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目的分析管状胃重建食管应用于老年食管癌三切口手术治疗中的临床效果。方法 2008年7月—2012年6月收治的胸中上段食管癌老年患者58例,经右胸、腹部、左颈三切口手术治疗。术中采用管状胃制作替代食管,观察术后患者吻合口瘘发生率、肺不张及肺部感染等呼吸道并发症,随访观察胸胃综合征、反流性食管炎发生率等临床效果。结果全组无死亡,发生吻合口瘘1例,肺不张1例,肺部感染2例均经治疗后痊愈。随访49例,远期死亡3例。生存者未见明显进食后心悸、胸闷等胸胃综合征及反流性食管炎。结论管状胃重建食管应用于食管癌患者手术治疗中可明显降低吻合口瘘发生率,减少肺部并发症及胸胃综合征、反流性食管炎,尤其适用于老年三切口食管癌手术。
Objective To analyze the clinical effect of tubular gastric reconstructive esophagectomy for surgical treatment of esophageal cancer in the elderly. Methods 58 elderly patients with middle-upper thoracic esophageal cancer who were treated from July 2008 to June 2012 were treated with three incisions of right chest, abdomen and left neck. Tubular stomach was used during surgery to replace the esophagus. The incidence of anastomotic leakage, pulmonary atelectasis, and pulmonary infections were observed in postoperative patients. The clinical effects of thoracic stomach syndrome and reflux esophagitis were followed up. Results There was no death in the whole group. There was 1 case of anastomotic leakage, 1 case of pulmonary atelectasis, and 2 cases of pulmonary infection. All cases recovered after treatment. Follow-up 49 cases, 3 cases of long-term death. The survivors did not have obvious chest and stomach syndromes such as heart palpitations and chest tightness, and reflux esophagitis. Conclusions The application of tubular reconstructed esophagus in the surgical treatment of esophageal cancer patients can significantly reduce the incidence of anastomotic leakage, reduce pulmonary complications and chest and stomach syndrome, reflux esophagitis, especially for elderly three-incision esophageal cancer surgery.