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目的:探讨腔镜辅助胃代食管胃咽吻合术在修复晚期下咽及颈段食管癌切除后咽环周缺损的临床应用。方法:在4例晚期下咽及颈段食管癌根治术后,采用腹腔镜技术代替传统开腹(开胸)的开放进路,同期行胃上徙胃代食管胃咽吻合术。结果:4例患者均成功行经腹腔镜辅助胃上徙胃代食管胃咽吻合术,均避免了开胸或开腹手术。1例术后出现咽瘘,半年后死亡。1例1年半后颈部淋巴结转移,因经济问题未再行治疗。2例仍存活,1例术后已3年半,1例术后已2年半。结论:腔镜辅助胃代食管胃咽吻合术确实可行,创新和改良了传统粗放的开放术式,可显著减轻手术创伤,提高手术安全性,提高患者术后的生存质量。
OBJECTIVE: To evaluate the clinical application of endoscopic esophagogastric and pharyngeal anastomosis assisted gastrectomy in the repair of late pharyngeal circumnuclear defects in patients with advanced hypopharyngeal and cervical esophageal cancer. METHODS: Four patients with advanced hypopharyngeal and cervical esophageal cancer were treated with laparoscopic technique instead of traditional open surgery (open thoracotomy). At the same time, gastric suprahepatic esophagogastric-pharyngeal anastomosis was performed. RESULTS: All the 4 patients were successfully performed laparoscopically assisted supragastric remnant esophagogastric-pharyngeal anastomosis, all of which avoided thoracotomy or open surgery. One patient had postoperative pharyngeal fistula and died six months later. One case of neck lymph node metastasis after one and a half years was not treated again due to economic problems. Two cases were still alive, one case had been postoperative for three and a half years, and one patient had been postoperative for two and a half years. Conclusion: The endoscopic esophagogastric and pharyngeal anastomosis with gastroscope is really feasible. The traditional open operation is innovative and improved. It can significantly reduce the surgical trauma, improve the safety of the operation, and improve the postoperative patient’s quality of life.