【摘要】 目的:探讨胸段食管癌三野根治术后预防性放射治疗的必要性。方法:将我院1993年1月3日～1999年12月31日行颈、胸和腹三野淋巴结联合根治术后的患者143例,用配对法分为单纯手术组(73例)和术后放疗组(70例)。手术方法:所有患者均行经右胸食管次全切除术+颈胸腹三野淋巴结清除根治术及胃管代食管左颈部吻合术。放疗方法:术后放疗的范围包括双侧锁骨上区、中上纵隔淋巴引流区、吻合口以及原食管瘤床,形成“T”型照射野,手术后3～4周开始放疗,中位总剂量54Gy/27次,2Gy/次,5次/周。结果:单纯手术组和术后放疗组有淋巴结转移患者的5年生存率分别为23.6%和43.9%,χ2=7.066,P=0.014;无淋巴结转移的5年生存率分别为67.3%和68.9%,χ2=0.034,P=0.524。两组局部淋巴结转移复发率分别为41.1%(30/73)和15.7%(11/70),χ2=11.527,P=0.001;血行转移率分别为19.2%(14/73)和17.1%(12/70),χ2=0.099,P=0.752。结论:胸段食管癌三野术后预防性放射治疗对无淋巴结转移患者效果不明显,对有淋巴转移患者可提高生存率,降低淋巴结转移复发率。更多还原

【Abstract】 OBJECTIVE:To investigate the essentiality of prophylactic postoperative radiotherapy for the patients with three field lymphadenectomy in thoracic carcinoma of esophagus. METHODS: The 143 patients, who were in our hospital from 1993.1.3 to 1999.12.31,with three field lymphadenectomy in thoracic carcinoma of esophagus were divided into 2 groups by the pairing method,which included a surgery group alone (73 cases) and a surgery plus radiotherapy group (70 cases). The operative method:All the patients were treated with subtotal resection of esophagus through right thorax plus three field lymphadenectomy, gastroesophago stomy at cervical part. The radiotherapeutic method: The area of postoperative radiotherapy included bilateral supraclavicular region, lymphoid draining region for mediastinum medium and mediastinum superior, stoma, and proesophageal tumor bed. The radiotherapy began at the third week or fourth week after operation.The exposure field was formed by “T”.The median total dose was 54 Gy/27f (2 Gy/f, 5 f/W). The 5-year survival rates of the two groups were 23.6% and 43.9% (χ2=7.066,P=0.014) of the patients who had lymphoid metastasis, 67.3% and 68.9% (χ2=0.034,P=0.524) of no metastasis. The recurrence rates of regional nodal metastasis were 41.1%(30/73) and 15.7%(11/70) (χ2=11.527,P=0.001), respectively. The hematogenous metastasis rates were 19.2%(14/73),17.1%(12/70) (χ2=0.099,P=0.752).CONCLUSIONS: Prophylactic postoperative radiotherapy is not effective for the patients who have no lymphoid metastasis, but it could raise the survival rate of the patients with lymphoid metastasis and degrade the recurrence rate of lymphoid metastasis.更多还原