：邹济华[1] 粱翔[1] 段德溥[1] 孙德魁[2] 吴松昌[2] 

机构地区：[1]上海解放军455医院胸心外科 [2]上海胸科医院,上海200050

出　　处：《临床和实验医学杂志》2007年第10期17-18,共2页Journal of Clinical and Experimental Medicine

摘　　要：目的研究外科治疗食管癌穿孔的手术方法及围手术期处理特点。方法对41例食管癌穿孔(其中穿入右肺19例,穿入纵隔17例,穿入气管5例)患者进行手术治疗。开胸手术39例,2例只做胃造瘘姑息手术治疗。其中右胸三切口术式16例,分期手术23例;本组病例经胸骨后间隙胃或结肠代食管35例。结果36例患者获得手术成功,手术死亡2例,1例术后吻合口气管瘘再通自动出院。术后随访3～72个月,其中存活6～12个月31例,24个月2例,72个月1例,康复期能经口腔进食保证营养,生活自理。结论手术治疗食管癌穿孔成功恢复消化道的连续性,明显提高了生存期和生活质量;手术径路以右胸三切口术式(胸骨后胃或结肠代食管)或分期手术为佳。Objective To study the ideal method and perioperative management in surgical treatment for perforation in esophageal carcinoma. Methods 41 cases with perforation in esophageal carcinoma were surgically treated in this series, among them perforating into right lung occurred in 19 cases, mediastinum in 17 cases and trachea in 5 cases. Open thoracic surgery was performed in 39 cases, in which the right thoracic approach with 3 incisions method was applied in 16 cases, and operation by stages in 23 cases. Among these 39 cases, retrosternal substitution of esophagus with stomach or colon was performed in 35 cases. Results Surgery was successfully carried out in 36 cases and operative death occurred in 2 cases, The postoperative follow -up study was performed for 3 - 72 months, among which 31 cases survived for 6 - 12 months, 2 cases for 24 months, and 1 cases for 72 months. These results can be considered as satisfactory. Conclusion The therapeutic result of surgical treatment for perforation in esophageal carcinoma was markedly superior to that of conventional conservative treatment, Authors suggest that surgical intervention should be undertaken without delay for patients with perforation in carcinoma of esophagus, and right thoracic approach with 3 incisions method （ retrosternal replacement of esophagus with stomach or colon） or operation by stages is preferable.

关 键 词：食管癌 食管穿孔 外科手术 

分 类 号：R735.1[医药卫生—肿瘤]