食管内翻拔脱术治疗食管癌

我们自1988年至2001年有选择性采用非开胸食管内翻拔脱术治疗食管癌39例，现报道如下。     

非开胸食管内翻拔脱术治疗食管癌105例

目的探讨非开胸食管内翻拔脱术治疗食管癌的适应证、手术技巧及并发症处理。方法回顾性分析2002年7月至2010年7月南京医科大学第一附属医院105例食管癌患者行食管内翻拔脱术(其中28例辅助使用电视纵隔镜)的临床资料,其中男59例,女46例;年龄63(48～81)岁。食管上段癌51例,中段癌18例,下段癌36例;分析手术效果和安全性。结果手术时间153(140～210)min,术中出血量150(100～250)ml,住院时间15(10～35)d。全组无手术死亡,残端未见肿瘤细胞残留。27例术后发生并发症,其中3例吻合口瘘,4例喉返神经损伤,5例胸腔积液,2例气胸,3例合并肺部感染,3例心律失常,1例乳糜胸,2例切口感染,2例胃排空障碍,2例吻合口狭窄,经治疗后均痊愈。术后随访16个月～5年,随访97例,失访8例,已生存1年以上患者94例,生存3年以上67例,生存5年以上34例,部分患者待进一步随访。结论食管内翻拔脱术损伤小、恢复快,可使不能耐受经胸或不宜经胸手术的Ⅱ期及更早的食管癌患者获益。     

非开胸食管内翻拔脱术治疗早期食管癌

自1988年4至1996年10月，对36例早期食管癌行非开胸食管内翻拨脱术，效果满意．现报道如下：     

食管内翻拔脱术的临床应用

食管内翻拔脱术的临床应用秦元孙德魁黄偶麟周允中吴松昌作者单位：２０００３０上海胸科医院胸外科我院自１９７８年６月至１９９４年６月采用不开胸食管拔脱术治疗食管良、恶性病例９９例，现报道如下：临床资料本组病例中男８３例，女１６例。年龄１４～８０岁，其中６...     

非开胸食管内翻拔脱治疗颈段食管癌19例

食管颈段是指食管入口至胸骨柄上缘,由于颈段食管癌术后并发症和病死率较其他部位高,手术效果不如胸段,传统的方法选择放射治疗,近年来趋向于手术治疗.1997年至今,我院采用非开胸食管内翻拔脱术治疗颈段食管癌19例,取得良好的效果,现报告如下.     

非开胸食管内翻拔脱术治疗食管胸上段癌：附20例报告

非开胸食管内翻拔脱术治疗食管胸上段癌（附２０例报告）曾多，李建业，蒋俭食管自胸廓入口至气管隆凸段为食管胸上段。一般认为该段解剖关系复杂，手术操作难度大，术后并发症多，死亡率高。因此，在缺乏合适的肿瘤切除技术和重建食管方法的条件下，放疗曾为该病主要的传...     

串列式食管内翻拔脱术

我们采用自制的分段打结呈串列式长纱布寸带,施行非开胸食管内翻拔脱术,称之为“串列式食管内翻拔脱术（reverting stripping of the esophagus by tandem-type without thoracotomy）”术。经临床应用,方法简便,提高了手术安全性,具有一定的优势,现总结供同道参考选用。     

新辅助化疗后腹腔镜辅助食管内翻拔脱术治疗颈段食管癌1例报告

本文报道2012年8月29日1例新辅助化疗后腹腔镜辅助食管内翻拔脱术治疗食管癌.患者男,58岁,吞咽困难进行性加重半年.经胃镜和活检病理诊断为颈段食管鳞状细胞癌.化疗3周期后,分期从T3N1M0降为T2N0M0,行腹腔镜辅助食管内翻拔脱术:腹腔镜下用超声刀游离胃、下段食管和膈食管裂孔,利用腔镜切割缝合器制成管状胃.同时,经颈部游离食管和清理颈部各组淋巴结.腹部悬吊,腹腔镜辅助食管内翻拔脱后,将管状胃牵至颈部,与食管残端吻合.手术时间2 h 50 min.术中出血量约210 ml.术后第7天进清流食,逐渐加量.术后第12天出院.住院期间未发生声嘶等并发症.术后病理:颈部各组淋巴结15枚,未见癌转移.术后3个月,酸反流4～6次/d,多在夜间.     

食管拔脱术治疗70岁以上老年人早期食管癌13例分析

<正> 我院自1997年～2001年共进行食管拔脱术治疗年龄在70岁以上老年人早期食管癌、贲门癌13例,取得了良好的治疗效果,现报告如下。 1 临床资料 1.1 一般资料:本组病人男性9例,女性4例,年龄在70～80岁之间。术前均行食道造影、胃镜、胸部CT等检查,确定为早期食管癌、贲门癌,其中上段5例,下段及贲门癌8例。10例患者术前伴有其它脏器疾病或功能障碍,其中4例合并两种     

食管内翻拔脱手术在喉咽部肿瘤及颈段食管肿瘤治疗中的应用

目的:探讨食管内翻拔脱手术在颈部肿瘤(喉咽部及颈段食管)治疗中的应用情况及效果。方法:回顾性分析2010年3月至2020年3月首都医科大学附属北京同仁医院胸外科手术治疗颈部肿瘤(喉咽部及颈段食管)患者238例。男135例,女103例;年龄42~78岁,中位年龄62岁。手术方式包括开放性腹部手术96例,腹腔镜手术142例...     

Long-term outcome of esophagectomy for high-grade dysplasia or cancer found during surveillance for barrett’s esophagus

Endoscopic surveillance is recommended for patients with Barrett’s esophagus to detect high-grade dys-plasia (HGD) or cancer. We studied the outcome of esophagectomy in a cohort of patients who devel-oped HGD or cancer between 1995 and 2003 while under surveillance for Barrett’s. Outcomes were measured by analysis of clinical records, symptom questionnaire, and SF-36 (version 2). In 34 patients, mean surveillance time was 48 months (range, 4–132); the mean number of endoscopies was 10 (range, 3–30). Preoperative diagnosis was HGD in 9 patients (26.5%), carcinoma in situ in 16 (47%), and ad-enocarcinoma in 9 (26.5%). There was no esophagectomy-related mortality; 10 patients (29%) had com-plications. At mean follow-up of 46 months (range, 13–108), SF-36 (version 2) results showed quality of life scores equal to or better than those of healthy individuals. Incidence and severity scores (VAS 1–10) for postoperative symptoms were reflux, 59% (2.8); dysphagia, 28% (3.7); bloating, 45% (2.6); nausea, 28% (2.1); and diarrhea, 55% (2.5). Twenty-nine patients (85%) have no clinical, radiographic, or en-doscopic evidence of recurrent esophageal cancer or metastasis. One patient has metastatic disease. En-doscopic surveillance in Barrett’s patients yields malignant lesions at an early, generally curable, stage. Esophagectomy is curative in the great majority and can be accomplished with minimal mortality and excellent quality of life. This work was supported in part by the Mary and Dennis Wise Fund and in part by an educational grant from United States Surgical Corpo-ration, Tyco Healthcare.     

Difference in main lymphatic pathways from the lower esophagus and gastric cardia

Lymphatic pathways draining the lower esophago-cardiac region were studied in 17 patients with carcinoma of the lower esophagus or gastric cardia, by measuring radioisotope uptakes in the regional lymph nodes. The uptakes were most remarkable in lower mediastinal and upper gastric lymph nodes, when the radioactive colloid was injected at the lower esophagus. A lesser degree of uptakes were observed both in other mediastinal and abdominal lymph nodes. On the contrary, a high degree of uptakes were detected only in abdominal lymph nodes, when the colloid was injected at the gastric cardia. The results indicated that main lymphatic pathways originating from the lower esophagus advance both upward and downward, and that those from the gastric cardia make their way downward to upper gastric, para-celiac and para-aortic lymph nodes. The actual incidences of lymph node metastases were also studied in 108 patients with carcinoma of the lower esophagus and 93 patients with carcinoma of the gastric cardia. In the former group, very high incidences were observed in lower esophageal and upper gastric lymph nodes. In the latter group, the incidence was most remarkable in upper gastric lymph nodes and far less significant in lower mediastinal lymph nodes. The results confirmed those of the radioisotope study. The importance of dissection of para-aortic lymph nodes near the left renal vein was also stressed.     

微创肌肉非损伤性开胸术治疗贲门肿瘤

目的探讨微创肌肉非损伤性开胸行贲门肿瘤手术的可行性. 方法采用经左胸第7肋间微创肌肉非损伤性开胸行贲门肿瘤手术25例. 结果 20例贲门腺癌,4例鳞癌,行近端胃大部和食管下段切除,残胃-食管胸内吻合术.1例贲门部增生型息肉,行胃底切开,肿瘤摘除术.全组患者无围术期严重并发症,无手术死亡. 结论微创肌肉非损伤性开胸术操作简单,暴露充分,对相对早期的贲门癌是一种可选择的手术方法.     

贲门癌经腹与经胸两种术式疗效的比较

目的 从贲门癌手术后的远期生存率方面,比较经腹与经胸两种手术入路的疗效.方法 对244例经手术治疗并有随访资料的病例进行统计分析,比较经腹与经胸两种手术入路患者1、3、5年生存率及切缘阳性率的差异.结果 两组间患者1、3、5年生存率差异无统计学意义,上切缘阳性率差异具有统计学意义.组内切缘阳性与切缘阴性病例生存率差异具有统计学意义.结论 两种手术入路对患者生存率的影响差异无统计学意义,但手术入路选择应个体化,对食管明显受侵患者,应采取经胸入路手术,以降低上切缘阳性率.     

En-bloc esophagectomy for esophageal cancer

BACKGROUND: The operative approach for esophageal cancer varies from simple palliative resection to extended esophagectomy with 3-field lymph-node dissection or en-bloc esophagectomy (EBE) depending on tumor and patient status and surgical strategy of the surgeon. The merits and demerits of such EBE are yet to be determined. METHODS: A literature review was done regarding EBE for esophageal cancer. RESULTS: Twenty articles describing EBE were reported from experienced institutions during the last 20 years and were selected for this study. The conclusions drawn from those articles showed that EBE would be a safe procedure with acceptable morbidity and low mortality rates when performed by an experienced surgeon. When strict patient selection criteria were maintained, this procedure decreased locoregional recurrence and improved long-term survival rates. CONCLUSIONS: EBE would be the treatment of choice in selected patients presenting with esophageal cancer. Development of meticulous preoperative risk assessment and optimum postoperative care may further improve the acceptability of this procedure with minimum morbidity and acceptable mortality rates.     

微创McKeown食管切除术治疗食管下段癌的临床价值

目的探讨微创McKeown食管切除术治疗下段食管癌的临床价值。方法选取2013-01-2017-06间在郑州大学第一附属医院接受食管切除术的下段食管癌患者。将行微创McKeown手术的患者作为微创组,将行开放Sweet手术的患者作为开放组,倾向得分匹配(PSM)用于降低2组一般资料的统计学差异。比较2组患者的疗效。结果全部患者均顺利完成手术。2组患者的病死率、肺部并发症和吻合口漏发生率差异无统计学意义(P>0.05)。微创组淋巴结清扫数、平均住院费用和手术时间均多于开放组,差异均有统计学意义(P<0.05)。结论微创McKeown食管切除术治疗下段食管癌,较传统开放手术淋巴结清扫数多,但手术时间和治疗费用较多。     

3D腹腔镜单向式胃游离在食管癌微创化治疗中的应用

目的 评价3D腹腔镜单向式胃游离法应用于食管癌微创化根治术的安全性、可行性及短期疗效.方法 回顾性分析武汉大学人民医院胸外科2018年2月至2019年12月收治的行胸腹腔镜下McKeown三切口食管癌根治术(二野淋巴结清扫)的118例食管癌患者的临床资料,其中男94例、女24例,年龄53.7(41～77)岁.其中55例...     

Laparoscopic transhiatal esophagectomy for esophageal cancer

BACKGROUND: Traditional esophagectomy may be associated with mortality, considerable morbidity, and lengthy recovery. It is often performed in cancer patients who are typically older, have associated comorbidities, and are often malnourished, all factors that increase surgical risk. Minimally invasive esophagectomy has the potential advantages of being a less traumatic procedure with an easier postoperative recovery and fewer wound and pulmonary complications. METHODS: A retrospective analysis of patients who underwent laparoscopic transhiatal esophagectomy was performed. Assessed parameters included patient demographics and operative data, pathology results, and long-term follow-up of at least 12 months. RESULTS: Twenty-two patients underwent laparoscopic transhiatal esophagectomy; 19 had esophageal cancer. Two patients were operated on for Barrett esophagus, and 1 patient had achalasia. The majority of patients were men (82%), and the mean age was 59 years (range 15 to 74 years); 1 patient (4.5%) was converted to open surgery. The average operative time was 380 minutes (range 285 to 525 minutes), and the average blood loss was 220 mL; only 3 patients required transfusion. The median hospital stay was 8 days (range 5 to 46 days). Postoperative mortality occurred in 1 patient (4.5%), and postoperative complications developed in 6 patients (27.2%). In the 19 cancer patients, the average number of harvested nodes was 14.3 (range 10 to 19). The average follow-up was 30 months (range 12 to 48 months). The overall survival for cancer patients was 61% (11 of 19), and disease-free survival was 39% (7/19). CONCLUSIONS: Esophagectomy is a major surgery with considerable morbidity and potential mortality. Minimally invasive esophagectomy is a feasible approach that can be safely performed by surgeons with extensive experience in that field. Advantages include less intraoperative blood loss, a smaller incision, and a potentially faster postoperative recovery. In cancer patients, immediate oncologic goals of adequate margins and lymph node dissection can be achieved, and long-term outcome appears to be similar to that found with open approaches.     

Comparison of extended esophagectomy through mini-thoracotomy/laparotomy with conventional thoracotomy/laparotomy for esophageal cancer

Objective: In order to assess the usefulness of esophagectomy through mini-thoracotomy/laparotomy as a minimally invasive surgical procedure for esophageal cancer, we compared the results to those of conventional right thoracotomy/laparotomy. Methods: From 1998 to 2002, 40 patients with thoracic esophageal cancer were prospectively assigned to two groups. Twenty patients underwent esophagectomy through mini-thoracotomy/laparotomy (M-group), while the other 20 had conventional thoracotomy/laparotomy (C-group). Surgical complications, the duration of the systemic inflammatory response syndrome (SIRS), postoperative pain, cytokine responses, and respiratory function were compared between the two groups. Results: There was no difference of morbidity between the M- and C-groups after surgery. There were also no differences between the two groups with respect to the operating time, bleeding, and number of dissected lymph nodes. The duration of SIRS was shorter in the M-group than in the C-group (p=0.055). Use of morphine was lower in the M-group than in the C-group with patient-controlled anesthesia (p=0.002) .The interleukin-6 level of the M-group was lower than that of the C-group at 3, 6 hours, and 3 days after the operation. Recovery of vital capacity by the M-group was better than by the C-group after the operation. Postoperative hospital stay of the M-group was significantly shorter than that of the C-group (p=0.014). Long-term survival was not different in the two groups. Conclusion: Mini-thoracotomy/laparotomy reduces invasiveness and pain compared with conventional thoracotomy/laparotomy for esophagectomy without causing any differences of morbidity or long-term survival.