左胸全胃食管床移植颈部吻合治疗胸段食管癌  

Left Thoracic Esophagectomy with Total Stomach Substitute and Cervical Anastomosis in the Treatment of Esophageal Cancer

作　　者：李德闽[1] 常春林[1] 景华[1] 张石江[1] 胡小南[1] 周志有[1] 高声甫[1] 周采璋[1] 

机构地区：[1]南京军区南京总医院心胸外科,南京市210002

出　　处：《中国肿瘤临床》1999年第11期815-817,共3页Chinese Journal of Clinical Oncology

摘　　要：目的: 报告左胸后外侧切口全胃移植颈部吻合手术治疗胸段食管癌的临床经验。方法: 全组1 124 例, 男749 例,女375 例;平均年龄58.5 岁。肿瘤分布:上段癌72 例,中段癌883 例,下段癌169 例。临床病理分期(TNM) Ⅰ期48 例,Ⅱa 期268 例,Ⅱb 期304 例,Ⅲ期425 例,Ⅳ期79 例。全部经左胸后外侧切口行食管次全切除,全胃食管床移植颈部吻合。结果:全组手术治愈1 118 例,死亡6 例(0 .53% ) ,吻合口瘘38 例(3 .38 % ) ,瘘死亡13 .16 % (5/38) 。乳糜胸7 例均获治愈。748 例随访2 年、3 年、5 年生存率分别为82 .2% 、52 .8% 和27 .8% 。结论:左胸食管床全胃移植颈部吻合治疗胸段食管癌是一种安全的手术方法,具有肿瘤切除彻底,并发症少的优点。Objective: To evaluate esophagectomy with total stomach replacement and cervical anastomosis for treatrment of esophageal cancer. Methods: A total of 1124 patients with esophagus cancer, 749 males and 375 females were evaluated. Average age of patients was 58.5 years. Number of patients with stage I disease was 48, stage IIa 268, stage IIb 304, stage III 425 and stage IV 79. All the cases underwent left thoracic esophagectomy with total stomach replacement and cervical anastomosis. Results:The overall mortality rate was 0.53%(6/1124) ,anastomotic leakage was found in 38 cases (3.38%) and death rate related with leakage was 13.16%(5/38). Seven cases with chylethorax were cured (4 by surgical intervention and 3 by conservative therapy. Of the 748 cases that followed,the 2-, 3-and 5-year survival rates were 82.2%, 52.8% and 27.8% respectively. Conclusion: Esophagectomy with total stomach replacement and cervical anastomosis is a safe approach for thoracic esophageal cancer. It has the advantages of radical resection with less complications.

关 键 词：食管癌 全胃食管床移植 颈部吻合 治疗 

分 类 号：R735.105[医药卫生—肿瘤]