食管癌和贲门癌的外科治疗

摘要

Objective　To understand the progress in surgical treatment of 12?970 patients with carcinoma of the esophagus and gastric cardiac during 1965-1998.　Methods　The patients were divided into A,B and C groups: 3?155 patients (group A) were treated surgically in the first 14 years, 5?952 patients (group B) in the next 10 years, and 3?863 patients (group C) in the last 10 years. The early stage lesions (Tis,T1) were assigned as a separate group. The results of these groups were compared.　Results　The resectability for esophageal and gastric cardiac carcinoma was 94.0% and 84.4% respectively, and the overall resectability was 91.3%. The resectability for group A,B,C and the early stage group was 82.1%,85.1%,90.2% and 100%, respectively. The overall operative mortality was 1.8%; it was 4.4% for group A, 1.6% for group B, and 0.5% for group C. The overall 5-year survival was 31.6%.The 5-year survival for group A,B,C and the early stage group was 27.0%, 29.1%, 32.0% and 92.6%, respectively. Among the 3 temporal groups, differences were observed in terms of lesion stage, location and size, surgery with or without combined therapy and postoperative complications. Conclusions Best results were achieved in the early cases, with a resectability of 100% and a 5-year survival of 92.6%. The indications for surgical treatment were extended with increased resectability and decreased mortality. Subtotal esophagectomy combined with cervical esophagogastrostomy was advocated as the procedure of first choice for esophageal carcinoma in attempt to diminish the chance of recurrence, and to achieve better outcomes by using combined therapy for patients with ≥stage Ⅲ lesion.%目的阐述1965～1998年外科治疗食管癌和贲门癌的进展情况，并总结其经验。方法将1965～1998年外科治疗的12?970例食管癌和贲门癌患者分3个阶段进行分析比较。1965～1979年手术患者3?155例为A组，1980～1990年5?952例为B组，1990～1998年3?863例为C组，早期癌(Tis，T1)单列计算。结果本组患者肿瘤总的切除率为91.3%，食管癌和贲门癌的切除率分别为94.0%和84.6%，其中食管癌患者A、B、C组及早期癌组切除率分别为86.6%、93.2%、95.8%和100.0%，贲门癌患者分别为82.1%、85.1%、90.2%和100.0%；总的手术病死率为1.8%，A、B、C组手术病死率分别为4.4%、1.6%和0.5%；总5年生存率为31.6%，A、B、C及早期癌组生存率分别为27.0%、29.1%、32.0%及92.6%。A、B、C 3组患者的病期、病变位置、病变大小、手术方法、综合治疗以及手术并发症均有显著不同。结论 (1)早期癌外科治疗效果最好，肿瘤手术切除率和患者5年生存率分别为100.0%和92.6%；(2)随着肿瘤诊治技术的不断提高，手术适应证逐渐扩大，手术切除率和患者5年生存率不断提高；(3)食管癌患者均应作食管次全切除颈部吻合术，这样可以减少肿瘤复发；(4)Ⅲ期以上病例行综合治疗可以取得较好的效果。