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目的 应用右胸腹二切口治疗中、下段食管癌。方法 自 1992年 12月至 1999年 6月 ,应用上腹、右胸二切口治疗中、下段食管癌 87例。全组病人均行食管钡餐检查 ,病变上缘均位于距门齿 2 8cm以下、长 2～ 9cm。先平卧位上腹正中切口开腹 ,游离胃大小网膜 ,清扫腹腔淋巴结。扩大膈食管裂孔 ,行幽门成形。改左侧卧位 ,右后外侧切口 ,经第五肋进胸。游离胸腔食管。结扎、切断奇静脉弓。整块切除食管周围组织 ,距胸顶 3cm处切断上端食管 ,在贲门处切断下端食管 ,封闭贲门。清扫纵隔淋巴结。低位结扎胸导管 ,食管 胃右胸顶吻合。结果 87例中 1例术后病理残端阳性。 1例术后 2 4小时发生ARDS经呼吸机辅助呼吸等辅助治疗治愈。 1例术后 72小时出现急性心肌梗塞经抢救治愈。全组无手术死亡。无吻合口瘘、狭窄及胃食管返流。结论 上腹 右胸二切口适于中、下断食管癌的手术治疗。
Objective To apply the right thoracotomy in the middle and lower esophageal cancer. Methods From December 1992 to June 1999, 87 cases of middle and lower esophageal cancer were treated with two incisions of the upper abdomen and right breast. All patients underwent esophageal barium meal examination, the lesions are located at the edge of the incisors below 2 8cm, length 2 ~ 9cm. The first supine median abdominal incision laparotomy, free stomach size omentum, abdominal lymph node dissection. Expand the diaphragm esophageal hiatus, line pylorus forming. Change the left lateral position, the right posterolateral incision, the fifth rib into the chest. Free chest esophagus. Ligation, cut off the azygos bow. The entire resection of esophageal tissue, cut off from the top of the esophagus 3cm at the esophagus, the cardia at the bottom of the esophagus, closed cardia. Clean mediastinal lymph nodes. Low ligation thoracic duct, esophageal right chest anastomosis. Results One of 87 cases was positive after operation. A case of ARDS after 24 hours of operation was treated with ventilator assisted breathing and other adjuvant therapy. A case of acute myocardial infarction 72 hours after the rescue and cure. The whole group died without surgery. No anastomotic leakage, stenosis and gastroesophageal reflux. Conclusion The upper abdomen right chest two incision is suitable for middle and lower esophageal cancer surgery.