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目的分析本院34年间外科治疗食管癌和贲门癌的病例资料并总结其经验,有利于进一步提高远期疗效及生活质量。方法对1974至2008年间外科治疗食管癌和贲门癌共3682例进行回顾性总结,将1974至1989年间手术886例列为A组,1990至1999年间手术1513例列为B组,2000至2008年间手术1283例列为C组,对这3组进行分析比较。结果总切除率为90.1%,食管癌和贲门癌切除率分别为92.2%和85.0%,其中食管癌A、B、C组切除率分别为81.6%、90.3%、97.8%,贲门癌患者分别为80.5%、84.5%、90.4%。总手术病死率为1.6%,A、B、C组手术病死率分别为4.5%、1.5%、0.6%。总5年生存率为29.3%,A、B、C组5年生存率分别为27.3%、29.4%、31.6%。A、B、C组患者的病期、病变部位、病变大小、手术方式、综合治疗以及手术并发症均有明显的差别。结论早期诊断和早期治疗是提高生存率的关键,应提高内镜诊治水平。Ⅱb～Ⅲ期以上食管癌须综合治疗,影响生存率的主要因素是分期和淋巴结转移,手术治疗要重视淋巴结清扫。手术技术的提高,手术方式的改进,手术适应症逐渐扩大,并发症和病死率明显下降,远期生存率虽有所提高但并不令人满意。在提高生存率的同时应重视患者的生活质量。
Objective To analyze the case data of surgical treatment of esophageal and cardiac cancer in our hospital for 34 years and summarize their experience, which is beneficial to further improve the long-term curative effect and quality of life. Methods A total of 3682 surgical cases of esophageal and cardiac cancer from 1974 to 2008 were retrospectively reviewed. A total of 886 cases of surgery between 1974 and 1989 were classified as group A. Among them, 1513 cases were classified as group B between 1990 and 1999. Between 2000 and 2008, 1283 cases were classified as C group, the three groups were analyzed and compared. Results The total resection rate was 90.1%. The resection rates of esophageal carcinoma and cardiac carcinoma were 92.2% and 85.0% respectively. The resection rates of esophageal carcinoma in groups A, B and C were 81.6%, 90.3% and 97.8%, respectively 80.5%, 84.5%, 90.4%. The total case fatality rate was 1.6%. The case fatality rates in group A, B and C were 4.5%, 1.5% and 0.6% respectively. The overall 5-year survival rate was 29.3%. The 5-year survival rates in groups A, B and C were 27.3%, 29.4% and 31.6%, respectively. A, B, C group of patients with disease stage, lesion size, size, surgical procedures, comprehensive treatment and surgical complications were significantly different. Conclusion Early diagnosis and early treatment are the keys to improve the survival rate, and should improve the level of endoscopic diagnosis and treatment. Ⅱ b ~ Ⅲ esophageal cancer should be comprehensive treatment, the main factor affecting the survival rate is staging and lymph node metastasis, surgical treatment should pay attention to lymph node dissection. Improvements in surgical techniques, surgical methods, surgery indications gradually expanded, complications and mortality decreased significantly, although the long-term survival rate has improved but not satisfactory. In improving the survival rate should pay attention to the quality of life of patients.