Fujita H, Kakegawa T, Inoue Y, Yamana H, Shirouzu G, Minami T, Tai Y
First Department of Surgery, Kurume University School of Medicine, Japan.
Jpn J Surg. 1991 Nov;21(6):650-4. doi: 10.1007/BF02471050.
The choice remains controversial as to which surgical procedure should be selected for carcinomas situated in the esophagus at the cervicothoracic junction involving the trachea. After mediastinal tracheostomy associated with pharyngolaryngoesophagectomy and thoracic esophagectomy, numerous reports have previously described severe postoperative complications, such as tracheal necrosis and rupture of the great vessels in the neck. To prevent such complications, we have developed the procedure called "upper esophagectomy" followed by a free jejunal graft and mediastinal tracheostomy through either manuburectomy or upper median sternotomy. We have established that this procedure maintains the vascular networks between the trachea and the esophagus, avoids an occurrence of tracheal necrosis or great vessel bleeding postoperatively, and obtains an improved prognosis in the surgical treatment of esophageal carcinoma at the cervicothoracic junction.
对于位于颈胸交界处且累及气管的食管癌应选择何种手术方式，目前仍存在争议。在纵隔气管造口术联合咽喉食管切除术和胸段食管切除术后，此前已有大量报道描述了严重的术后并发症，如气管坏死和颈部大血管破裂。为预防此类并发症，我们开发了一种名为“上段食管切除术”的手术方法，随后进行游离空肠移植，并通过胸骨柄切除术或上正中胸骨切开术进行纵隔气管造口术。我们已经证实，该手术方法可维持气管与食管之间的血管网络，避免术后发生气管坏死或大血管出血，并在颈胸交界处食管癌的外科治疗中取得更好的预后。
