食管癌和贲门癌术后复发或再发胸食管-胃癌与胸内消化道二次重建术  

Secondary reconstruction of thoracic digestive tract for relapsed or recurrent thoracic esophageal-gastric cancer after operation of esophageal and preventriculus cancer

作　　者：汪进益[1] 王光学[2] 陈国涵[1] 韩扬[2] 李钦传[1] WANG Jinyi;WANG Guangxue;CHEN Guohan;HAN Yang;LI Qinchuan(Department of Thoracic Surgery,East Hospital Affiliated to Tongji University,Shanghai,200120,P.R.China;Center for Translational Medicine,East Hospital Affiliated to Tongji University,Shanghai,200120,P.R.China)

机构地区：[1]同济大学附属东方医院胸外科,上海200120 [2]同济大学附属东方医院转化医学研究中心,上海200120

出　　处：《中国胸心血管外科临床杂志》2021年第9期1049-1053,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：上海市浦东新区科技发展基金民主科研专项(PKJ2017-Y21);上海市浦东新区卫生系统行业专项资助(PW2020E-5);国家自然科学基金资助项目(81773266)。

摘　　要：目的探讨食管癌和贲门癌术后复发或再发胸食管-胃癌(thoracic esophageal-gastric cancer,TEGC)的临床特点及胸内消化道二次重建术的安全性和有效性。方法回顾性分析2007年7月至2019年12月接受内镜复查的353例食管癌和贲门癌术后患者的临床资料。共发现31例(8.78%)术后复发或再发TEGC患者,其中男24例、女7例,平均年龄58.5(42~68)岁;其中腺癌18例(58.06%)、鳞状细胞癌13例(41.94%),且均接受了TEGC切除及胸内消化道二次重建术。随访胸腹部CT与上消化道造影检查,对于可疑患者进行胃镜检查;随访时间截至患者死亡或2019年12月30日。采用Kaplan-Meier方法计算生存率,生存分析采用log-rank检验。结果本组31例患者在接受了TEGC切除之后,再行胸内消化道二次重建术,其中残胃-食管胸内吻合术8例、结肠代食管术13例、空肠代食管术6例(其中食管-空肠Roux-en-Y吻合1例)、颈部食管-胃吻合术4例。患者平均手术时间为404.8(340~475)min;术中平均出血量为378.4(180~620)mL;术后并发症4例,其中肺部感染3例、颈部切口感染l例;术后平均住院时间为17.1(14~21)d。所有入组患者均获得随访,11例Ⅰ~ⅡA期患者中位生存时间为25(19.8~35.0)个月,20例ⅡB~ⅢA期患者中位生存时间为16(12.5~19.5)个月,两者差异有统计学意义(χ^(2)=7.8408,P<0.01)。结论食管癌和贲门癌术后存在复发或再发TEGC,多为异时胃癌或残留食管床肿瘤复发侵及胸胃壁所致,术后定期内镜复查是主要方法。对TEGC患者再手术进行胸内消化道二次重建术的治疗在技术上安全可行,可使患者生存获益。Objective To investigate the clinical characteristics of thoracic esophageal-gastric cancer(TEGC)and the safety and effectiveness of secondary reconstruction of thoracic and gastrointestinal tract after esophageal and preventriculus cancer(esophagogastric junction)surgery.Methods The clinical data of 353 patients with esophageal and preventriculus cancer who underwent endoscopic review from July 2007 to December 2019 were retrospectively analyzed.A total of 31(8.78%)patients with relapsed or recurrent TEGC were found,including 24 males and 7 females with a mean age of 58.5 years(range:42 to 68 years).There were 18(58.06%)patients of adenocarcinoma and 13(41.94%)squamous cell carcinoma.All patients underwent TEGC resection and secondary reconstruction of thoracic gastrointestinal tract.Thoracoabdominal computed tomography(CT)and upper gastrointestinal imaging(GI)were performed during followup,and gastroscopy was performed for suspected patients.All the patients were followed-up till death or December 30,2019.The survival rate was calculated by Kaplan-Meier method,and the survival was analyzed using the log-rank test.Results Thirty-one patients underwent thoracic esophagectomy and gastric cancer resection,and then reconstruction of the thoracic and gastrointestinal tract.Eight patients underwent residual gastroesophageal thoracic anastomosis,13 patients colon esophagectomy,6 patients jejunal esophagectomy(1 patient esophago-jejunal Roux-en-Y anastomosis),and 4 patients cervical esophagogastric anastomosis.The mean operation time and intraoperative blood loss were 404.8(340-475)min and 378.4(180-620)mL.The postoperative complications ocurred in 4 patients,including 3 patients of pulmonary infection and 1 patient of cervical incision infection.The mean hospital stay was 17.1(14-21)d.All patients were followed up,the median survival time of 11 patients in stageⅠ-ⅡA was 25(19.8-35.0)months and 20 patients in stageⅡB-ⅢA was 16(12.5-19.5)months.There was a significant difference between the two groups(χ^(2)=7.84

关 键 词：食管癌 贲门癌 胸食管-胃癌 胸内消化道二次重建术 手术 

分 类 号：R735.1[医药卫生—肿瘤]