胃代食管途径与术后并发症相关分析  

Different approachs of gastric transposition and postoperative complications

作　　者：冯锡建 李国珍[1] 孙培军[1] 

机构地区：[1]河南辉县市人民医院胸外科,河南453600

出　　处：《肿瘤》2003年第2期151-152,共2页Tumor

摘　　要：目的　探讨食管次全切除后 ,根据病人具体情况选择胃代食管的最佳途径。方法　对 2 37例食管癌行食管次全切除 ,食管胃颈部吻合术后的病例进行回顾性总结 ,分析两条胃代食管途径和手术后并发症的相关性。结果　经食管床的 94例纵隔胃病人 ,术后胸胃综合征、心肺并发症最少 ,胸腔放置引流管时间最短。经左胸腔的 143例胸腔胃病人 ,术后放射治疗者胃肠反应轻 ;术后肿瘤复发的部分病人可经 2次手术治愈 ,或再次放疗 ,延长生存期。结论　对于早期食管癌 ,或高龄心肺功能较差的病人 ,预计术后不需要放射治疗者 ,可行胃经食管床食管纵隔胃吻合。对中晚期食管癌、或青中年、体质良好的病人 ,预计术后必须放射治疗者 ,仍应选择传统的胃经左胸腔的食管胸胃吻合。对于颈段、胸上段的中晚期食管癌、需要三切口的病人 ,应尽可能采取术前放疗、新辅助化疗、术中化疗和彻底清扫淋巴结 ,减少术后复发转移。Objective To inestigate the best surgical approach for gastric transpositon.Methods 237 patients with esophagieal carcinoma underwent cervical esophagogastrostomy.The approachs of the stomach lift were in midiastinum in 94 cases and left-thoracic cavity in 143.Results The cases whose stomach lift through the midiastinum had less postoperative complications such as the thoracic stomach syndrome and heart and lung complications than the cases whose stomach lifted through left thoracic cavity.The drainage tube could be pulled out early in the cases with midiastinum stomach. The cases with the thoracic stomach had no serious digestive system reaction when they accepted postoperative radiotherapy.Conclusion If the cases needn't accept postoperative radiotherapy or whose cardiac and lung function was just possible to embrace the operation,that the stomach was lifted through the midiastinum was suitable and for others who need accept postoperative radiotherapy, it was better to lift the stomach through left thoracic cavity. For patients of advanced esophageal cancer who would accept cervico-thoraco-abdominal triple incision operation preoperative radio therapy,neoadjuvant chemotherapy,complete getting rid of lemph nodes and adjuvant chemotherapy during operation should be adopted to decease postoperative recurrence and metastasis of carcinoma.

关 键 词：食管癌 胃代食管 并发症 

分 类 号：R735.1[医药卫生—肿瘤]