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目的探讨胃手术后再患食管中、上段癌的外科治疗方法。方法回顾分析1980—2004年收治的86例胃手术后食管癌患者的临床资料。食管中段癌50例,上段癌31例,颈段5例。TNM分期Ⅰ期16例,Ⅱa期62例,Ⅱb期5例,Ⅲ期3例。既往曾行全胃或胃部分切除术,术后至诊断为食管癌的时间为2～22年。手术术式病变食管切除以残胃上提代食管2例,倒置胃管代食管3例,短段带血管蒂结肠间置代食管5例,长段血管蒂结肠代食管74例,空肠造口减状术2例。结果术后30d内出现并发症10例(12%),经处理治愈。76例(88%)病变食管切除,恢复正常进食;7例(8%)病变食管旷置,经口进食;2例空肠造口给肠内营养;1例死亡。术后随访67例,术后1,3,5年生存率分别为84%(56/67),57%(38/67)和22%(15/67)。结论胃手术后再患食管中、上段癌患者的治疗仍首选手术切除病变食管,大部分的病例可采用结肠代食管。
Objective To investigate the surgical treatment of upper esophagus and upper esophagus after gastric surgery. Methods The clinical data of 86 patients with esophageal cancer after gastric surgery admitted from 1980 to 2004 were retrospectively analyzed. Esophageal cancer in 50 cases, 31 cases of upper cervical cancer, cervical in 5 cases. TNM stage Ⅰ 16 cases, Ⅱ a 62 cases, Ⅱ b 5 cases, Ⅲ 3 cases. Past history of the whole stomach or partial gastrectomy, postoperative diagnosis of esophageal cancer for 2 to 22 years. Surgical surgical lesions esophageal resection of the esophagus on behalf of the esophagus in 2 cases, inverted esophageal on behalf of the esophagus in 3 cases, short segment with transvascular pedicle esophageal interposition esophageal in 5 cases, long segment of the pedicle of the colon on behalf of the esophagus in 74 cases, jejunostomy Decompression in 2 cases. Results Complications occurred in 10 cases (12%) within 30 days after operation and were cured after treatment. Seventy-six (88%) lesions were esophagectomized and returned to normal diet; 7 (8%) lesions were esophageal exclusion and were orally fed; 2 were jejunostomy for enteral nutrition; and 1 was fatal. The postoperative follow-up of 67 cases showed that the 1, 3, 5-year survival rates were 84% (56/67), 57% (38/67) and 22% (15/67) respectively. Conclusion Re-esophageal cancer patients after gastric surgery, the upper cancer treatment is still the preferred surgical resection of the esophagus, the majority of cases can be used on behalf of the colon on behalf of the esophagus.