目的总结穿孔食管癌的外科治疗经验。方法回顾1990—2004年对34例穿孔食管癌临床治疗情况,男26例,女8例,年龄42~71岁;胸上段癌5例,胸中段16例,胸下段13例,穿孔直径0.3~1.2 cm;穿入总气管4例,左主支气管6例,右主支气管3例,左肺下叶3例,穿入纵隔16例,左肺上叶及左侧胸膜腔各1例。手术采用左后外开胸、左后外开胸开颈、右后外开胸开腹开颈三切口,食管癌切除同时行穿孔脏器修补或合并穿孔脏器切除。结果34例无手术死亡,单纯开胸探查占15%(5/34),总切除率占85%(29/34);1、3、5年生存率分别为54%(13/24)、16%(3/19)、9%(1/11)。结论穿孔食管癌属晚期病例(T4),经严格选择,部分患者仍适宜进行外科手术治疗,术后综合治疗可延长生存期。 Objective To summarize the surgical experience of perforation esophageal cancer. Methods The clinical data of 34 patients with perforation of esophageal cancer from 1990 to 2004 were retrospectively analyzed. There were 26 males and 8 females, aged 42-71 years old. The upper thoracic carcinoma was 5 cases, the middle thoracic segment was 16 cases, the thoracic segment was 13 cases, the perforation diameter was 0.3 ~ 1.2 cm. There were 4 cases penetrating the total trachea, 6 cases of the left main bronchus, 3 cases of the right main bronchus, 3 cases of the left lower lobe, 16 cases penetrating the mediastinum, 1 case of the left upper lobe and the left pleural cavity. Operative left thoracotomy, left thoracotomy thoracotomy, right thoracotomy open thoracotomy three incisions, esophageal cancer resection while perforation organ repair or perforation organ resection. RESULTS: Thirty-four patients died without surgery. Thoracotomy alone accounted for 15% (5/34), and total resection rate was 85% (29/34). The 1-, 3-, and 5-year survival rates were 54% (13/24) 16% (3/19), 9% (1/11). Conclusion Perforation of esophageal cancer is a late-stage case (T4). After strict selection, some patients are still suitable for surgical treatment. Comprehensive treatment after operation can prolong survival.