分期手术治疗食管恶性肿瘤70例临床分析  

Clinical analysis of 70 cases of staged surgery for complex esophageal malignancies

作　　者：陈春基 章宏 华荣 李斌[1] 李志刚 郭旭峰[1] Chen Chunji;Zhang Hong;Hua Rong;Li Bin;Li Zhigang;Guo Xufeng(Department of Thoracic Surgery,Shanghai Chest Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200030,China)

机构地区：[1]上海市胸科医院上海交通大学医学院附属胸科医院胸外科,上海200030

出　　处：《中华外科杂志》2024年第11期1032-1037,共6页Chinese Journal of Surgery

摘　　要：目的:探讨分期手术治疗食管恶性肿瘤的围手术期安全性和预后情况。方法:本研究为回顾性病例系列研究。回顾性分析上海交通大学医学院附属胸科医院胸外科2015年1月至2023年1月收治的接受食管恶性肿瘤分期手术的70例患者的临床资料。男性58例,女性12例,年龄[M(IQR)]61(22)岁(范围:9~79岁),65岁以上的比例为51.4%(36/70)。患者均接受一期手术切除食管肿瘤及二期手术完成消化道重建。总结分期手术原因,记录并发症及其处理结果。利用Kaplan-Meier曲线分析预后情况。结果:分期手术间隔时间为49(35)d(范围:32~82 d)。随访时间为28(50)个月(范围:1~69个月)。患者一期手术后30 d内病死率为4.3%(3/70),二期手术后30 d内病死率为0(0/63)。一期手术总体并发症发生率为55.7%(39/70),呼吸系统并发症发生率为10.0%(7/70),心血管系统并发症发生率为5.7%(4/70)。二期手术吻合口瘘发生率为11.1%(7/63)。患者术后2、3、5年的总体生存率分别为35.7%、30.0%、15.7%。结论:食管恶性肿瘤分期手术是可行的,效果较为满意。Objective To investigate the perioperative safety and survival benefits of two-stage operation in the treatment of esophageal malignancies.Methods This is a retrospective case series study.The clinical data of 70 patients who underwent two-stage operation for esophageal malignancies from January 2015 to January 2023 in the Department of Thoracic Surgery,Shanghai Chest Hospital,Shanghai Jiao Tong University School of Medicine were retrospectively analyzed.There were 58 males and 12 females.The age(M(IQR))was 61(22)years(range:9 to 79 years),and 51.4%(36/70)of the patients were older than 65 years.All patients underwent the first operation to remove esophageal tumor and the second operation to complete digestive tract reconstruction.The reasons for two-stage operation were summarized,complications and treatment results were recorded,and the prognosis was calculated using Kaplan-Meier curve.Results The interval between the two stages was 49(35)days(range:32 to 82 days).The follow-up perrod was 28(50)months(range:1 to 69 months).The 30-day fatality rate after the first operation was 4.3%(3/70)and the 30-day fatality rate after the second operation was 0(0/63).The total complication rate of first operation was 55.7%(39/70),the respiratory complication rate was 10.0%(7/70)and the cardiovascular complication rate was 5.7%(4/70)The incidence of anastomotic leakage was 11.1%(9/63).The overall survival rate at 2,3 and 5 years was 35.7%,30.0%and 15.7%,respectively.Conclusion Two-stage operation in the treatment of complex esophageal malignancies is feasible and yields satisfaetory results.

关 键 词：食管肿瘤 食管切除术 分期手术 并发症 生存 

分 类 号：R735.1[医药卫生—肿瘤]