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目的:探讨食管多原发癌的临床特点及治疗方法。方法:回顾分析1994年10月~2005年7月我科手术治疗食管多原发癌17例。手术方式为左开胸食管胃弓下吻合术1例,二切口/三切口食管胃颈部吻合术16例(二切口11例、三切口5例)。结果:本组17例术后病理证实为食管多发性原发癌,且病理类型均为鳞癌。本组2个原发灶的12例,3个病灶的2例,5、13及15个病灶的各为1例;其中仅有1例术前经上消化道钡餐造影发现多个病灶,2例手术中发现多个病灶,其他14例均在术后病理检查时才发现为多原发癌。全组随访1、3、5年的生存率为100%(17/17)、38.5%(5/13)、22.2%(2/9)。结论:食管多发性原发癌不属于转移癌,治疗上仍首选外科治疗。由于食管癌可能存在多个病灶,术前或术中难以发现,手术方式宜采取三切口/二切口,食管大部分切除,区域淋巴结清扫、颈部食管胃吻合术,必要时可行结肠代食管术。
Objective: To explore the clinical features and treatment of multiple primary esophageal cancer. Methods: A retrospective analysis of 17 cases of esophageal multiple primary carcinoma treated by our department from October 1994 to July 2005 was performed. The operation mode was left anastomosis of esophageal and gastric anastomosis in 1 case, and 16 cases of esophagogastrostomy (11 cases of two incisions and 5 cases of three incisions) underwent two incisions / three incisions. Results: 17 cases of this group of pathological confirmed esophageal multiple primary cancer, and pathological types are squamous cell carcinoma. The group of 2 primary lesions in 12 cases, 3 lesions in 2 cases, 5,13 and 15 lesions in each of 1 case; only 1 case of preoperative upper gastrointestinal barium meal found multiple lesions, 2 Cases found multiple lesions in surgery, the other 14 cases were found in the postoperative pathological examination of multiple primary cancer. The overall survival rates at 1, 3 and 5 years were 100% (17/17), 38.5% (5/13) and 22.2% (2/9), respectively. Conclusion: Multiple primary esophageal cancer does not belong to metastatic cancer, the treatment is still the preferred surgical treatment. Because there may be multiple lesions of esophageal cancer, preoperative or intraoperative difficult to find, surgical approach should take three incisions / two incisions, esophageal resection, regional lymph node dissection, cervical esophagogastric anastomosis, if necessary, feasible colon esophagectomy .