食管癌和食管胃结合部癌术后复发与再发癌的手术疗效  

Efficacy of reoperations for relapsed and recurrent carcinoma of the esophagus and the esophagogastric junction

作　　者：刘俊峰[1] 王福顺[1] 曹富民[1] 姜涛[1] 石志华[1] 刘新波[1] 刘磊[1] 李保庆[1] 

机构地区：[1]河北医科大学第四医院胸外科,石家庄050011

出　　处：《中华消化外科杂志》2013年第10期779-782,共4页Chinese Journal of Digestive Surgery

基　　金：河北省科技适用课题追踪项目（GL200818）

摘　　要：目的探讨食管癌和食管胃结合部癌术后复发与再发癌的手术疗效。方法回顾性分析2002年4月至2012年10月河北医科大学第四医院收治的15例食管癌和食管胃结合部癌术后复发或再发癌患者的临床资料。12例复发癌患者确诊距第1次手术平均时间为28个月（8～66个月），3例再发癌患者确诊距第1次手术平均时间为196个月（60～288个月）。对吻合口局部复发患者，如果切除复发癌后残胃大小足够重建食管，则用残胃重建食管。复发癌切除后残余胃不足以重建食管或需同时进行全胃切除，则根据患者的身体状况采用结肠或空肠代食管。术后对所有患者每半年随访1次，随访时间截至患者死亡或2012年12月31日。术后2年内每半年进行1次胸腹部CT与上消化道造影检查，术后2年每年进行1次胸腹部CT与上消化道造影检查，对于可疑患者进行胃镜检查。根据患者第2次术后临床病理分期，采用Kaplan—Meier方法计算生存率，生存分析采用Log—rank检验。结果15例手术患者中，10例贲门腺癌术后吻合口复发患者，4例行复发癌切除±残胃与食管胸内吻合术，4例行结肠代食管术，2例行空肠代食管术；3例贲门腺癌术后再发食管鳞癌患者，2例行肿瘤切除±结肠代食管术，1例行食管下段癌与残胃切除＋食管空肠Roux—en—Y吻合术；2例食管癌术后吻合口复发患者，行复发癌切除±颈部食管胃吻合术。患者平均手术时间为460min（390～540min）；术中平均出血量为430ml（200～700ml）；术后发生ARDS、肺部感染、颈部切口感染各1例；死亡2例，其中1例为突发心肌梗死，另1例为术后出现顽固性低蛋白血症合并肺部感染死亡；平均住院时间为29．5d（25～36d）。15例再手术患者中，1a期1例、1b期1例、Ⅱa期4例、Ⅱb期4例、Ⅲa期5例。13例获得随访的患者中，6例I、Ⅱa期患者中位生存时间为25个月�Objective To investigate the efficacy of reoperations for relapsed and recurrent carcinoma of the esophagus and the esophagogastric junction. Methods The clinical data of 15 patients with relapsed and recurrent carcinoma of the esophagus and the esophagogastric junction who were surgically treated at the Fourth Hospital of Hehei Medical University from April 2002 to October 2012 were retrospectively analyzed. The mean duration between definite diagnosis and the first operation of the 12 patients with relapsed cancer was 28 months （range, 8-66 months） , and the mean duration between definite diagnosis and the first operation of the 3 patients with recurrent cancer was 196 months （range, 60-288 months）. For patients with relapsed cancer at anastomosis, the esophagus was reconstructed with residual stomach if the residual stomach was big enough, or the esophagus was reconstructed with colon or jejunum if the residual stomach was not big enough or the patients needed to receive total gastrectomy. All the patients were followed-up every half year via mail or phone call, and the follow up was ended till the death or December 31, 2012. Thoracoabdominal computed tomography （CT） and upper gastrointestinal imaging were carried out every half year within the first 2 years after operation and then once a year2 years after the operation. Gastroscopy was applied to suspected patients. Pathological staging was done based on the condition of patients after the secondary operation. The survival rate was calculated by Kaplan-Meier method, and the survival was analyzed using the Log-rank test. Results Of the 10 patients with relapsed cancer at anastomosis after gastroesophagectomy for carcinoma of the esophagogastric junction, 4 received resection of relapsed cancer ＋ intrathoracic anastomosis of the residual stomach and esophagus, 4 received esophageal replacement with the colon, 2 received esophageal replacement with the jejunum. Of the 3 patients with recurrent squamous cell carcinoma （SCC） after resection of c

关 键 词：食管肿瘤 食管胃结合部肿瘤 复发 治疗 

分 类 号：R735.1[医药卫生—肿瘤] R735.2[医药卫生—临床医学]