原发性食管腺癌的外科治疗

Surgical treatment of primary esophageal adenocarcinoma

目的总结原发性食管腺癌的临床生物学特征和外科治疗经验。方法回顾性分析1980—2000年间外科治疗的43例原发性食管腺癌患者的临床病理资料。结果 43例原发性食管腺癌占同期手术治疗的5638例食管癌的0.8%,均行左后外开胸食管胃部分切除、食管胃手工吻合术。肿瘤位于食管胸中段12例,胸下段31例。食管单纯腺癌14例,腺鳞(棘)癌29例。原发性食管腺癌的淋巴结转移率为65.1%,明显高于食管鳞癌的31.6%。食管腺癌的术后1、3、5年生存率分别为81.4%、46.5%和28.2%,低于食管鳞癌。结论原发性食管腺癌好发于食管下段,淋巴结转移率高,预后较食管鳞癌差。外科手术是其首选治疗方法,早诊断、早治疗以及肿瘤的根治性切除是改善预后的关键,合理的综合治疗有助于提高远期疗效。

Objective To summarize the surgical treatment and clinical biocbaracteristics of primary esophageal adenocareinoma （ PEAC ）. Methods Clinical data of 43 cases with PEAC who had undergone operation from February 1980 to December 2000 in Linzhou City Esophageal Tumor Hospital were retrospectively analyzed. Results Forty-three cases PEAC were reported in this study, which were 0. 8% out of 5638 cases pathologically confirmed esophageal carcinoma treated during this period. Twelve cases （27.9%） were in the middle 1/3 of esophagus, thirty-one cases （72. 1% ） in the lower 1/3, which were significantly different from esophageal squamous cell carcinoma （ESCC）. Fourteen cases were pure esophageal adenocarcinoma （32.6%）, twenty-nine cases were adenosquamous cell carcinoma and adenospina cell carcinoma （67. 4% ）. The ratio of lymph node metastasis of PEAC was higher than that of ESCC （65.1% vs. 31.6%, P 〈0.001）. The overall survival rates of 1, 3 and 5-year of PEAC were 81.4%, 46. 5% and 28.2% , respectively, which were lower than those of ESCC （89. 7% , 68.2% and 39. 4%, respectively ; Х^2 = 4. 846, P = 0. 028 ）. Conclusions Compared with ESCC, PEAC, mainly located in the inferior 1/3 of esophagus, is a malignant disease with higher frequency of lymph node metastasis and poor prognosis. Surgical resection should be the first choice of treatment. Early diagnosis and early treatment as well as curative operation could improve prognosis. The long-term survival may be increased by adjunct multi-modality treatment.