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目的：提高食管癌和贲门癌的根治切除率和临床治愈率，预防吻合口瘘。方法：设计了Ⅰ、Ⅱ、Ⅲ三种术式：上、中段食管癌采用右胸前外侧切口，经第３或４肋间开胸，左腹直肌旁或左肋弓下斜切口开腹和右颈部切口，保留２～３ｃｍ颈段食管，食管次全切除，贲门部或部分胃切除，在颈部食管胃端侧分层吻合（Ⅰ式）。中段食管癌采用左胸前外侧切口，经第４或５肋间开胸，腹部切口同前，左颈部切口，保留３～４ｃｍ颈段食管，食管次全切除，部分胃切除，在左颈部食管胃端侧分层吻合（Ⅱ式）。贲门癌采用左胸前外侧切口，经第５或４肋间开胸，腹部切口同前，中段食管和近半胃或纵半胃切除，在主动脉弓下食管胃端侧分层吻合（Ⅲ式）。尽可能清除区域淋巴结，吻合口均用大网膜包盖加固。结果：食管癌和贲门癌总切除率９２１％（１７４／１８９），其中根治性切除率为７５１％（１４２／１８９），探查率（未切除）为７９％（１５／１８９），三种术式的总吻合口瘘发生率为４０％（７／１７４），无围手术期死亡。结论：三种术式可提高根治性切除率，大网膜包盖加固吻合口可减少瘘的发生率，食管胃分层吻合法可降低吻合口狭窄的发生率，临床治愈率高，围手术期死亡率低。
Objective: To improve radical resection rate and clinical cure rate of esophageal and cardiac cancers and prevent anastomotic leakage. METHODS: Three types of I, II and III surgical procedures were designed. The upper and middle esophageal cancers were performed with an anterior thoracic incision. The third or fourth intercostal thoracotomy was performed. The left rectus abdominis or the left rib arch incision incision was opened. And the right neck incision, retaining 2 ~ 3cm cervical esophagus, esophageal subtotal resection, cardiac or partial gastrectomy, in the cervical esophagogastric lamina end-to-side (I type). Middle esophageal cancer uses an anterior thoracic left incision, thoracotomy through the 4th or 5th intercostal space, abdominal incision with the former, left neck incision, retained 3 ~ 4cm cervical esophagus, subtotal esophagectomy, partial gastrectomy, in the left neck Partial esophagogastric anastomosis (Type II). Cardiac cancer uses an anterior thoracic incision, thoracotomy through the 5th or 4th intercostal space, abdominal incision with the anterior, mid-esophagus and near-half gastric or longitudinal hemigastric resection, and anastomosis at the esophageal end of the lower aorta (III). . Regional lymph nodes were removed as much as possible, and anastomosis was reinforced with a large omentum. Results: The total resection rate of esophageal and cardia cancers was 92.1% (174/189), of which the radical resection rate was 75.1% (142/189), and the exploration rate (non-excision) was 7.9% (15/15). 189) The total anastomotic leakage rate of the three procedures was 40% (7/174), and no perioperative death occurred. Conclusion: Three kinds of operation can improve the radical resection rate. The use of an omentum can improve the anastomosis can reduce the incidence of hemorrhoids. The esophagogastric stratified anastomosis can reduce the incidence of anastomotic stenosis. The clinical cure rate is high. Perioperative The mortality rate is low.