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自1977年5月～1995年12月,我们对44例食管癌根治性放疗后局部病变未控制或考虑复发的患者施行手术治疗,疗效满意.临床资料本组44例中,男性29例,女性15例;年龄为40～73岁,平均58岁.病变居胸上段24例,胸中段18例,胸下段2例.放疗剂量为60～70Gy.复发时间:病变未控制5例,2～8个月31例(70.5%),1～2年6例,4年1例10年1例.进流食困难者12例(27.3%),其中4例施行了食管狭窄扩张术;进半流或普食者32例.X线检查显示食管狭窄、僵硬、管壁尚光滑者23例,食管扭曲、溃疡、充盈缺损或有龛影者21例;病变长度≤5cm11例,>5～8cm29例(65.9%),>8cm4例.内镜检查32例中15例(46.9%)活检或刷片检查为癌,17例(53.1%)未发现癌细胞.手术方法和结果本组根治性切除38例,姑息性切除2例,单纯探查4例.总切除率为90.9%(40/44).左侧开胸17例,右脚、右颈、上腹正中三切口27例.弓上吻合7例,颈部吻合31例,胃咽吻合2例.术中切除受侵奇静脉9例,气管膜部损伤5例,切除部分心包3例,食管破裂5例,主动脉出血1例,奇静脉出血2例.术后并发颈部吻合口瘘6例(15%),支气管肺炎3例,左侧乳糜胸1例,喉返神经损伤2例.并发症发生率为27.3%,死于肺炎1例,死亡率为2.3%.本组40例切除标本中,无癌12例(30%),有癌28例(70%).病理证实转移淋巴结:锁骨上2例,食管旁1例,胃
From May 1977 to December 1995, we performed surgical treatment on 44 patients with uncontrolled or recurrent lesions after radical radiotherapy for esophageal cancer. The clinical data were satisfactory in this group of 44 males and 29 females. 15 cases; aged 40-73 years old, average 58 years old. The lesions were in the upper thoracic segment in 24 cases, 18 in the middle thoracic segment and 2 in the lower thoracic segment. The radiation dose was 60-70 Gy. The time of recurrence was: the lesion was not controlled in 5 cases, 2-8 31 cases (70.5%) in 1 month, 6 cases in 1 to 2 years, 4 cases in 1 year, 10 cases in 1 year, 12 cases (27.3%) suffering from dysentery, 4 cases of esophageal stenosis dilation; In the 32 cases of normal food, X-ray examination showed 23 cases of esophageal stricture, stiffness, smooth wall, 21 cases of esophageal distortion, ulcer, filling defect or shadowing; lesion length ≤ 5cm 11 cases,> 5 ~ 8cm 29 cases ( 65.9%),> 8cm4 cases. Endoscopic examination of the 32 cases (46.9%) of the 32 cases of biopsy or brush examination as cancer, 17 cases (53.1%) found no cancer cells. Surgical methods and results of this group of 38 cases of radical resection Palliative resection was performed in 2 cases, and 4 cases were simply probed. The total resection rate was 90.9% (40/44). There were 17 cases of left thoracotomy, and 27 cases of right middle, right neck and upper middle abdomen. There were 7 cases of bow anastomosis. , Neck anastomosis in 31 cases, Gastric-pharyngeal anastomosis in 2 cases. Intraoperative cut Injury veins in 9 cases, 5 in the tracheal membrane, 3 in the pericardium, 5 in the esophagus, 1 in the aorta, and 2 in the venous hemorrhage. Postoperative neck anastomotic leakage in 6 cases (15%) Three cases of bronchial pneumonia, 1 case of left chylothorax, and 2 cases of recurrent laryngeal nerve injury. The complication rate was 27.3%, 1 case died of pneumonia, and the mortality rate was 2.3%. In this group of 40 cases, no specimens were removed. 12 cases (30%) had cancer and 28 cases (70%) had cancer. Pathologically confirmed metastatic lymph nodes: 2 in supraclavicular region, 1 in esophagus, stomach