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目的通过分析食管多原发癌的临床病理特征及预后,探讨食管多原发癌的诊断和治疗措施。方法回顾性收集自2000年10月至2008年1月经右胸行En-bloc切除的食管多原发癌患者的临床病理资料和随访结果,分析食管多原发癌的临床病理特点及预后,并结合国内外近年来相关文献,对其诊断和治疗措施进行讨论。结果食管多发癌的发生率为9.6%。8例患者皆为男性,7例吸烟大于20包/d×年,4例嗜酒。病理皆为鳞癌。主癌灶多累及食管全层,次癌灶多为原位癌,部分病例伴有上皮不典型增生。全部患者接受食管癌En-bloc切除及胃食管左颈吻合术。1,3年生存率分别为62.5%和12.5%,中位生存期13个月。结论食管多原发癌的发生是区域癌化的结果;采用Lugol碘液染色下胃镜活检可提高食管多原发癌诊断率;行全食管切除可减少食管癌术后复发率;食管多原发癌发现时多偏晚期,预后较差。
Objective To analyze the clinicopathological characteristics and prognosis of multiple primary esophageal cancer to explore the diagnosis and treatment of multiple primary esophageal cancer. Methods The clinicopathological data and follow-up results of esophageal multiple primary carcinoma resected by En-bloc of the right chest from October 2000 to January 2008 were retrospectively analyzed. The clinicopathological features and prognosis of multiple primary esophageal cancer were analyzed. Combined with the relevant literature at home and abroad in recent years, the diagnosis and treatment measures are discussed. The incidence of multiple esophageal cancer was 9.6%. All 8 patients were male, 7 patients smoked more than 20 packs / d × years, and 4 were alcoholic. Pathology are squamous cell carcinoma. Multiple main esophageal lesions involving the entire esophagus, sub-cancer mostly in situ carcinoma, some cases accompanied by epithelial dysplasia. All patients underwent esophageal cancer En-bloc resection and gastro-oesophageal left anastomosis. The 1-year and 3-year survival rates were 62.5% and 12.5% respectively, with a median survival of 13 months. Conclusion The occurrence of esophageal multiple primary carcinomas is the result of regional carcinogenesis. Gastroscopy biopsy with Lugol iodine staining can improve the diagnostic rate of multiple primary esophageal cancer. Esophageal resection can reduce the recurrence rate of esophageal carcinoma after multiple esophagectomy. More advanced stage of cancer found, the prognosis is poor.