胃代食管术治疗下咽食管鳞状细胞癌的疗效分析

Gastric pull-up reconstruction after pharyngoesphagectomy for advanced hypopharyngeal or cervical esophageal squamous cell carcinoma

目的 分析胃代食管术在治疗下咽食管鳞状细胞癌（鳞癌）中的临床效果.方法 回顾性总结2006年6月-2015年6月在中国医学科学院北京协和医学院肿瘤医院头颈外科行全下咽食管切除胃代食管的90例下咽食管癌患者资料,分析患者治疗后的并发症、生存率、复发及转移率.结果 90例患者中有下咽癌8例,颈段食管癌51例,下咽食管多原发癌31例;采用单纯手术40例,计划性综合治疗29例,放化疗后挽救手术21例.中位随访22个月（6 ～ 104个月）后死亡54例,3年总生存率为36.3％,17例出现局部复发,10例出现颈部或纵隔淋巴结转移,无复发转移患者3年总生存率为45.7％,而复发的仅为5.9％（x2=11.564,P=0.001）;23例远处转移,无远处转移和远处转移患者的3年生存率分别为41.8％、22.9％（x2=4.534,P=0.033）.多因素分析显示局部复发和远处转移是预后的独立因素.围手术期死亡患者3例,病死率3.3％,吻合口瘘发生率为13.3％（12/90）.结论 胃代食管是治疗颈段食管癌、下咽食管多原发癌的主要外科手段,治疗后部分患者仍能获得长期生存,围手术期病死率及并发症发生率较既往明显降低,建议对符合适应证的患者进行积极的综合治疗.

Objective To analyze the clinical results of gastric pull-up reconstruction following total pharyngoesophagectomy.Methods A total of 90 patients with hypopharyngeal or cervical esophageal cancinoma who underwent gatric pull-up reconstruction after pharyngoesophagectomy between June 2006 and June 2015 were reviewed retrospectively.Clinical data were analyzed.Rates of survival,recurrence and complicates were calculated with SPSS software.Results Of 90 patients,8 patients had hypopharyngeal cancinoma invading cervical esophagus,51 patients had cervical esophageal carcinoma,and 31 patients had hypophageal and esophageal multiple parimary carcinomas.Forty patients were treated with surgery alone,29 patients with planned surgery,and 21 patients with salvage surgery.After follow up of 6-104 months with a median of 22 months,54 patients died and the total 3-year survival rate was 36.3%.Seventeen patients developed local recurrences and l0 patients cervical or mediastinal lymph node metastasis （LNM）.The 3-year survival rates of patients with and without recurrence or LNM were respectively 5.9%,and 45.7% （x2 =11.564,P =0.001）.Twenty-three patients developed distant metastasis.The 3-year survival rate of patients with and without distant metastasis were respectively 22.9% and 41.8% （x2 =4.534,P =0.033）.Multivariate analysis showed local recurrence and distant metastasis as predictors for poor survival.The rates of perioperative mortality and anastomotic fistula were 3.3% （3/90） and 13.3% （12/90）,respectively.Conclusions Gastric pull-up reconstruction is a relatively safe and effective method for esophageal reconstruction after removal of hypopharyngeal or cervical esophageal carcinoma.Some patients could achieve good survival with low mortality and acceptable morbidity after multidisciplinary treatments.