胃大部切除术后食管癌手术方法分析

摘要

Objective To evaluate the preferred plan of surgical treatment for esophageal carcinoma after subtotal gastrectomy.Methods Surgical procedures for 8 patients with esophageal carcinoma after subtotal gastrectomy from January 2006 to June 2010 in Zhongnan Hospital were retrospectively analyzed.In four patients, the lesions were removed, and the colon was used as the substitute for esophagus.In three patients,the lesions were resected, the residual stomach together with spleen and caudal portion of pancreas was moved into the thorax,and remnant gastric transposition for esophageal replacement was chosen as radical correction of esophageal carcinoma,because the colon could not be dissociated from the abdominal adhesion.Surgical treatment was abandoned in one case due to the extensive abdominal adhesion.Some supporting treatments including anti - infection, acid - suppression and enteral nutrition were given after surgical treatment.Results Three cases of remnant gastric transposition for esophageal replacement recovered rapidly without complications.Recovery was perfect in 2 cases of all 4 cases of colon interposition for esophageal replacement while postoperative complications occurred in the other two cases, including ankylenteron and lower alimentary tract hemorrhage in one case, and anastomotic fistula appeared on the fifth postoperative day in one case.Both were cured after given symptomatic and supporting treatment.Conclusion For patients with esophageal carcinoma after subtotal gastrectomy, colonic esophageal replacement is a usual surgical method.If the abdominal adhesion is extensive and serious, remnant gastric transposition for esophageal replacement should be chosen as a safe and effective method with less postoperative complications and better recovery.%目的 探讨胃大部切除术后食管癌患者手术治疗方式的选择.方法 自2006年1月至2010年6月,我院收治8例有胃大部切除术史的食管癌患者,对其治疗方法进行分析.食管癌切除,结肠代食管4例;3例腹腔粘连,结肠无法游离,将残胃连同脾脏及胰体尾移入胸腔,残胃代食管完成食管癌根治手术;1例腹腔广泛粘连无法分离放弃手术.术后给予抗感染、抑酸、空肠营养支持等处理.结果 3例残胃代食管手术后恢复快,无并发症;4例结肠代食管患者中,2例恢复良好,1例术后肠粘连梗阻并出现下消化道出血,1例术后第5天出现吻合口瘘,给予对症支持治疗后均治愈出院.结论 胃大部切除术后食管癌患者,结肠代食管是常见术式,腹腔粘连较重时,将残胃连同脾脏及胰体尾移入胸腔,在弓下或弓上与食管吻合,残胃代食管完成食管癌根治手术是一种安全、有效的手术方法,并发症少,术后恢复快.