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目的分析右胸径路与颈部食管胃单层宽边吻合术行胸上段食管癌根治术的效果。方法回顾性分析右三切口与颈部食管胃单层宽边吻合术674例胸上段食管癌根治术的手术方法与优点。此法避开主动脉弓、弓上大血管与气管对胸上段食管的遮挡,直视下锐性切除胸上段食管癌,保存食管起端1～2cm行颈部食管胃单层宽边吻合术,可实现食管次全切除。结果本组手术死亡3例(0.9%),吻合口瘘2例(0.5%),吻合口狭窄12例(3.5%)。上切端癌细胞阴性319例(94.7%),阳性18例(5.3%)。生存率:1年94.3%,3年58.1%,5年28.6%。结论右胸径路与颈部食管胃单层宽边吻合术可有效地实现胸上段食管切除的彻底性,使胸上段食管癌同中、下段食管癌一样可首选的根治术,且具有同样良好的效果。
Objective To analyze the effect of transvaginal esophagectomy on the upper thoracic esophagus with wide-side anastomosis of the right thoracic pathology and cervical esophageal monolayer. Methods The surgical methods and advantages of 674 cases of upper thoracic esophageal cancer radical mastectomy with right anterior incision and wide esophageal anastomosis of the neck were retrospectively analyzed. This method to avoid the aortic arch, the bow on the large blood vessels and trachea on the upper esophagus obstruction, under direct vision to remove the upper thoracic esophageal cancer, save esophageal at the beginning of 1 ~ 2cm line of cervical esophageal monolayer broadside anastomosis, Achieve subtotal esophageal resection. Results The group died of operation in 3 cases (0.9%), anastomotic fistula in 2 cases (0.5%) and anastomotic stenosis in 12 cases (3.5%). There were 319 cases (94.7%) of cancerous cells on the incision and 18 cases (5.3%) of them were positive. Survival: 94.3% for 1 year, 58.1% for 3 years and 28.6% for 5 years. Conclusions The right anterograde approach and cervical esophagogastric monolayer broadside anastomosis can effectively achieve the thoracic esophagectomy thoroughness so that the upper thoracic esophageal cancer with the same, lower esophageal cancer can be the first choice for radical mastectomy, and has the same good effect.