【摘要】 目的　阐述 196 5～ 1998年外科治疗食管癌和贲门癌的进展情况 ,并总结其经验。　方法　将 196 5～ 1998年外科治疗的 12 970例食管癌和贲门癌患者分 3个阶段进行分析比较。 196 5～1979年手术患者 315 5例为A组 ,1980～ 1990年 5 95 2例为B组 ,1990～ 1998年 386 3例为C组 ,早期癌(Tis,T1)单列计算。　结果　本组患者肿瘤总的切除率为 91 3% ,食管癌和贲门癌的切除率分别为94 0 %和 84 6 % ,其中食管癌患者A、B、C组及早期癌组切除率分别为 86 6 %、93 2 %、95 8%和10 0 0 % ,贲门癌患者分别为 82 1%、85 1%、90 2 %和 10 0 0 % ;总的手术病死率为 1 8% ,A、B、C组手术病死率分别为 4 4%、1 6 %和 0 5 % ;总 5年生存率为 31 6 % ,A、B、C及早期癌组生存率分别为2 7 0 %、2 9 1%、32 0 %及 92 6 %。A、B、C 3组患者的病期、病变位置、病变大小、手术方法、综合治疗以及手术并发症均有显著不同。　结论　 (1)早期癌外科治疗效果最好 ,肿瘤手术切除率和患者 5年生存率分别为 10 0 0 %和 92 6 % ;(2 )随着肿瘤诊治技术的不断提高 ,手术适应证逐渐扩大 ,手术切除率和患者 5年生存率不断提高 ;(3)食管癌患者均应作食管次全切除颈部吻合术 ,这样可以减少肿瘤复发 ;(4 )Ⅲ期以上病例行综合治疗可以更多还原

【Abstract】 Objective[WT5”BZ] To understand the progress in surgical treatment of 12?970 patients with carcinoma of the esophagus and gastric cardiac during 1965 1998. [WT5”HZ]Methods[WT5”BZ] The patients were divided into A,B and C groups: 3?155 patients (group A) were treated surgically in the first 14 years, 5?952 patients (group B) in the next 10 years, and 3?863 patients (group C) in the last 10 years. The early stage lesions (Tis,T1) were assigned as a separate group. The results of these groups were compared. [WT5”HZ]Results[WT5”BZ] The resectability for esophageal and gastric cardiac carcinoma was 94 0% and 84 4% respectively, and the overall resectability was 91 3%. The resectability for group A,B,C and the early stage group was 82 1%,85 1%,90 2% and 100%, respectively. The overall operative mortality was 1 8%; it was 4 4% for group A, 1 6% for group B, and 0 5% for group C. The overall 5 year survival was 31 6%.The 5 year survival for group A,B,C and the early stage group was 27 0%, 29 1%, 32 0% and 92 6%, respectively. Among the 3 temporal groups, differences were observed in terms of lesion stage, location and size, surgery with or without combined therapy and postoperative complications. [WT5”HZ]Conclusions[WT5”BZ] Best results were achieved in the early cases, with a resectability of 100% and a 5 year survival of 92 6%. The indications for surgical treatment were extended with increased resectability and decreased mortality. Subtotal esophagectomy combined with cervical esophagogastrostomy was advocated as the procedure of first choice for esophageal carcinoma in attempt to diminish the chance of recurrence, and to achieve better outcomes by using combined therapy for patients with ≥stage Ⅲ lesion.更多还原