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高位食管癌切除颈部吻合并发症发生率较高,我们为了探索颈部吻合并发症与手术有关因素及其防治措施,对本院1975～1996年收治的163例高位食管癌患者,实施癌切除,术后发生并发症共59例,报告如下。 1 临床资料 1.1 一般资料:本组男114例,女49例(2.3∶1),年龄29～66岁,平均49.9岁。依照UICC(1987)的食管癌分段和分期标准,颈段4例,胸上段103例,高位胸中段56例。 1.2 术前快速放疗102例,其中胸上段50例,高位胸中段52例。5天为一疗程,每日放疗2次,上、下午各1次,中间相隔6小时以上,每次剂量250cGy。一疗程总剂量为2500cGy。结束放疗1周后开胸探查。 1.3 手术径路分为三组:Ⅰ组左颈、左胸后外侧二切口114例;Ⅱ组右颈、右胸前外侧、上腹正中三切门17例;Ⅲ组左颈、上腹正中二切口,行食管内翻拔脱术32例。 1.4 术后并发症情况见表1:
The incidence of complications of neck anastomosis in high esophageal cancer resection was higher. We sought cancer resection in 163 patients with high esophageal cancer admitted to our hospital from 1975 to 1996 in order to explore the complications of neck anastomosis and related surgical factors and prevention measures. A total of 59 postoperative complications were reported as follows. 1 Clinical data 1.1 General information: This group of 114 males and 49 females (2.3:1), aged 29 to 66 years, mean 49.9 years old. According to UICC (1987) criteria for esophageal cancer segmentation and staging, there were 4 cases in the cervical segment, 103 in the upper thoracic segment, and 56 in the upper midthoracic segment. 1.2 Preoperative rapid radiation therapy in 102 cases, including 50 cases of upper thoracic and 52 cases of high chest. 5 days for a course of treatment, 2 times a day of radiotherapy, 1 in the afternoon, 1 hour in the middle, separated by more than 6 hours, each dose of 250cGy. The total dose for one course of treatment is 2500 cGy. One week after the end of radiotherapy, open the chest and explore. 1.3 The surgical route was divided into three groups: 114 cases of left neck and left posterior lateral two incisions in group I; 17 cases of right neck, right thorax anterolateral, and upper mid-abdomen in group II; III group of left neck and upper middle abdomen Incision, esophageal varus pull out surgery in 32 cases. 1.4 Postoperative complications are shown in Table 1: