带蒂结肠移植治疗有胃或食管手术史的食管癌患者的临床分析

Clinical analysis of pedicled colon transplantation in the treatment of esophageal cancer patients with a history of gastric or esophageal surgery

目的探讨带蒂结肠移植治疗有胃或食管手术史的食管癌患者再次手术治疗的可行性和临床结局。方法回顾性分析1992年3月—2018年3月北京同仁医院112例曾有食管、胃手术史再罹患食管癌患者接受结肠代食管术式的临床及病理资料,评估围术期并发症,采用Kaplan-Meier生存分析评估3年及5年生存率。采用Log-rank检验比较不同TNM分期食管癌患者生存曲线。结果术后30 d内并发症发生率为15.2%,死亡率为1.8%。全部患者术后3年及5年生存率分别为51.35%和23.53%。Ⅰ+ⅡA期患者生存率高于ⅡB+Ⅲ期患者(P=0.003)。结论对既往有食管或胃手术史的食管癌患者,可采用病变食管切除、结肠代食管或结肠代食管空肠代胃的手术治疗方式。

Objective To explore the feasibility and clinical outcome of pedicled colon transplantation in the treatment of esophageal cancer patients with a history of gastric or esophageal surgery.Methods A total of 112 esophageal cancer patients with a history of gastric or esophageal surgery in Beijing Tongren Hospital who underwent esophageal cancer resection and colon replacement surgery from March 1992 to March 2018 were collected.The perioperative complications and the postoperative quality of life was evaluated.Kaplan-Meier survival analysis was used to evaluate survival rates.The Log-rank test was used to compare the survival curves of patients in different TNM stages.Results The complication rate and the mortality rate within 30 days postoperation was 15.2%and 1.8%.The three year and five year survival rates of all patients were 51.35%and 23.53%,respectively.The survival rate of patients with stageⅠ+ⅡA was significantly higher than that of patients with stageⅡB+Ⅲ(P=0.003).Conclusion For patients with esophageal cancer with a history of esophagus or gastric surgery,diseased esophagectomy,colon instead of esophagus,or colon instead of esophagus and jejunum instead of stomach can be used for surgical treatment.