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目的 探讨食管癌术中放射治疗方法。方法 30例手术切除的食管癌中“二切口”根治术 2 9例 ,“三切口”根治术 1例。在术中将直线加速器限光筒置入胸腔内瘤床及淋巴引流区 ,1次大剂量放射 2 0～ 2 5Gy。设同期对照 30例单纯手术。结果 照射组满 30个月的 4例和满 2年的 9例均生存 ,无局部复发病例 ,2年生存率为 10 0 .0 %。对照组 2年生存率为 77.7%与术中放射组比较差异无显著性意义 (χ2 =1.45 ,P >0 .10 )。 2个组 2年局部控制率术中放射治疗组优于对照组 ;2个组手术并发症差异无显著性意义 (P >0 .5 0 )。术中放射组有 1例在放射后查看限光筒内有残胃滑入照射野 ,术后第 9d发生吻合口瘘 ,经修补后治愈出院。生存 2年以上的无 1例发生放射性纵隔炎、脊髓放射损伤反应及放射性肺炎。结论 食管癌术中放射作为综合治疗方法之一 ,其所用的照射剂量和照射野大小对疗效的提高是明显的 ,值得进一步研究
Objective To investigate the intraoperative radiotherapy for esophageal cancer. Methods Twenty-nine patients undergoing “two-incision” radical resection in esophageal cancer undergoing surgical resection, and one case of “three-incision” radical resection. In the operation, the linear accelerator tube was inserted into the intrathoracic tumor bed and the lymphatic drainage area, and a large dose of radiation was 2 0 to 25 Gy. Set up the same period in 30 cases of simple surgery. Results Four patients in the irradiated group and 30 patients in the two groups survived in 9 cases. No local recurrence occurred. The 2-year survival rate was 10%. There was no significant difference in the 2-year survival rate between the control group and the intraoperative radiotherapy group (77.7%) (χ2 = 1.45, P > 0.10). The two-year local control rate in the two groups was better than that in the control group; there was no significant difference in the surgical complications between the two groups (P > 0.50). In the intraoperative radiological group, there was 1 case in which the residual gas was visible in the photoreceptor tube and slided into the irradiation field after the radiation. Anastomotic fistula occurred at the 9th day after operation and was cured and discharged after being repaired. None of the patients who survived for more than two years had radioactive mediastinitis, spinal cord radiation injury response, and radiation pneumonitis. Conclusions Intraoperative radiation of esophageal cancer is one of the comprehensive treatment methods. The dose of radiation used and the size of the irradiation field are significant for the improvement of efficacy. It is worth further study.