【摘要】 <正> 自1953～1973年,北京医学院附属第一医院与附属人民医院胸外科共收治食管癌和贲门癌患者1654例,其中手术切除1025例。本文总结手术切除治疗的远期疗效及其影响因素。 手术治疗 食管癌共1O79例,男女之比为3.1:1,病史平均为4.2个月。818例进行了手术探查术(818/1079,75.8％),切除664例(664/818,更多还原

【Abstract】 During a 21year period from 1953 to 1973 inclusive, 1079 esophageal cancer patients& 575 patients with carcinoma of cardia of the stomach were admitted to our hospitals. In the esophageal group 818 patients underwent exploratory thoracotomy and the lesionwas resected in 664. The resection was radical in 575, carrying an operative mortality of5.6% (32 patients). The follow up rate was 98. 4%. The 5- 10- 15- and 20-year survival rates after radical resection were shown in the accompanying table. Factors influencing theprognosis after surgery were: 1) regional lymph node metastasis when the nodes were nega-tive for metastasis, the 5-year and 10--year survival rates were 47.9% (146/305 patients)and 33.9% (87/257) respectively. In those with positive nodes the 5-year and 10-year survi-val rates were only 6.3% (13/208) and 5.0% (9/180). 2) location of the tumor theupper third tumor carried the most unfavourable survival rate, while the lower third thebest. The same is true even when the regional lymph node is negative for metastasis. In agroup of 305 patients with negative nodes the 5-year survival rate for the upper thirdtumor was 18.8% (3/16), the middle third 43.8% (81/185) and the lower third 59.6%(62/104).3) the depth of tumor infiltration into the esophageal wall in cases with negativenodes the 5--year and 10--year survival rates of patients with tumor extended to the ex-terior of the esophageal wall were 11.8% & 13.3%. When the tumor was still confinedin the esophageal wall the 5- and 10- year survival rates were 48.6% (135/278) and 33.5%(78/233) respectively. However, when the regional lymph node was positive for metastasisthere was no significant difference in the survival rates, no matter, whether the tumor wasstill confined within the esophagus or not. 162 patients survived more than five years after radical resection of esophageal cancer.There were 82 deaths thereafter. Five died of recurrence of the disease. Two patients diedof a second primary esophageal cancer of the upper third more than 13 years after radicalresection of a lower third tumor. Eight patients died of other malignancies. 52 died of inter-current dieases, mostly cardiovascular. 15 died of unknown causes. In the present series of575 patients, 413 died within 5 years after radical resection. The causes of death were regis-tered in 307, including post-operative deaths. 244 died of recurrence of the tumor, and inthe vast majority the recurrence was in the thoracic cavity, especially in the mediastinum.It is suggested that pre-operative irradiation might increase the survival rate after surgery. In the group of 575 cases of carcinoma of cardia of the stomach, exploratory operationwas performed in 488. The lesion was resected in 361, and in 300 the resection was radical.The operative mortality rate of these 300 patients was 3.3%, and the survival rates wereshown in the accompanying table. Both the resectability rate and survival rates are lowerthan those of esophageal cancer. Survival Rates after Surgical Resection for Carcinoma of Esophagus andCardia of Stomach Percentage (No. of survival/No. resected)更多还原