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目的探讨食管癌根治性放疗后再度吞咽困难的诊断与治疗。方法回顾性总结4l例食管癌根治性放疗后再度吞咽困难患者的诊疗经过;分析症状再发的原因、探讨诊断依据及治疗方法。结果本组选择手术治疗,切除率97%,手术死亡率4.8%,手术并发症发生率29%,术后1、3、5年生存率分别为72.7%、36.3%、18.1%,术后病理为放疗反应Ⅲ级者13.2%,鳞癌82.8%。结论食管癌放疗后再度吞咽困难者多为放疗未控/病变复发,少数为重度放疗反应;术前检查有时难以区别恶性病变与放疗后狭窄。部分局部无癌的狭窄有区域淋巴结的转移癌。对复发病变及放疗后的高度狭窄,只要无明显的手术禁忌证就应积极手术治疗;术中所见以瘢痕为主,解剖有一定困难。
Objective To investigate the diagnosis and treatment of dysphagia after radical radiotherapy for esophageal cancer. Methods A retrospective review was made of the diagnosis and treatment of 4 1 patients with esophageal cancer who had undergone radical radiotherapy with dysphagia. The causes of the recurrence of symptoms, the basis for diagnosis, and the treatment methods were analyzed. The results of this group to choose surgical treatment, the resection rate of 97%, operative mortality rate of 4.8%, the incidence of surgical complications was 29%, postoperative 1, 3, 5-year survival rates were 72.7%, 36.3%, 18.1%, postoperative pathology For radiation therapy, 13.2% of patients were in grade III and 82.8% of squamous cell carcinoma. Conclusion The patients with dysphagia after radiotherapy for esophageal cancer are mostly uncontrolled radiotherapy/recurrence of disease, and a few for severe radiotherapy. Preoperative examination is sometimes difficult to distinguish between malignant lesions and radiotherapy stenosis. Some localized cancer-free stenosis metastases with regional lymph nodes. For recurrent lesions and high stenosis after radiotherapy, as long as there is no obvious surgical contraindication should be actively treated; scars are mainly seen during the operation, there are certain difficulties in anatomy.