食管次全切除回结肠代食管术治疗早中期食管癌疗效分析  

Subtotal esophagectomy and ileocolon interposition for esophageal replacement in patients with e- sophageal cancer of stage Ⅰ - Ⅱ

作　　者：路培法[1] 孙俊峰[1] 王强[1] 程学飞[1] 郑晓勇[1] 孙作永[1] 

机构地区：[1]山东省滨州市人民医院胸心外科,256610

出　　处：《中国实用医刊》2012年第2期31-33,共3页Chinese Journal of Practical Medicine

摘　　要：目的探讨食管次全切除回结肠代食管颈部吻合术治疗早中期食管癌的临床经验及远期疗效。方法回顾性分析1991年至2009年间151例早中期食管癌患者的临床资料，所有患者均行食管次全切除回结肠代食管经胸骨后路颈部吻合术。术后TNM分期，Ⅰ期39例，Ⅱa期86例，Ⅱb期26例。其中上胸段13例，中胸段95例，下胸段43例。结果术后颈部吻合口瘘9例（6．0％），喉返神经损伤7例（4．6％），颈部吻合口狨窄11例（7．3％），肺部感染5例（3．3％），死亡3例（2．0％）。总并发症发生率为23．2％。135例获随访1—15年，术后3、5、10年生存率分别为79．5％、46．3％、26．7％。患者术后均恢复日常饮食习惯，生活质量满意，能从事一般工作及体力劳动。结论食管次全切除回结肠代食管经胸骨后路颈部吻合术治疗早、中期食管癌可明显提高患者的远期生存率和术后生活质量，提高外科技术，可显著降低结肠代食管术的并发症发生率。Objective To investigate the clinical experience and long-term functional results of subtotal esophagectomy and ileocolon interposition for esophageal replacement in patients with esophageal cancer of stageⅠ - Ⅱ. Methods The clinical datas of 151 cases of esophageal cancer underwent subtotal esophagectomy and esophageal reconstruction with ileocolon graft from 1991 -2009. The postoperative path- ological stage was： 39 cases in stage ⅠI, 86 cases in stage Ⅱa and 26 cases in stage Ⅱb. Results The inci- dence of postoperative complication was 23.2%, including cervical anastomotic leakage in 9 cases （6. 0% ）, laryngeal nerve injury in 7 cases（4. 6% ）, cervical anastorhotic stenosis in 11 cases（7.3% ）, re- spiratory infection in 5 cases（3.3% ） and death in 3 cases （2. 0% ）. Among the 135 cases who were fol- lowed up for 1 - 15 years, the overall 3-year, 5-year and 10-year survival rates were 79. 5%, 46. 3% and 26. 7%, respectively. All survival patients had restored normal life with satisfying quality. Conclusions Relative long-term survival with normal and satisfying life quality can b~ achieved in patients with esophageal cancer of stage Ⅰ - Ⅱ by ileo-colon interposition for esophageal replacement after subtotal esophagectomy. The incidence of postoperative complications can be reduced obviously by improvement of surgical technique and skill.

关 键 词：食管肿瘤 食管次全切除 回结肠代食管 结肠血管 

分 类 号：R735.1[医药卫生—肿瘤]