摘要
目的回顾性分析超长食管癌不同方法治疗后的疗效，探讨超长食管癌的治疗对策。方法对１９８７年３月至１９９２年８月间２１５例超长食管癌单纯外放射治疗、外放射＋腔内放疗、单纯手术治疗、术后放疗和术前放疗患者的生存率采用ｋａｐｌａｎ－Ｍｅｉｅｒ分析、ｌｏｇ－ｒａｎｋ检验，其它结果采用卡方检验，探讨不同治疗方法的疗效及失败的原因。结果超长食管癌术后放疗和术前放疗疗效较好，术前放疗不增加手术并发症，能明显降低“Ｔ”分期（Ｐ＜０．０５）；姑息术后放疗能明显提高５年生存率（Ｐ＜０．０５），根治术后放疗组５年生存率比单纯手术组提高１５．１％，术后放疗能明显降低淋巴结转移率（Ｐ＜０．０５）；超长食管癌失败的主要原因为局部未控或复发和远处转移，外放射＋腔内放疗有降低局部未控或复发率的趋势。结论对超长食管癌应采用手术＋放疗进行综合治疗，不能手术治疗者应采用非常规分割外放射配合腔内放疗和全身化疗。
Objective The treatment effects by radiotherapy alone,operation alone,postoperative radiotherapy and preoperative radiotherapy for superlength esophageal carcinoma(>8cm)were retrospectively reviewed.Methods 215 patients with superlength esophageal carcinoma were treated by different therapy methods from 1987 through 1992.KaplanMeier survival analysis and logrank test were used to evaluate the treatment effects of different therapy methods and the causes of failure.Results The 5year survival rates were markedly increased and lymph node metastasis rates were markedly decreased for patients with postoperative and preoperative radiotherapy.Patients with external beam combined with intracavitary radiotherapy gave a better local control rates than those of exteranl beam rediotherapy alone.Residual or recurrent cancer and metastasis are the main causes of failure.Conclusion Operation combined with radiotherapy must be carried out for superlength esophageal carcinoma.Nonconventional fractionation external beam combined with intracavitary radiotherapy and chemotherapy is the first choice for nonoperated superlength esophgeal carcionoma.
