食管癌、贲门癌术后复发的再次手术

Reoperation for recurrent carcinoma of the esophagus and cardia

目的探讨食管癌、贲门癌手术后复发再手术的可能性及其适应证。方法作者总结了１９７９年至１９９６年的４４例食管癌、贲门癌术后复发患者进行再次手术的经验。男３６例，女８例，年龄４２～６８岁。食管癌术后２１例，贲门癌术后２３例。手术切除３４例，探查１０例。术后发生各类并发症７例次，发生率２０．５％，手术死亡２例，手术病死率５．８％。病理证实吻合口复发２６例，残留食管再发癌７例，癌残留食管床复发１例。淋巴结转移１５例，转移率４４．１％。结果术后生存５年以上４例，３年以上４例，２年以上３例，１年以上６例，１５例分别在１年及１年内死亡；探查者１０例分别于６～１３个月内死亡。结论对食管癌、贲门癌术后复发者，若病变未浸及动脉或气管，放疗后病变缩小，无远处转移，且心肺功能可以耐受手术者，都应积极再次手术。

Objective To review the experience of reoperation for recurrent carcinoma of the esophagus and cardia. Method Between 1979 and 1996, 44 patients with recurrent esophageal and cardiac cancer after the first operation underwent reoperation. Among them, 21 had esophageal cancer and 23 cardiac cancer. 36 patients were male and 8 female,with age ranged from 42 to 68 years. Result The resectability rate was 77 2 % (34/44) and the hospital mortality rate was 5 8 %. Postoperative complications occurred in 7 patients with a morbidity of 20 5 %. Pathologically, previous anastomotic relapse was seen in 26 patients,recurrent lesion of residual esophagus in 7,and recurrent cancerous residue at the esophageal bed in 1. 15 patients (44 %) showed lymph node metastasis. Follow up showed that 4 patients survived for 5 years, 4 for 3 years, and 3 for 2 years. 15 patients died within one year after reoperation. Conclusion The recurrence of esophageal and cardiac cancer after first operation is not a contraindication to reoperation,but careful preoperative assessment and patients′ selection should become an integral part of the evaluation of these patients.