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目的：探讨胃切除术后食管癌（Ｅｃａ）的手术治疗方式和效果。方法：对１９８７年～１９９６年间手术治疗８１５例Ｅｃａ中４１例胃切除后Ｅｃａ的手术治疗进行分析。１例胸下段Ｅｃａ行切除并残胃食管弓下吻合术，４０例右胸入路行右半结肠代食管术合并颈、胸、腹淋巴结清除术。结果：４１例胃切除术后Ｅｃａ颈、上纵隔、中下纵隔和腹部淋巴转移率分别为３４．１％、２１．９％和１９．６％。并发症发生率４８．７％。颈部吻合口瘘发生率３４．１％，无手术死亡。全组３、５年生存率４１．６％和１５．４％。根治性手术３、５年生存率４６．６％和２２．２％。姑息手术无１例生存超过５年。３年生存率１４．３％。结论：对胃切除术后Ｅｃａ颈、上纵隔和腹部淋巴结清扫很重要。结肠代食管术为安全有效办法。右半结肠经胸骨前、后径路代食管术是胃切除后Ｅｃａ手术的最好方法之一
Objective: To investigate the surgical treatment and effect of esophageal carcinoma (Eca) after gastrectomy. METHODS: Surgical treatment of 41 cases of Eca after gastrectomy was performed in 815 cases of Eca from 1987 to 1996. One patient underwent thoracic Eca resection and residual gastroesophageal anastomosis. Forty right thoracic patients underwent transesophageal esophageal surgery combined with cervical, thoracic, and abdominal lymphadenectomy. RESULTS: The metastatic rates of Eca neck, upper mediastinum, mediastinum and abdomen were 41.1%, 21.9% and 19.6% respectively after gastrectomy. The incidence of complications was 48.7%. The incidence of anastomotic fistula in the neck was 34.1%, and no operative death occurred. The 3 and 5-year survival rates in the whole group were 41.6% and 15.4%. The 3-year and 5-year survival rates of radical surgery were 46.6% and 22.2%. No palliative surgery survived more than 5 years. The 3-year survival rate is 14.3%. Conclusions: It is important for Eca neck, upper mediastinum, and abdominal lymph node dissection after gastrectomy. Colonic esophagectomy is a safe and effective method. Transplantation of the right hemi- colon via the anterior and posterior approaches of the sternum is one of the best methods for Eca surgery after gastrectomy