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目的探讨胃大部切除术后食管癌的手术治疗方式和效果。方法对1972年至1998年间20例胃切除术后食管癌的手术治疗进行分析。结果左、右后外开胸、上腹正中开腹及左颈3切口,食管癌切除、移植结肠至颈部与食管吻合,腹腔结肠与残胃吻合7例;胸腹联合切口,食管癌切除,将残胃、脾、胰体尾移入左胸内,行食管残胃弓上吻合,空肠RouxenY重建消化道3例;食管残胃弓上吻合,空肠RouxenY重建消化道4例;食管空肠RouxenY重建消化道4例探查并行小肠造瘘术2例。本组食管癌切除率为90.0%18/20。总并发症为30.0%6/20。1、3、5年生存率分别为90.0%、64.3%和36.4%。结论胃大部切除术后食管癌的手术治疗需根据病变部位和病情选择手术方式。胸上段癌采用移植结肠代食管术,胸中、下段癌采用残胃及小肠代食管术,胸下段癌采用选择性小肠代食管术,其方法较为合理。残胃、脾、胰体尾移植入左胸内、食管癌切除、食管残胃吻合、空肠RouxenY重建消化道可供临床作为一种新术式,值得推荐。
Objective To investigate the surgical treatment and effect of esophageal cancer after major gastrectomy. Methods Surgical treatment of 20 cases of esophageal cancer after gastrectomy was performed from 1972 to 1998. Results Left and right posterior thoracotomy, upper abdominal abdomen open and left neck 3 incision, esophageal cancer resection, colon to neck and esophagus anastomosis, abdominal colon and residual gas anastomosis in 7 cases; thoraco-abdominal incision, esophageal cancer resection The remnant stomach, spleen, pancreatic body and tail were moved into the left chest, anastomosis of the esophageal stump arch, jejunal RouxenY reconstruction of the digestive tract in 3 cases; esophageal residual gastric bow anastomosis, jejunal RouxenY reconstruction of the digestive tract in 4 cases; esophageal jejunum RouxenY reconstruction 4 cases of gastrointestinal tract exploration parallel small intestine ostomy 2 cases. The resection rate of esophageal cancer in this group was 90.0% and 18/20. The overall complication rate was 30.0% 6/20. The 1, 3, and 5-year survival rates were 90.0%, 64.3%, and 36.4%, respectively. Conclusion Surgical treatment of esophageal cancer after subtotal gastrectomy should be based on the location and condition of the disease. The upper thoracic cancer was treated with colon-transplanted esophagus. The middle and lower thoracic cancers were treated with residual gastroenterology and small intestine replacement esophagus. The lower thoracic carcinoma was treated with selective small intestine replacement esophagus. The method was more reasonable. Remnant stomach, spleen, pancreatic body and tail transplantation into the left chest, esophageal cancer resection, esophageal residual gastric anastomosis, jejunum RouxenY reconstruction of the digestive tract for clinical use as a new surgical method, it is worth recommending.