【摘要】 目的:评价改良Ivor-Lewis手术对胸中段食管鳞癌的治疗效果。方法:对1997年1月～2001年1月间,改良Ivor-Lewis手术治疗的241例胸中段食管鳞癌患者回顾研究。应用Kaplan-Meier法计算生存率;Cox回归分析判定预后的危险因素。结果:围手术期内40例(16.6%)患者有并发症发生,死亡6例(2.5%)。整体5年生存率为31%。Ⅰ、ⅡA、ⅡB和Ⅲ期患者的5年生存率分别为72%、40%、16%和13%(P<0.001)。手术后辅助放疗的T3和N1患者肿瘤局部复发率为23.3%,未完成放疗者的局部复发率为41.3%(P<0.05)。Cox回归分析显示,N1(HR=2.074,P<0.01)和T3(HR=3.493,P<0.01)是独立的预后危险因素。结论:改良Ivor-Lewis手术无严重的手术后并发症。手术后辅助放疗可降低N1和T3患者的肿瘤局部复发率。患者的预后取决于T及N分期。该手术可以治愈多数T1N0M0和T2N0M0胸中段食管鳞癌患者,但是对于T3和N1患者,单纯手术的远期疗效欠佳。更多还原

【Abstract】 Objective: To examine the efficacy of the modified Ivor-Lewis esophagectomy for middle third thoracic esophageal cancer. Methods: Records were reviewed for a total of 241 patients with squamous cell carcinoma in the middle third of the thoracic esophagus who underwent Ivor-Lewis esophagectomy with two-field lymphadenectomy from 1997 through 2001. Survival rate was calculated using the Kaplan-Meier method. Cox regression analysis was performed to identify prognostic risk factors. Results: Peri-operative complications occurred in 40 patients (16.6%) and death occurred in 6 patients (2.5%). The overall 5-year survival rate was 31%, and the 5-year survival rate for patients with stage Ⅰ, stage ⅡA, stage ⅡB, and stage Ⅲ disease was 72%, 40%, 16% and 13%, respectively (P<0.001). Local recurrence rate (23.3%) was lower in patients with N1 or T3 disease receiving radiotherapy after surgery, compared to that (41.3%) in patients without radiotherapy (P<0.05). In Cox analysis positive lymph nodes (HR=2.074, P<0.01) and T3 tumors (HR=3.493, P<0.01) were prognostic risk factors. Conclusion: Ivor-Lewis esophagectomy for the middle third thoracic esophageal cancer is a safe surgical operation. Post-operative radiotherapy was helpful to control local recurrence. Long-term survival is T and N stage dependent. Most patients with T1N0M0 and T2N0M0 disease could be cured by this procedure, while poor results were associated with T3 and N1 stage disease.更多还原