胸外科讲课食管癌

Esophagealcancer

食管癌淮安市第一人民医院胸外科吴清泉流行病学Epidemiology*Distribution流行病学Epidemiology背景*定义*历史资料描述Surgicalresection1871

Billroth

Animalexperiment1877

Czerny

Esocancerresection1940

吴英恺

FirstoperationinChina危险因素吸烟和饮酒饮食因素潜在的食管疾病遗传因素

生物因素

食管癌饮食因素*亚硝氨基化合物

*维生素和微量元素缺乏*热的食物和饮料Return潜在的食管疾病*Barrett食管*失弛症*瘢痕性狭窄*憩室

*损伤

Return病理学Pathology解剖学Anatomy外观Appearance组织学分类Histologicalclassification分期TNMstaging浸润和转移InvasionandMetastasis解剖Anatomy胸廓入口食管裂孔气管分叉ReturnEsocancerlocation髓质型外观Appearance蕈伞型溃疡型缩窄型/硬化型Return组织学分类鳞状细胞癌腺癌其它Return侵袭和转移InvasionandMetastasis原发肿瘤区域淋巴结远处转移食管癌肺骨其他肝血液淋巴ReturnTNMStagingStagegroupTNM0TisN0M0ⅠT1N0M0ⅡAT2T3N0M0ⅡBT1T2N0M0ⅢT3T4N1AnyNM0ⅣAnyTAnyNM1ReturnTNMStaging胸骨后不适异物感无症状梗阻感呕吐胸背部疼痛体重减轻进行性吞咽困难声嘶Hornersyndrome恶液汁穿孔EarlystageProgressivestageAdvancedstage临床表现远处转移诊断Diagnosis病史和体格检查钡剂食管造影食管镜食管拉网脱落细胞学检查CTEUS(Esophagealultrasound)ReturnReturnReturn鉴别诊断DifferentialDiagnosis无吞咽困难Withoutdysphagia食管炎

食管憩室

食管静脉曲张

吞咽困难dysphagia贲门失弛缓症

腐蚀性狭窄

良性肿瘤

治疗Treatment外科手术放疗化疗其它外科干预手术切除姑息治疗

食管切除重建淋巴清扫旁路插管肠造口

胃造口resectableunresectableRLOperativeapproach*Thoracotomy*NothoracotomyLTLT+CRT+ARTRT+A+CInvert-strippingTranshiatalVideo-assitedAPC,EMRReturnReconstruction*Stomach*Jejunum*colonReturnLymphadenectomy*2-Field*3-FieldReturnTechniquerequiredMorecomplicationsBadlifequalityBypassReturnIntubationReturnGastrostomosisReturnComplications*出血Bleeding*感染Infection*乳糜胸Chylothorax*吻合口瘘anastomoticleakage放疗RadiotherapyPreoperativePostoperativeRadiotherap