经颈胸腹三切口手术治疗胸中上段食管癌76例疗效观察

目的观察经颈胸腹三切口手术治疗胸中上段食管癌的临床疗效。方法观察剖胸探查确诊为中下段食管癌的82倒患者中经右胸、腹正中、左颈三切口切除胸中上段食管癌76侧患者的临床疗效。结果中上段食管癌82例中经三切口切除76例，其中胸上段17例，胸中段59例；根治性切除71例，姑息性切除5例，切除率92．7％。术后69例痊愈，5例好转，2例死亡。术后肺部并发症18例，吻合口瘘1例，胃排空障碍2倒，喉返神经损伤2例，心率失常3例，切口感染3例。术后随访65例，失访9例，随访率87．8％，随访时间3-54个月，3年生存率52．3％。结论三切口手术肿瘤切除率高，切除彻底。病例的合理选择，最优化的围手术期管理，淋巴结的规范化清扫，管状胃、吻合器技术及空肠营养管的应用，可减少手术并发症和病死率。

Therapeutic effect of neck-chest-abdomen tri-incision formoderate and superior segment esophageal cancer

Objective To investigate that the clinical therapeutic effect of neck-chest-abdomen tri-incision with moderate and superior segment esophageal cancer.Methods The clinical therapeutic effect of 76 patients with moderate and superior segment esophageal cancer treated with neck-chest-abdomen tri-incision was observed.Results Exploratory thoracotomy were executed for 82 patients with chest moderate and superior segment esophageal cancer.There were 76 cases for neck-chest-abdomen tri-incision,especially 17 cases for chest superior segment and 59 cases for chest moderate segment.There were 71 cases for completely excision and 5 cases for partial excision.The rate of excision was 92.7%.After operation,there were recovery for 69 cases,improvement for 5 cases,and death for 2 cases.Postoperative complications included pulmonary infection for 18 cases,fistula of anastomotic stoma for 1 case,disability of gastric emptying for 2 cases,recurrent laryngeal nerve damage for 2 cases,arrhythmias for 3 cases,and postoperative infection for 3 cases.After operation,65 cases from three to fifty-four months and missing 9 cases.The follow-up rate was 87.8%.The survival rate of three years was 52.3%.Conclusion The excision rate of tumor for tri-nick operation was very high.It was good for decreasing operative complication and fatality rate for that reasonable choose of patient,optimization of preoperative period management,scavenge of normalization for lymph nodes,application of tubular shape stomach,anastomat technique,and jejunum nutrient canal.