食管癌术中放疗30例疗效观察  

Intraoperative radiotherapy for 30 esophageal carcinoma patients

作　　者：严福来[1] 周星明[1] 陈奇勋[1] 江蓉轩[2] 方军[2] 连燕红[2] 郑晓[3] 陈秀勇[3] 朱远[3] 狄晓云[3] 王健[3] 

机构地区：[1]浙江省肿瘤医院胸腹外科,杭州310022 [2]浙江省肿瘤医院麻醉科,杭州310022 [3]浙江省肿瘤医院放疗科,杭州310022

出　　处：《中华肿瘤杂志》2003年第2期178-180,共3页Chinese Journal of Oncology

摘　　要：目的　观察食管癌手术切除加术中放疗的疗效 ,并对放射并发症及其预防进行探讨。方法　全组 6 0例均行食管胸段癌剖右胸切除术 ,其中 30例术中加一次性 15～ 2 5Gy的放疗 ;30例为单纯手术切除。结果　围手术期术中放疗组并发症有局限性肺部感染 2例 ,吻合区瘘 1例 ,切口感染1例 ,均治愈 ;单纯手术组有脓胸 1例 ,吻合口瘘 1例 ,均治愈。两组无围手术期死亡。术后 3年随访 ,术中放疗组死亡 3例 ,2例分别于术后 2年及 2年 2个月死于放射性肺炎 ,其中 1例合并支气管食管瘘 ;1例死于两肺广泛转移。 3年生存率放射组为 88.0 % (2 2 / 2 5 ) ,单纯手术组为 76 .0 % (19/ 2 5 )。结论　凡胸段食管癌病例 ,无胸部手术禁忌证、无远处转移者均适宜行术中放疗。术中放疗可降低局部复发率 ,但放射性肺炎较多见 ,治疗较难 ,预后不佳 ,故术中放疗时须特别注意保护健肺及支气管等 ,以减少或免受放射的伤害。Objective To analyze the complications and treatment results of intraoperative radiotherapy (IORT) for esophageal carcinoma. Methods Sixty patients with thoracic esophageal carcinoma underwent esophagectomy through right thoractomy, 30 patients of whom received IORT of 15 25 Gy. Results In patients who underwent IORT, 2 cases of pneumonitis, 1 case of anastomotic leak and 1 case of incisional wound infection were found. In patients underwent surgery only, 1 case of thoracic empyema and 1 case of anastomotic leak were found. All the complications ultimately healed. There was no operative mortality. During the follow up of 3 years, in patients who underwent IORT, 2 of 3 died of radiation pneumonitis 24 and 26 months after IORT with one complicated with bronchoesophageal fistula. One of 3 died of multiple lung metastases. The 3 year survival rate was 88.0% (22/25) in IORT group and 76.0% (19/25) in surgery only group. Conclusion Intraoperative radiotherapy can reduce locoregional recurrence if performed to thoracic esophageal carcinoma patients without surgical contraindication or distant metastasis. Radiation pneumonitis, a common complication difficult to manage, implies a poor prognosis and, consequently, the lung and bronchus should be protected from the radiation.

关 键 词：食管癌 切除手术 放射疗法 疗效 适应证 

分 类 号：R735.1[医药卫生—肿瘤]