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目的探讨非开胸食管内翻拔脱术治疗食管癌的适应证、手术技巧及并发症处理。方法回顾性分析2002年7月至2010年7月南京医科大学第一附属医院105例食管癌患者行食管内翻拔脱术(其中28例辅助使用电视纵隔镜)的临床资料,其中男59例,女46例;年龄63(48～81)岁。食管上段癌51例,中段癌18例,下段癌36例;分析手术效果和安全性。结果手术时间153(140～210)min,术中出血量150(100～250)ml,住院时间15(10～35)d。全组无手术死亡,残端未见肿瘤细胞残留。27例术后发生并发症,其中3例吻合口瘘,4例喉返神经损伤,5例胸腔积液,2例气胸,3例合并肺部感染,3例心律失常,1例乳糜胸,2例切口感染,2例胃排空障碍,2例吻合口狭窄,经治疗后均痊愈。术后随访16个月～5年,随访97例,失访8例,已生存1年以上患者94例,生存3年以上67例,生存5年以上34例,部分患者待进一步随访。结论食管内翻拔脱术损伤小、恢复快,可使不能耐受经胸或不宜经胸手术的Ⅱ期及更早的食管癌患者获益。
Objective To investigate the indications, surgical techniques and complication management of esophageal cancer without esophageal variceal extraction. Methods The clinical data of 105 patients with esophageal varices esophageal varices (including 28 assisted mediastinoscopy) from July 2002 to July 2010 in the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. Among them, 59 , 46 females; age 63 (48 ~ 81) years old. Upper esophageal cancer in 51 cases, 18 cases of middle and lower cancer in 36 cases; analysis of surgical results and safety. Results The operation time was 153 (140 ~ 210) min, the intraoperative blood loss was 150 (100 ~ 250) ml and the hospitalization time was 15 (10 ~ 35) d. The whole group had no surgical death, no residual tumor cells were found in the stump. 27 cases had postoperative complications including 3 anastomotic leakage, 4 recurrent laryngeal nerve injury, 5 pleural effusion, 2 pneumothorax, 3 pulmonary infection, 3 arrhythmia, 1 chylothorax, 2 Case incision infection, 2 cases of gastric emptying disorders, 2 cases of anastomotic stenosis, were cured after treatment. The patients were followed up for 16 months to 5 years. 97 patients were followed up and 8 patients were lost. There were 94 patients who had survived for more than 1 year, 67 survived for 3 years or more, 34 survived for more than 5 years and some patients were further followed up. Conclusions Esophageal varus extraction is less injury and faster recovery, which can benefit patients with stage Ⅱ and earlier esophageal cancer who can not tolerate or not by transthoracic surgery.