Lozac'h P, Topart P, Volant A, Perrament M, Gouerou H, Charles J F
Service de Chirurgie Générale et Digestive, CHU Morvan, Brest, France.
Ann Chir. 1992;46(10):912-8.
168 Ivor Lewis operations for squamous carcinoma of the lower esophagus are reviewed. 155 men and 13 women with a mean age of 59 years were operated on. 46 tumors were stage I and II, and 122 were stage III. Operations were considered to be curative for 120 patients and only palliative for 48. An esophagectomy associated with lymphadenectomy was performed through laparotomy and right thoracotomy. Feeding jejunostomy and pyloroplasty were routine. EEA or ILS 25 staplers were used to perform esophagogastric anastomosis and the gastroplasty tube was fashioned by TA 90 stapler. In every case an extended esophagectomy was performed with anastomosis between 3 ans 7 cm below the pharyngo-esophageal junction. Postoperative mortality was 4.7%. There were 10 leaks (6%) and 28 pulmonary complications. Median actuarial survival is 17 months. Actuarial survival at 2 years is significantly greater for stages I and II (68.4%) than for stage III (23.2%) (p < 0.01). Ivor Lewis esophagectomy is a reliable procedure to treat squamous carcinoma of the lower two thirds of the esophagus ensuring a good quality of life.
回顾了168例针对食管下段鳞状细胞癌的艾弗·刘易斯手术。接受手术的患者有155名男性和13名女性，平均年龄59岁。46例肿瘤为I期和II期，122例为III期。120例患者的手术被认为是根治性的，48例仅为姑息性的。通过剖腹术和右胸切开术进行食管切除术并伴有淋巴结清扫术。空肠造口管饲术和幽门成形术为常规操作。使用EEA或ILS 25吻合器进行食管胃吻合，并用TA 90吻合器制作胃成形管。每例均进行扩大食管切除术，吻合口位于咽食管交界处下方3至7厘米处。术后死亡率为4.7%。有10例漏口（6%）和28例肺部并发症。中位精算生存期为17个月。I期和II期患者2年精算生存率（68.4%）显著高于III期患者（23.2%）（p<0.01）。艾弗·刘易斯食管切除术是治疗食管下三分之二鳞状细胞癌的可靠方法，可确保良好的生活质量。
