摘要
目的探讨食管癌根治性放疗后再度吞咽困难的诊断与治疗。方法回顾性总结4l例食管癌根治性放疗后再度吞咽困难患者的诊疗经过;分析症状再发的原因、探讨诊断依据及治疗方法。结果本组选择手术治疗,切除率97%,手术死亡率4.8%,手术并发症发生率29%,术后1、3、5年生存率分别为72.7%、36.3%、18.1%,术后病理为放疗反应Ⅲ级者13.2%,鳞癌82.8%。结论食管癌放疗后再度吞咽困难者多为放疗未控/病变复发,少数为重度放疗反应;术前检查有时难以区别恶性病变与放疗后狭窄。部分局部无癌的狭窄有区域淋巴结的转移癌。对复发病变及放疗后的高度狭窄,只要无明显的手术禁忌证就应积极手术治疗;术中所见以瘢痕为主,解剖有一定困难。
Objective To investigate the diagnosis and treatment of recurrent dysphagia of esophageal carcinoma after radical radiotherapy.Methods The experince of 41 cases with recurrent dysphagia of esophageal carcinoma after radical radiotherpy were retrospectively summerized.Results All of the cases were surgically treated from July,1989 to May,1997 with aresectability rate of in 97%,operative mortality of 4.8% and postoperative morbidity of 29%.Pathological examination showed squamous cell carcinoma in 82.8%,and serious radiation reaction in 13.2% after operation.The 1,3,5year survival rates after operation were 72.7%、36.3%,18.1% respectively.Conclusion Most of recurrent dysphagia for these cases were due to uncontrolled/recurrent cancer.A small portion of them was due to constriction after radiotherpy.It is difficult to distinguish cancer from Severe benigh constriction before operation.Some cases had lymphatic metastasis Without local cancer.For those patients with recurrent disphagia,operation should be performed as early as possible.
