胃大部分切除术后食管癌的外科治疗(附3例报告及文献复习)  

Surgical treatment in patients with esophageal carcinoma undergone hemigastrectomy(Three cases report and review of literatures)

作　　者：陈敏东[1] 陈曲海[1] 邓卫兵[1] 徐子迅[1] 梁登峰[1] 

机构地区：[1]广州市第一人民医院胸外科,510180

出　　处：《广州医药》2009年第2期20-22,共3页Guangzhou Medical Journal

摘　　要：目的探讨胃大部分切除术后患食管癌的外科治疗手术中利用残胃与食管吻合术重建消化道的手术方法。方法回顾分析3例患食管癌并且曾施行胃大部分切除术的老年患者的临床资料,结合近15年国内文献复习,总结104例残胃与食管吻合的手术方法和效果。结果本组患者及文献报道病例均无手术死亡,总术后并发症发生率9.6%,其中吻合口瘘0.96%,食管上切端残留癌2例(1.9%)。56例术后随访1年生存率86.8%,生存超过3年28例,5年生存者17例。结论BillrothⅡ式胃大部分切除术后患食管癌的患者可选择外科治疗,在手术切除食管肿瘤后,残胃与食管在主动脉弓上或弓下吻合,其手术方法简单,安全性较高,对临床外科选择个体化方案治疗胃大部分切除术后食管癌有实用意义。Objective To assess and to recommend a operative way , which to make use of residual stomach esophagus anastomosis to reconstruct esophagus after the lesions of esophageal tumor had been removed in patients with esophageal carcinoma undergone hemigastrectomy. Methods 3 elderly patients with esophageal carcinoma undergone hemigastrectomy were reported. These patients had been performed esophageal tumor resection and esophagus reconstruction by using residual stomach esophagus anastomosis, and the literatures was reviewed for 15-year. Summary those operative ways and theier effectivity on 104 cases which underwent esophageal tumor resection and the replacement with the residual stomach to reconstruct esophagus. Results No perioperative mortality, the total postoperative complications occurred in 9. 6%, including anastomatic leakage 0.96%. 2 patients had been detected submucous invasive cancer in the esophageal stump near the anastomosis on histopatology, the occurred in 1.9%. Follow-up of 56 patients for 1 - 5 years, in which the survival rates overall 1-year was 86. 8%. 18 patients remain alive over 3 years and 7 patients over 5 years alive. Conclusion The patients with esophhageal carcinoma undergone hemigastrectomy that used of Billroth Ⅱ operative way, their remaining stomach can been moved into the thorax to anastomase with esophageal either supra or infra arch of aorta after remove the esophageal tumor. The author points out the operative way is easily and relatively safe. It＇s useful to choose one of methods on individualized surgical strategies for the patients undergone hemigastrectomy with esophageal carcinoma.

关 键 词：胃大部切除术 食管癌 外科治疗 

分 类 号：R735.1[医药卫生—肿瘤] R656.6[医药卫生—临床医学]