回结肠代食管治疗早中期食管癌疗效分析_临床医学论文.docVIP

回结肠代食管治疗早中期食管癌疗效分析_临床医学论文 回结肠代食管治疗早中期食管癌疗效分析_临床医学论文 作者：路培发，孔令贵，王斌，方志勇，杜宝青，张辉 【摘要】 目的 探讨回结肠代食管治疗早中期食管癌的临床经验及远期疗效。方法 回顾分析130例以回结肠经胸骨后路代食管治疗早中期食管癌的临床资料。术后TNM分期，Ⅰ期30例，Ⅱa期72例，Ⅱb期28例。其中颈段癌5例，上胸段21例，中胸段65例，下胸段39例。结果 术后颈部吻合口瘘8例（6.15%），喉返神经损伤5例（3.85%），颈部吻合口狭窄13例（10.00%），移植回肠段迂曲梗阻1例（0.77%），死亡2例（1.54%）。总并发症率22.31%。全部病例随访1～15年，术后3年、5年、10年生存率分别为84.6%、66.9%、35.5%。患者术后均恢复正常饮食，生活质量满意，能从事一般工作及体力劳动。结论 回结肠经胸骨后路代食管治疗早中期食管癌，可明显提高患者术后生活质量，提高外科技术可显著降低结肠代食管术的并发症发生率。 【关键词】 食管肿瘤；外科手术；结肠代食管；结肠血管 Effect of esophageal replacement with ileum-colon in patients with esophageal cancer of stage Ⅰ～Ⅱ ［Abstract］ Objective To investigate the experience and long-term effect of esophageal replacement with ileum-colon in patients with esophageal cancer of stageⅠ～Ⅱ.Methods Retrospective analysis was carried out in 130 cases with esophageal cancer underwent esophageal replacement with ileum-colon from 1991～2007.The postoperative pathological stage was:stage Ⅰ in 30 cases，Ⅱa in 72 cases and Ⅱb in 28 cases. Results The incidence of postoperative complication was 22.30%，including cervical anastomotic leakage in 8 cases（6.15%），laryngeal nerve injury in 5 cases（3.85%），cervical anastomotic stenosis in 13 cases（10.00%），obstruction of ileum segment in one case（0.77%），death in 2 cases（1.54%）.All cases were followed up for 1～15 years.The overall 3-year，5-year and 10-year survival rate were 84.6%，66.9% and 35.5% respectively.All survival patients had restored normal life with satisfying quality.Conclusion Relative long-term survival with normal and satisfying life quality can be achieved in patients with esophageal cancer of stage Ⅰ～Ⅱ by esophageal replacement with ileum-colon.The incidence of postoperative complications can be reduced obviously by improvement in surgical technique. ［Key words］ esophageal neoplasm；surgical procedures；esophageal replacement with ileum-colon;colon blood vessel 食管癌切除术后最常用胃代食管行胸内或颈部吻合，但是术后胸胃综合征、反流性食管炎及饮食习惯改变等术后合并症常影响患者术后生活质量。结肠代食管术最符合生理要求，术后生活质量好，其价值已为医学界肯定，但因手术操作复杂、并发症发生率高，使该技术的应用受到限制