中下段食管癌以及合并贲门癌的外科治疗  

The surgical treatment for the middle and lower phases of esophageal cancer with carcinoma of gastric cardia

作　　者：王钢[1] 孟镔[2] 蒋德华[2] 何健鸿[2] 何进[2] 李英杰[2] 

机构地区：[1]安徽理工大学医学院 [2]安徽理工大学医学院临床外科应用解剖教研室,安徽淮南232001

出　　处：《局解手术学杂志》2008年第2期86-87,共2页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探讨中下段食管癌以及合并贲门癌的外科治疗方法。方法我院1992年至2006年外科手术治疗中下段食管癌97例,85例行根治术,7例剖胸探查术,5例姑息性切除术。左进胸60例,右进胸22例,三切口15例(均为合并贲门癌患者)。结果全组无手术死亡。右进胸的切除率为82.14%,左进胸为89.63%,总切除率为87.63%。术后胸腔内吻合口漏2例,颈部吻合口漏2例,术后出血3例,膈疝3例,喉返神经损伤6例、吻合口狭窄3例,心律失常6例。结论食管癌治疗以手术为主,根据肿瘤部位灵活选择手术切口;手术治疗中吻合口重建是关键,吻合技术的改进非常重要;在合并有贲门癌时充分的术前准备、正确把握手术适应证、精细的手术操作、术后对各种可能并发症的早期预防和及时有效处理仍是降低手术并发症发生率和病死率的关键。Objective To summarize the experience in the surgical treatment for the middle and lower phases of esophageal cancer with carcinoma of gastric cardia. Methods Total 97patients with the middle and lower phases of esophageal cancer treated by surgical operation were retrospectively analyzed from 1992 to 2006. The age ranged from 41 to 76 years. 85 cases underwent radical operation and thoracotomy in 7 cases. 5 cases underwent conservative operation. Left thoracic approach is 60 cases. Right thoracic approach is 22 cases. Triple inci- sions were 15 cases. Results All patients survived well. Right thoracic approach＇ s excision rate for 82.14%, Left thoracic approach for 89.63%, total excision rate is 87.63%. Two cases were postoperative intmthoracic anastomotic leakage, 2 cases were cervical anastomotic leakage, 3 eases were postoperative bleeding, 3 eases were diaphragmatic hernia, 6 eases were injury of recurrent laryngeal nerve, 3 eases were straitness of anastomotic stoma, 6 eases were cardiac arrhythmia. Conclusion Surgical operation is the main method in esophageal cancer,the approach is selected according to the tumor position, anastomotic technology critical to improve the therapic effect. Thoroughly preparation pre-operation, pertinent indication, and expert technique, are very important to decrease complication and case fatality.

关 键 词：食管癌 贲门癌 外科治疗 

分 类 号：R655.4[医药卫生—外科学] R735.1[医药卫生—临床医学]