根治性放疗后短期复发食管癌的手术治疗

Surgical procedure for recurrent esophageal carcinoma after curative radiotherapy

目的：探讨根治性放疗后短期复发食管癌的合理治疗。方法：回顾性分析21例食管癌放疗后短期复发患者（手术组）的手术情况，并与22例接受保守性治疗的患者（保守治疗组）进行比较。结果：手术组有20例（95．2％）完成了肿瘤切除，术后发生低氧血症15例，肺部感染2例，吻合口瘘1例。手术组术后1、3、5年生存率分别为71．4％、33．3％和14．3％。保守治疗组术后1年生存率为45．5％，与手术组比较差异无统计学意义（P〉0．05）；保守治疗组2年后无生存者，生存期2～17个月。肿瘤复发治疗后半年疗效满意度手术组为66．7％，明显高于保守治疗组的27．3％（P〈0．01）。结论：根治性放疗后短期复发食管癌的手术风险较大，手术难度增加，须仔细行围手术期准备，手术能给患者带来生存受益。

Objective： To explore a rational therapy for recurrent esophageal carcinoma after radical radiotherapy. Methods：The clinical data of 21 patients with esophageal carcinoma having received esophagectomy were analyzed and compared with those of 22 patients treated by conservative therapy. Results：Twenty cases in the surgery group（95.2% ） underwent esophagectomy. Postoperative hyoxemia occurred in 15 cases, anastomotic leakage in 1 case and pulmonary infection in 2 cases. The 1,3 and 5-year survival rate was 71.4% ,33.3% and 14.3% respectively in the surgery group,while the 1-year survival rate was 45.5% in the conservative treatment group, the difference was not significant （P 〉 0.05 ）, no one in the conservative treatment group survived after 2 years, and their survival duration was 2 - 17 months. The satisfaction degree half-year after the recurrence was 66.7% in the surgery group, which was significantly higher than the 27.3% in the conservative treatment group（ P 〈 0.01 ）. Conclusions：Surgery is of great risk for patients with recurrent esophageal carcinoma after curative radiotherapy, so attentive peril-operation preparation is essential. Operation may bring survival benefit to those patients.