胸段食管鳞状细胞癌伴发孤立性肝转移瘤手术治疗效果

Therapeutic effects of operative treatment for thoracic esophageal squamous cell carcinoma complicated with solitary hepatic metastasis

目的:比较手术和非手术治疗胸段食管鳞状细胞癌(ESCC)伴发孤立性肝转移瘤的疗效。方法:回顾性分析郑州大学第一附属医院39例胸段ESCC伴发孤立性肝转移瘤患者的临床资料。手术治疗包括Ivor-Lewis法和颈胸腹三切口手术;肝转移灶切除;术后辅助化疗。非手术治疗包括全身化疗;肝转移灶的局部治疗(射频消融、聚焦高强度超声消融和微波消融)。结果:手术治疗12例,非手术治疗27例。手术组中,3例行规则肝切除术,9例行不规则肝切除术;无手术相关死亡发生;3例发生术后并发症,均治愈。非手术组患者无治疗相关死亡及治疗相关严重并发症发生。随访时间4.0~58.0个月,两组Kaplan-Meier生存曲线比较,差异有统计学意义(P=0.044),手术组中位生存期明显长于非手术组(27.0个月vs 17.0个月)。结论:胸段ESCC伴发孤立性肝转移瘤的手术治疗效果优于非手术治疗。

:To compare the effects of operative and non-operative treatment for thoracic esophageal squamous cell carcinoma(ESCC)complicated with solitary hepatic metastasis.Methods:The clinical data of 39 patients with thoracic ESCC complicated with solitary hepatic metastasis in the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively.The operative treatment consisted of Ivor-Lewis method and neck-chest-abdomen three incisions,hepatectomy for removing hepatic metastases,and adjuvant chemotherapy after operation.Non-operative treatment included systemic chemotherapy and local treatment of liver metastases(radiofrequency ablation,focused high-intensity ultrasound ablation and microwave ablation).Results:Operative treatment was performed in 12 cases and non-operative treatment in 27 cases.In the operative treatment group,3 cases underwent regular hepatectomy,and 9 cases,irregular hepatectomy;no operation-related deaths occurred;3 cases had postoperative complications and were cured.No treatment-related death or serious treatment-related complications occurred in the non-operative treatment group.The follow-up time was 4.0-58.0 months.The Kaplan-Meier survival curve was significantly different between the two groups(P=0.044);the median survival time of the operative treatment group was significantly longer than that of the non-operative treatment group(27.0 months vs 17.0 months).Conclusion:The effects of operative treatment for thoracic ESCC complicated with solitary hepatic metastasis are better than those of non-operative treatment.