气管支气管节段切除和重建在累及气道食管癌外科治疗中的应用  

Tracheobronchial segmental resection and reconstruction applied to surgical treatment of esophageal cancer with airway involvement

作　　者：黄伟明[1] 张诗杰[1] 刘向征[1] 刘海波[1] 李简[1] 

机构地区：[1]北京大学第一医院胸外科,100034

出　　处：《中华医学杂志》2017年第33期2595-2599,共5页National Medical Journal of China

摘　　要：目的评估在侵犯气道的食管癌患者中，气管支气管节段切除和重建在外科治疗中的效果。方法2004年1月至2013年6月，共13例患者在北京大学第一医院胸外科进行根治性食管癌切除联合气管支气管的节段切除与重建。回顾分析了患者的临床特征，手术过程，术后并发症以及远期生存。结果所有的肿瘤均完全切除，切除气道的平均长度为（2．7±0．73）cm。此外，合并隆突加肺叶切除两例（包括隆突全肺切除），联合胸主动脉置换1例。有5例出现了术后并发症，有2例术后30d内死亡。4例患者出现气道吻合口狭窄，其中的3位没有接受支气管镜下治疗均于术后2年内死亡。术后中位生存为2年（0．5—10年）；1、2和5年生存率分别为72．7％、45．5％和24．2％。结论气管支气管的节段切除可以为侵犯气道的食管癌患者提供一个完全性切除的机会和生存获益，其并发症和死亡率也在可接受的范围。术后气道吻合口狭窄需要得到积极的治疗。Objective To evaluate the efficacy of tracheobronchial segmental resection and reconstruction applied to surgical treatment in the patients with esophageal cancer with airway invasion. Methods From January 2004 to April 2014, 13 patients in our center underwent radical esophagectomy combined with tracheobronchial segmental resection and reconstruction. Patient characteristics, operative procedures, postoperative complications and long-term survival were retrospectively reviewed. Results All patients received complete resection （R0） with an average length of resected airway 2. 77 ± 0. 73 cm. In addition, carinal resection plus lobar resection （including carinal pneumonectomy） was accomplished in 2 patients;1 patient underwent aortic replacement. Complications were noted in 5 patients （39%） and 2 patients （15.38%） died within 30 days after operation. 4 patients （30.76%） suffered from airway anastomosis stenosis and all 3 of them died within 2 years after operation due to refusing bronchoscopy interventions. The overall 1-, 2-, and 5-year survival rates were 72.7%, 45.5%, and 24.2%, respectively, with a median survival time of 2 years （0. 5 - 10 years）. Conclusion Tracheobronchial segmental resection and reconstruction can provide an opportunity of complete resection and a survival benefit for patients with esophageal cancer invading airway with acceptable morbidity and mortality. Postoperative airway anastomosis stenosis needs active treatment.

关 键 词：食管肿瘤 呼吸道肿瘤 术后并发症 生存率 

分 类 号：R735.1[医药卫生—肿瘤]