CAJ | 학술논문

目的总结手术治疗侵犯气管并需行喉全切除术的颈段或颈胸段食管癌的经验.方法回顾性分析2004-2011年手术治疗的侵犯气管并需行全喉切除、气管永久造口术的10例颈段或颈胸段食管癌患者的病例资料.根据气管受累情况将患者分为2组,病变仅累及颈段气管(简称颈组,5例),病变累及颈胸段气管(简称胸组,5例).胸组患者开胸切除病变,并行前纵隔气管造口术.对手术方式、术后并发症、术后病理、患者预后等进行分析.结果 10例患者术后随访6～76个月,中位随访时间23个月.颈组中3例患者已无瘤存活5年以上,2例死亡患者中1例于术后14个月死于局部复发,1例于术后26个月死于心肌梗死;胸组2例死于围手术期,术后存活的3例中1例于术后16个月死于局部复发,2例于术后6个月、20个月死于远处转移.结论侵犯气管并非颈段或颈胸段食管癌的手术禁忌证.对于只有颈段气管受累的患者,根治性手术效果良好,应积极手术治疗,术后应辅以放疗.对于胸段气管亦受累的病例,尤其是气管残端小于5 cm者,手术应慎重.
목적 총결수술치료침범기관병수행후전절제술적경단혹경흉단식관암적경험.방법 회고성분석2004-2011년수술치료적침범기관병수행전후절제、기관영구조구술적10례경단혹경흉단식관암환자적병례자료.근거기관수루정황장환자분위2조,병변부루급경단기관(간칭경조,5례),병변루급경흉단기관(간칭흉조,5례).흉조환자개흉절제병변,병행전종격기관조구술.대수술방식、술후병발증、술후병리、환자예후등진행분석.결과 10례환자술후수방6～76개월,중위수방시간23개월.경조중3례환자이무류존활5년이상,2례사망환자중1례우술후14개월사우국부복발,1례우술후26개월사우심기경사;흉조2례사우위수술기,술후존활적3례중1례우술후16개월사우국부복발,2례우술후6개월、20개월사우원처전이.결론 침범기관병비경단혹경흉단식관암적수술금기증.대우지유경단기관수루적환자,근치성수술효과량호,응적겁수술치료,술후응보이방료.대우흉단기관역수루적병례,우기시기관잔단소우5 cm자,수술응신중.
Objective To evaluate the surgical treatment and outcome of cervicothoracic esophageal carcinoma with tracheal.Methods Ten cases of cervicothoracic esophageal carcinoma with tracheal invasion underwent surgical treatment between 2004 and 2011 was reviewed.Operative methods,complications,pathology,and prognosis were analyzed.Results The patients were divided into 2 groups,5 patients with cervical tracheal invasion group and 5 patients with cervicothoracic tracheal invasion.Thoracotomy and anterior mediastinal tracheostomy (AMT) were required for 5 patients with cervicothoracic tracheal invasion.The median follow-up was 23 months (ranging from 6 to 76 months).Of 5 patients with cervical tracheal invasion,3 patients survived with free of disease for more than 5 years postoperatively,1 patient died of local recurrence at 14 months postoperatively,and 1 patient died of cardiac infarction at 26 months postoperatively.Among 5 patients with cervicothoracic tracheal invasion,2 patients died during hospitalization,and 1 patient died of local recurrence at 16 months postoperatively,and 2 patients died of distant metastasis at 6 and 20 months after surgery respectively.Conclusions Tracheal invasion is not a contraindication to radical operation for the cervicothoracic esophageal carcinoma.Surgical treatment has a good outcome in cervicothoracic esophageal carcinoma with only cervical tracheal invasion.If thoracic trachea is involved,especially when the length of the distal trachea is less than 5 cm,operation should be performed with caution.