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目的 阐述1965年～1998年外科治疗食管癌和贲门癌的进展情况,并总结其经验。方法 将 1965年～1998年外科治疗的12 970例食管癌和贲门癌患者分 3个阶段进行分析比较。1965年～1979年手术患者3 155例为 A组,1980年～1990年 5 952例为 B组,1990年～1998年 3 863例为 C组,早期癌(Tis,T1)单列计算。结果 本组患者肿瘤总的切除率为91.3％,食管癌和贲门癌的切除率分别为94.0％和84.6％,其中食管癌患者A、B、C组及早期癌组切除率分别为86.6％、93.2％、95.8％和100.0％,贲门癌患者分别为82.1％、85.1％、90.2％和100.0％;总的手术病死率为1.8％,A、B、C组手术病死率分别为4.4％、1.6％和0.5％;总5年生存率为31.6%,A、B、C及早期癌组生存率分别为27.0％、29.1%、32.0％、92.6％。A、B、C3组患者的病期、病变位置、病变大小、手术方法、综合治疗以及手术并发症均有显著不同。结论 早期癌外科治疗效果最好,肿瘤手术切除率和患者5年生存率分别为100.0％和92.6％;随着肿瘤诊治技术的不断提高,手术适应证逐渐扩大,手术切除率和患者5年生存率不断提高;食管癌患者均应作食管次全切除颈部吻合术,这样可以减少肿瘤复发;Ⅲ期以上病例行综合治疗可以取得较好的效果。
Objective To describe the progress of surgical treatment of esophageal and cardiac cancer from 1965 to 1998 and to summarize its experience. Methods A total of 12 970 patients with esophageal and cardiac cancer who underwent surgical treatment from 1965 to 1998 were analyzed in three stages. From 1965 to 1979, 3 155 cases of surgical patients were in group A, 5 952 cases in group B in 1980 ~ 1990, and 3 863 cases in group C in early 1990 ~ 1998. Results The total tumor removal rate was 91.3% in this group, and the resection rates of esophageal and cardia carcinoma were 94.0% and 84.6% respectively. The resection rates of esophageal cancer patients in groups A, B, C and early cancer were 86.6% 93.2%, 95.8% and 100.0% respectively. The patients with cardiac cancer were 82.1%, 85.1%, 90.2% and 100.0% respectively. The total operative mortality was 1.8%. The operative mortality rates in group A, B and C were 4.4% and 1.6 % And 0.5% respectively. The overall 5-year survival rate was 31.6%. The survival rates of A, B, C and early cancer groups were 27.0%, 29.1%, 32.0% and 92.6%, respectively. Patients in group A, B and C3 had different disease duration, lesion location, size of lesion, operation method, comprehensive treatment and surgical complications. Conclusions The early surgical treatment of carcinoma is the best, and the tumor resection rate and 5-year survival rate are 100.0% and 92.6% respectively. As the diagnosis and treatment of tumors continues to increase, the surgical indications are gradually expanding. The resection rate and 5-year survival of patients Rate of continuous improvement; esophageal cancer patients should be made for subtotal esophagectomy cervical anastomosis, so as to reduce tumor recurrence; Ⅲ or more cases of comprehensive treatment can get better results.