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背景与目的:食管癌的死因包括局部浸润和/或远处转移,手术的介入会对死因产生影响。本研究对食管癌术后死亡时的复发类型及死亡原因进行总结,分析食管癌死亡时间以及导致食管癌死亡的危险因素。方法:1999年6月—2004年6月手术治疗后确诊死亡的食管癌80例,收集临床病理资料。用Spearm an法进行各个临床因素与复发类型、生存时间的相关分析;用Kap lan-M e ier法绘制生存曲线,以log-rank比较各因素对死亡时间的影响。结果:全组一年内死亡为49例(61.3%),2年内死亡为67例(83.8%)。死亡原因为纵隔内复发16例(20%),淋巴道转移30例(37.5%),血道转移为34例(42.5%)。行淋巴结清扫的复发类型以血道转移为主,与淋巴结采样的相比有明显差异,P<0.01;纵隔内复发、淋巴道转移与血道转移3组患者的生存时间无显著区别。64例肿瘤完全切除的患者,淋巴结阴性的比阳性的生存时间长(P=0.0468)。淋巴结采样的一年内死亡比淋巴结清扫的明显多,P=0.02;姑息切除的无一例活过2年。结论:血道转移、纵隔内复发及淋巴道复发都是引起食管癌死亡的重要原因,而复发类型与淋巴结切除程度有关。食管癌的完全切除及淋巴结清扫可降低局部复发,减少因局部及区域复发而导致的死亡。
BACKGROUND & OBJECTIVE: The causes of esophageal cancer include local infiltration and / or distant metastasis, and surgical intervention may have an impact on the cause of death. This study summarizes the types and causes of death after esophageal cancer death, and analyzes the time of esophageal cancer death and the risk factors of esophageal cancer death. Methods: From June 1999 to June 2004, 80 cases of esophageal cancer were diagnosed after operation, and clinical and pathological data were collected. Spearm an method was used to analyze the correlation between various clinical factors and recurrence type and survival time. Kaplan-Meier method was used to draw the survival curve. The log-rank test was used to compare the effect of various factors on death time. Results: In the whole year, 49 cases (61.3%) died and 67 cases (83.8%) died within 2 years. The causes of death were mediastinal recurrence in 16 cases (20%), lymphatic metastasis in 30 cases (37.5%) and hematogenous metastasis in 34 cases (42.5%). The type of recurrence of lymph node dissection was mainly hematogenous metastasis, which was significantly different from that of lymph node sampling (P <0.01). There was no significant difference in survival time between the mediastinal recurrence, lymph node metastasis and hematogenous metastasis. In 64 patients with complete tumor resection, lymph node-negative survival was longer than positive (P = 0.0468). Lymph node sampling within one year of death significantly more than lymph node dissection, P = 0.02; palliative resection of none of live 2 years. Conclusion: Hematogenous metastasis, recurrence in mediastinum and lymph node recurrence are the important causes of esophageal cancer death, and the relapse type is related to the degree of lymph node resection. Complete resection of esophageal cancer and lymph node dissection can reduce the local recurrence, reduce the local and regional recurrence caused by death.