摘要
目的 总结Ivor Lewis二切口手术对中、下段食管癌的治疗效果 ,判定预后的危险因素。方法 对 1995～ 1998年间 ,采用Ivor Lewis手术根治性切除的 136例胸中、下段食管鳞癌患者进行回顾性研究。应用Kaplan Meier法计算生存率 ,Log Rank检验比较生存差别 ;Cox回归分析判定预后的危险因素。结果 围手术期主要并发症包括 :吻合口瘘 5例 ( 3.7% ) ,幽门不全梗阻 4例 ( 2 .9% ) ,乳糜胸 2例 ( 1.5 % )。围手术期死亡 2例 ( 1.5 % )。Ⅰ期、ⅡA期、ⅡB期和Ⅲ期患者的 5年生存率分别为 6 8.2 %、4 6 .1%、12 .5 %和 7.4 % ,四组间比较差别显著 (P <0 .0 0 1)。Cox回归分析结果显示 ,T3 (P =0 .0 0 3,RR =2 .6 )和N1(P <0 .0 0 1,RR =3.4 )是预后的危险因素。结论 Ivor Lewis手术无严重的手术后并发症 ,患者的预后取决于T分期及N分期。该手术可以治愈多数Ⅰ期和部分ⅡA期胸中、下段食管鳞癌患者 ,但是对于ⅡB期和Ⅲ期患者 ,单纯手术的远期疗效欠佳 ,应该加强手术前、后的辅助治疗。
Objective To examine the efficacy of the Ivor Lewis esophagectomy for middle and lower third esophageal cancer and determine risk prognostic factors. Methods One hundred and thirty six patients with middle and lower third squmous cell carcinoma of the esophagus, who underwent Ivor Lewis esophagectomy with curative intent from 1995 through 1998, were reviewed. The patients were followed up and survival was calculated by Kaplan Meier method. Difference in survival was compared by Log Rank test. Cox regression analysis was performed to identify risk prognostic factors. Results Major peri operative complications occurred in 11 patients which included anastomotic leakage in 5 (3.7%), incomplete pyloric obstruction in 4 (2.9%), and chylothorax in 2 (1.5%) cases, respectively. Peri operative death in 2 patients (1.5%).The 5 year survival rates were 68.2 % for patients with stageⅠ, 46.1% for patients with stageⅡA, 12.5% for patients with stageⅡB, and 7.4% for patients with stage Ⅲ, respectively. There is a significant survival rate difference among them ( P <0.001). In Cox analysis both lymph node ( P <0.001, RR=3.4) and T 3 tumor ( P =0.003, RR=2.6) are risk prognostic factors. Conclusion Ivor Lewis esophagectomy for middle and lower third esophageal cancer is a safe operation. Survival rate is T and N factors dependent. Most patients with stageⅠand some with stageⅡA disease could be cured by this procedure. Lower survival rate was associated with advanced cancers (patients with stage ⅡB and stage Ⅲ), some effective means of adjuvant therapy should be added before and after the operation.
出处
《肿瘤》
CAS
CSCD
北大核心
2004年第3期286-289,共4页
Tumor
