食管癌术后复发再次手术临床疗效分析  

Clinical curative effect of re-resection in the treatment of local recurrence of esophageal cancer after surgery

作　　者：谢颂平[1] 康敢军[1] 张兴华[1] 江万里[1] 黄杰[1] XIE Songping;KANG Ganjun;ZHANG Xinghua(Department of Thoracic Surgery,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院胸外科,430060

出　　处：《临床外科杂志》2018年第9期674-675,共2页Journal of Clinical Surgery

摘　　要：目的总结食管癌或贲门癌术后复发癌的再次手术治疗的临床疗效。方法食管癌术后复发行再次手术切除病人18例,其中根治性切除17例,姑息性切除1例。采用经左胸腹联合切口行残胃-食管吻合术3例;采用胸腹联合切口3例,其中2例行食管-空肠R-Y吻合术,另1例行横结肠-食管、横结肠-残胃吻合术;采用颈、胸、腹三切口,先行颈部食管-结肠吻合术、结肠-残胃或空肠吻合术12例。13例病人同期行食管癌切除术加消化道重建术,5例病人先行结肠代食管术,择期行食管癌切除术。结果无围术期死亡。术后发生颈部食管-结肠吻合口漏1例,肺部感染4例,腹部切口感染1例,均经治疗后痊愈。所有病例均获随访,1例姑息性切除病人于术后13个月死亡。结论对于复发食管癌肿较局限的病人,如病人体质允许,掌握手术指征,采取积极的再次手术治疗可延长病人生存时间。Objective To explore the surgery therapy for recurrent esophageal cancer patients after radical resection. Methods The clinical data of 18 recurrent esophageal cancer patients who underwent radical resection were retrospectively reviewed. Surgery for recurrent gastric cancer patients achieves ideal long-term prognosis,which should perform actively. Radical resection was performed in 17 cases and palliative resection in 1 cases. Remnant gastric-esophago anastomosis through Left oblique thoracoabdominal incision in 3 patients; 2 cases were performed ofesophageal Roux-en-Y anastomosis and 1 case was performed coloesophago anastomosis through Left oblique thoracoabdominal incision; 12 cases were performed esophagectomy and coloesophago anastomosis through the three-incision（ right thoracotomy,midline laparotomy and left cervical incisions）. Esophagectomy and alimentary canal reconstruction were performed in 13 patients at the same time. 5 patients were treated with colonic esophageal substitution and selective operation for thenesophagectomy. Results The in-hospital postoperative mortality was 0. Pulmonary complications were most commonly observed complications among 4 patients; cervical Esophagocolo anastomosis site leakage developed in 1 patient; abdominal incision infection in 1 patient,all were cured after treatment. All patients were followed up,the palliative resected patients died 13 months after the operation. Conclusion For patients with limited recurrence of esophageal cancer,if the patient＇s constitution allows,we have master surgical indications,taking active reoperation can prolong the patient ＇s survival time.

关 键 词：复发性食管癌 再切除术 

分 类 号：R735.1[医药卫生—肿瘤]