Dudhat S B, Shinde S R
Department of Surgery, Tata Memorial Hospital, Parel, Mumbai, India.
Dis Esophagus. 1998 Oct;11(4):226-30. doi: 10.1093/dote/11.4.226.
Eighty patients underwent transhiatal esophagectomy for squamous cell carcinoma of the esophagus. Dysphagia for solids was the presenting symptom in 90% of the patients. The standard technique of transhiatal esophagectomy was used and cervical anastomosis were hand sewn. The average operative time and blood loss were 190 min and 350 cc respectively. The 30 day mortality rate was 7.5% (six patients). Major respiratory complications were observed in 15 (18.7%) patients. Anastomotic leak rate was 10% (eight patients). The incidence of recurrent laryngeal nerve injury was 6.2% (five patients). The average hospital stay was 14 days. Four patients had stage I, 30 had stage II and 46 had stage III disease. Forty-nine patients (60%) had lymph node involvement. The overall actual survival at 2 years was 55% and at 5 years was 37%. Of the operative survivors, 87% patients resumed normal swallowing and 10 patients (13.5%) required dilatation for anastomotic stricture. Transhiatal esophagectomy can be performed with low operative mortality, acceptable morbidity and offers good long-term functional results without compromising the survival of patients.
80例患者因食管鳞状细胞癌接受经胸食管切除术。90%的患者以固体食物吞咽困难为首发症状。采用经胸食管切除术的标准技术，颈部吻合口采用手工缝合。平均手术时间和失血量分别为190分钟和350毫升。30天死亡率为7.5%（6例患者）。15例（18.7%）患者出现主要呼吸并发症。吻合口漏发生率为10%（8例患者）。喉返神经损伤发生率为6.2%（5例患者）。平均住院时间为14天。4例患者为I期，30例为II期，46例为III期疾病。49例患者（60%）有淋巴结受累。2年总体实际生存率为55%，5年为37%。手术存活患者中，87%恢复正常吞咽，10例患者（13.5%）因吻合口狭窄需要扩张。经胸食管切除术可在低手术死亡率、可接受的发病率下进行，并能提供良好的长期功能结果，而不影响患者的生存。
