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对11例因胃良性或恶性病变行胃大部或上半胃切除术后发生的食管癌或贲门癌,按癌灶部位及首次手术情况,分别选用结肠代食管胸骨后径路颈部吻合8例、空肠代食管间置弓上吻合1例、空肠代胃代食管弓下Roux-en-Y吻合2例。术后颈部切口感染1例,全组无手术死亡。文中对结肠代食管的技术问题作了探讨,强调术中大量、反复灌洗移植的结肠段,并保证其有适当长度及充足的血运;并认为作残胃全切、空肠代胃、弓下吻合时以切除左第八肋骨后外切口进胸为好,此径路显露良好,便于胸内吻合、腹部粘连松解及淋巴结清扫。
11 cases of esophageal or cardiac cancer after gastrectomy or gastrostomy due to benign or malignant gastric lesions were performed. According to the location of the tumor and the first operation, 8 cases of cervical anastomosis of the sternum after sternal esophagectomy were selected respectively. The jejunal esophagus was placed on the bow with anastomosis in 1 case and the jejunal surrogate stomach replaced the Roux-en-Y under the esophageal arch in 2 cases. One case of neck incision infection was postoperative, and no operative death occurred in the entire group. This article discusses the technical problems of colonic esophageal replacement, emphasizing the large number of repeated lavage colons in the operation, and guaranteeing proper length and adequate blood supply; and considers that the entire stomach can be completely cut, the jejunal stomach, bow When the lower anastomosis is performed, the posterior incision of the left eighth rib is cut into the chest. This pathway is well exposed and facilitates anastomosis of the chest, adhesion of the abdomen, and lymph node dissection.