摘要
目的;探索用新术式治疗食管中、下段癌和部分上段癌的可行性。方法:本组全部经左胸第五肋间后外侧切口剖胸。用国产弯管形吻合器经食管床作食管胃端侧吻合。吻合部位在主动脉弓上、胸顶或颈根部(超胸顶)。在主动脉弓下折叠缝合胸胃小弯侧,使成直径4cm-5cm的管状。结果:本组共103例,有102例一次吻合成功。96例作主动脉弓上或胸顶吻合,7例作颈根部吻合。全组切缘均阴性,无吻合口瘘、狭窄及胃梗阻,无手术死亡。胸胃经食管床距离短,可最大限度的切除有癌灶的食管;吻合口和幽门区张力小,可减少吻合口瘘和幽门痉挛。胸胃在食管床内,可减少创面渗出,减轻对心肺压迫,减轻返流。由胸内游离颈根部食管,可减少喉返神经损伤的机会,不作颈部切口。结论:此术式融合了食管胃机械吻合、经食管床、缩小胸胃、经胸作颈根部吻合多个术式的优点,提高了患者生活质量,适用于大部分食管中、下段癌及部分胸上段癌患者。
Objective:To evaluate the feasibility of surgical treatment for the middle,lower and partial upper esophageal carcinoma with
a new operation.Methods:the thorax was cut open along the 5th costal interspace at left posterolateral chest wall.We used curved tubal stapler
(made in china)in the esophago-gastrostomy.Anastomosis was operated either above the aortic arch or in the base of cervical region(above the
apex thorax),and the thoracio stomach remained in the bed of esophagus.The thoracio stomach was sutured to be a tube under the aortic arch.
Results:Among 103 patients treated by esophago-gastrostomy with stapling anastomosis there was no anastomotic stricture,gastric obstruction or
perioperative death.Thoracic stomach above the aortic arch,at the top of chest or in the base of cervical region reduced the incidence of anasto-
motic leakage.Because the distance of anastomosis was shortened,more esophagus could be cut without positive margins,the effusion of wound
decreased,the pressure on heart and lung reduced and the reflux of food was relieved.Trauma could be diminished by this procedure.Conclu-
sion:This operative method merges many kinds of advantage,which can improve the life guatity and reduce cost.
出处
《四川肿瘤防治》
2004年第2期74-76,共3页
Sichuan Journal of Cancer Control
