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目的:探讨腹颈两切口食管切除术的临床应用价值,旨在提高部分食管外科手术的安全性,降低病死率。方法:回顾应用腹颈两切口完成食管切除术83例,其中食管穿孔6例,下咽癌5例,颈段食管癌24例,胸上段食管癌11例,胸中段25例,胸下段10例,贲门癌2例;手术常规采用腹颈两切口,应用全胃、胃管或结肠代食管。结果:83例手术均成功,吻合口瘘15例,喉返神经麻痹10例;纵隔出血3例;术后<30 d死亡者3例;术后随访率85%(64/75),1、3年生存率分别为89.1%(57/64)、68.7%(44/64)。结论:腹颈两切口食管切除术创伤小,安全性高,可选择应用于食管穿孔、下咽癌、颈段食管癌、胸段食管癌及贲门癌不能耐受开胸手术的患者,在恶性肿瘤中以原位癌最为适宜。
Objective: To investigate the clinical value of esophagectomy with two incisions for improving the safety of partial esophageal surgery and reducing the mortality rate. Methods: Eighty-three cases of esophagectomy were retrospectively studied, including 6 cases of esophageal perforation, 5 cases of hypopharyngeal carcinoma, 24 cases of cervical esophageal cancer, 11 cases of upper esophageal cancer, 25 cases of middle and lower thoracic esophagus, 10 cases of lower thoracic esophagus , 2 cases of cardia cancer; surgery routine use of two incisions of the abdomen, the application of the whole stomach, stomach or colon on behalf of the esophagus. Results: All the operations were successful in 83 cases, including 15 cases of anastomotic fistula, 10 cases of recurrent laryngeal nerve paralysis, 3 cases of mediastinal hemorrhage, 3 cases of death after 30 days, and the follow-up rate was 85% (64/75) The 3-year survival rates were 89.1% (57/64) and 68.7% (44/64), respectively. Conclusions: The abdominal and neck incision esophagectomy has the advantages of less trauma and high safety. It can be used in patients with esophageal perforation, hypopharyngeal cancer, cervical esophageal cancer, thoracic esophageal cancer and cardia cancer who can not tolerate thoracotomy. Tumors in situ in the most appropriate.