食管癌肉瘤22例临床病理分析

Clinicopathological analysis of esophageal carcinosarcoma：a report of 22 cases

目的探讨食管癌肉瘤（ECS）的临床病理特征和外科治疗方法。方法总结分析22例食管癌肉瘤患者的临床资料。结果本组患者术前均经食管吞钡及食管镜检查，仅有1例（4．5％）术前活检确诊为癌肉瘤。所有病例均经左胸行食管肿瘤切除，20例行主动脉弓上食管胃吻合术，2例行弓下吻合。全组病例均完成手术，无手术死亡及近、远期严重并发症。术后病检均为ECS，瘤体主要成分为肉瘤者14例，主要为癌组织者8例；12例侵及黏膜下层，10例侵达食管肌层，未见侵犯纤维膜者；淋巴结转移率18．2％（4／22）；T1N0M012例，T2N0M06例，T2N1M04例。全组患者1、3、5年生存率分别为90．9％（20／22）、77.3％（17／22）、68．2％（15／22）。结论食管癌肉瘤术前确诊率低。其侵袭性不强，淋巴转移发生率较低，手术切除是主要治疗手段。

Objective To evaluate the clinicopathological characteristics and surgical treatment of esophageal carcinosarcoma. Methods The patients with esophageal carcinosarcoma were divided into two types according to barium swallow： intraluminal carcinosarcoma （n=20） and fungating carcinosarcoma （n=2）. Only one esophageal carcinosarcoma case was diagnosed by esophagoscopic biopsy preoperatively. Twenty patients underwent left thoracic approach esophagectomy and esophagogastrostomy above aortic arch, and two patients underwent esophagectomy and esophagogastrostomy below aortic arch. Results All the cases-survived during operation and had no severe complication. Post-operative biopsy revealed that 21 cases had definite boundary between the carcinoma and the sarcoma. Only one case showed the invasion of carcinomatous tissues into sarcomatous tissues and mixed growth. Four cases had lymph node metastases （18.2%）. The 1-, 3- and 5-year survival rates were 90.9%（20/22）, 77.3% （17/22） and 68.2%（15/22） respectively. Conclusions Esophageal carcinosarcoma is a rare malignant tumor with little invasiveness, low lymph node metastasis, early clinical symptom occurrence, low preoperative accurate diagnostic rate and good prognosis. Surgical resection is the main treatment for esophageal carcinosarcoma.