Zou Ji-Hua, Liang Xiang, Duan De-Pu
Department of Cardiovascular Surgery, No. 455 Hospital of PLA, Shanghai, 200052, P. R. China.
Ai Zheng. 2008 Feb;27(2):174-7.
BACKGROUND & OBJECTIVE: Perforation in esophageal carcinoma usually occurs at late stage, and is often accompanied with thoracic infections. Conventional conservative treatments, including parenteral nutritional support and stent placement under the endoscope, can neither eliminate the carcinoma nor control the infection completely. The mortality soon after perforation is fairly high. This study was to investigate the ideal operation patterns and perioperative treatment of perforation in esophageal carcinoma.
A total of 41 patients with esophageal carcinoma perforated the right lung (19 cases), the mediastinum (17 cases) and the trachea (5 cases) were treated with operations: 39 underwent open thoracic operation, and 2 only underwent palliative gastric ostomy. Of the 39 patients, 16 received operation through the right thoracic approach with 3 incisions, and 23 received staging operation; 35 received retrosternal substitution of esophagus with stomach or colon, 4 underwent substitution of the esophagus with stomach via the esophageal bed.
The operations were success in 36 cases. The patients could eat and take care of themselves. The patients were followed up for 3-72 months after operation: 2 survived for 3 months, 31 survived for 6-12 months, 2 survived for 24 months, and 1 survived for 72 months; 2 died during operation and 3 dead in 1 month after discharge. Of the latter 3 patients, 2 had underwent palliative gastric ostomy, 1 had stoma tracheal fistula recanalization.
The surgical treatment of perforation in esophageal carcinoma could improve the survival rate and life quality of the patients. We suggest to perform retrosternal replacement of esophagus with stomach or colon through the right thoracic approach with 3 incisions or staging operations for the patients with perforation in carcinoma.
食管癌穿孔多发生于晚期，常伴有胸腔感染。传统保守治疗，包括肠外营养支持及内镜下支架置入，既不能消除肿瘤，也不能完全控制感染。穿孔后死亡率相当高。本研究旨在探讨食管癌穿孔的理想手术方式及围手术期治疗。
对41例食管癌穿破右肺（19例）、纵隔（17例）和气管（5例）的患者进行手术治疗：39例行开胸手术，2例仅行姑息性胃造口术。39例患者中，16例经右胸三切口手术，23例行分期手术；35例行胸骨后胃或结肠代食管术，4例行经食管床胃代食管术。
手术成功36例。患者术后能进食并自理。术后随访3 - 72个月：2例存活3个月，31例存活6 - 12个月，2例存活24个月，1例存活72个月；2例术中死亡，3例出院后1个月内死亡。后3例患者中，2例行姑息性胃造口术，1例气管造瘘再通。
食管癌穿孔的手术治疗可提高患者生存率及生活质量。我们建议对食管癌穿孔患者采用经右胸三切口或分期手术行胸骨后胃或结肠代食管术。
