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目的探讨术前化疗对局部晚期食管癌的生存影响,并研究术前化疗对肿瘤切除率,术后并发症发生率、死亡率的影响。方法自2001年1月至2004年1月按收治顺序纳入符合条件的局部晚期食管癌患者277例,根据胸腹CT检查和临床体征进行术前分期,术前化疗方案5-FU2.4g/m2。第1~3、20~23天持续72h静脉输注,DDP75mg/m2,第1、20天静脉滴注,化疗结束二周后施行食管癌切除,消化道重建。结果全组277例,其中270例完成了术前化疗,264例进一步接受了手术,无术前化疗引起的骨髓抑制等毒副反应导致无法手术或死亡,术前化疗的临床有效率为82.2%,病理完全缓解率32%,手术切除率100%,术后肺部感染、吻合口瘘、手术死亡率分别是34.2%,6.2%,1.4%。结论本治疗方案,患者耐受性良好,但化疗的毒性反应不容忽视,手术后吻合口瘘发生率较高,达6.2%。术前化疗可以明显降低食管癌的分期,并取得较高的临床有效率和病理缓解率。
Objective To investigate the effect of preoperative chemotherapy on the survival of locally advanced esophageal cancer and to study the effect of preoperative chemotherapy on tumor resection rate, postoperative complication rate and mortality. Methods From January 2001 to January 2004, 277 eligible patients with locally advanced esophageal cancer were enrolled in accordance with the order of treatment. Preoperative staging was performed according to CT and clinical signs. The preoperative chemotherapy regimen, 5-FU, 2.4g / m2 . The 1st ~ 3rd and 20th ~ 23th days of continuous 72h intravenous infusion, DDP75mg / m2, the first, 20 days intravenous infusion, two weeks after the end of chemotherapy, esophageal resection, digestive reconstruction. Results The whole group of 277 cases, of which 270 cases completed the preoperative chemotherapy, 264 patients underwent further surgery without preoperative chemotherapy-induced bone marrow suppression and other adverse reactions lead to surgery or death, the clinical effective rate of preoperative chemotherapy was 82.2% , Pathological complete remission rate of 32%, surgical resection rate of 100%, postoperative pulmonary infection, anastomotic leakage, operative mortality were 34.2%, 6.2%, 1.4%. Conclusion The treatment regimen is well tolerated in patients. However, the toxicity of chemotherapy should not be neglected. The incidence of anastomotic fistula after operation is high at 6.2%. Preoperative chemotherapy can significantly reduce the staging of esophageal cancer, and achieved high clinical efficiency and pathological remission rate.