食管癌术后胸胃复发癌的临床特点

The characteristics of thoracic stomach cancer after surgical treatment for esophageal carcinoma

背景与目的:食管癌术后复发是影响患者生存和生活质量的主要因素,本研究旨在探讨食管癌术后胸胃复发癌(thoracic stomach cancer,TSC)的临床特点。方法:对本院收治的51例食管癌患者术后TSC进行回顾性分析。结果:TSC占本院同时期内镜检查食管癌术后病例的10.97%(51/465);其中13例合并吻合口复发;46例(90.2%)TSC发生位置与术前食管癌位置相符;病理检查胃鳞癌48例,胃腺癌3例;内镜下表现分为隆起浸润型占39.2%(20/51),块状型占15.7%(8/51),溃疡型占7.8%(4/51),溃疡浸润型占33.3%(17/51),弥漫侵润型较少见,占胸胃癌的3.9%(2/51),此外尚有狭窄型等。结论:TSC在食管癌术后发病率相当高,病因多为留食管床肿瘤复发侵及胸胃壁;其内镜下类型和胃癌有一定差异;定期对食管癌术后患者行胃镜复查,是诊断TSC的主要方法。

Background and purpose： Postoperative recurrence of esophageal cancer is one of the main factors that affect the patients＇ prognosis and quality of life. This study mainly investigated the clinical features of thoracic stomach cancer （TSC） after surgical treatment for esophageal carcinoma. Methods： We retrospectively reviewed 51 cases of postoperative TSC in our hospital. Results： 10.97% of the cases with TSC were diagnosed by endoscopy. There were 13 cases who also had anastomotic recurrence. The locations of 46 cases （90.2%） in 51 patients were same as the primary cancer. 48 cases of them were squamous cell carcinoma and 3 cases were adenocarcinoma at the time of esophagectomy for esophageal carcinoma. Endoscopic manifestations were puffiness-infiltrating type 39.2%（20/51）, massive type 15.7%（8/51）, ulcerative type 7.8%（4/51） and ulcer-infiltrating type 33.3%（17/51） and diffuse infiltrating type 3.9（2/51）. Conclusion： The incidence of TSC after surgical treatment for esophageal carcinoma was high. The main cause was that the local residual cancer invaded the gastric wall. The gastroscopic features of TSC were different from gastric cancer. The follow up with endoscopy for the postoperative patients with esophageal carcinoma is a primary way to diagnose TSC.