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目的：研究非开胸食管内翻拔脱术治疗下咽癌、颈段食管癌疗效及术后胃肠营养的维持。方法：自１９８５年至１９９５年间，采用非开胸食管内翻拔脱术治疗下咽癌１６例，颈段食管癌３２例，术后病理均为鳞癌。其中，经食管床咽胃吻合术２５例，经胸骨后咽结肠吻合术２３例。采用高位空肠造瘘逆行插管行术后胃肠减压及维持胃肠营养。结果：术后并发症，咽胃吻合口瘘２例（８％），咽结肠吻合瘘４例（１７．４％），均治愈。喉返神经损伤３例（６．３％）。１例术后死于心肌梗塞。术后随访咽胃吻合１、３、５年生存率分别为８１．８％（１８／２２）、６１．１％（１１／１８）、４０．０％（６／１５），咽结肠吻合１、３、５年生存率分别为８０．０％（１６／２０）、６８．８％（１１／１６）、４１．７％（５／１２）。两组间无显著性差异（Ｐ＞０．０５）。结论：此术式无论采用咽胃吻合或咽结肠吻合，手术效果均满意。高位空肠造瘘逆行插管是术后胃肠减压及维持胃肠营养一种有效的新方法。
Objective: To study the efficacy of thoracic esophageal evacuation in the treatment of hypopharyngeal carcinoma and cervical esophageal carcinoma and the maintenance of postoperative gastrointestinal nutrition. Methods: From 1985 to 1995, 16 cases of hypopharyngeal carcinoma and 32 cases of cervical esophageal carcinoma were treated with open-loop esophagectomy and indirect extraction. The pathological changes were squamous cell carcinoma. Among them, transesophageal bed pharyngo-gastric anastomosis in 25 cases, transsternal resection of the pharynx in 23 cases. High-grade jejunostomy retrogradely intubates the gastrointestinal decompression and maintains gastrointestinal nutrition. RESULTS: Postoperative complications, 2 cases of pharyngeal anastomotic fistula (8%), and 4 cases (17.4%) of pharyngeal anastomotic spasm were cured. Recurrent laryngeal nerve injury in 3 cases (6.3%). One patient died of myocardial infarction after surgery. The 1-, 3-, and 5-year survival rates of pharyngeal anastomosis at follow-up were 81.8% (18/22), 61.1% (11/18), and 40.0% (6/15), respectively. The 3-year and 5-year survival rates were 80.0% (16/20), 68.8% (11/16), and 41.7% (5/12), respectively. There was no significant difference between the two groups (P>0.05). Conclusion: The surgical outcome of this surgical procedure was satisfactory regardless of pharyngeal anastomosis or pharyngeal colon anastomosis. High jejunostomy retrograde cannulation is an effective new method for postoperative gastrointestinal decompression and maintenance of gastrointestinal nutrition.