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目的总结原发性食管腺癌的临床生物学特征和外科治疗经验。方法回顾性分析1980—2000年间外科治疗的43例原发性食管腺癌患者的临床病理资料。结果 43例原发性食管腺癌占同期手术治疗的5638例食管癌的0.8%,均行左后外开胸食管胃部分切除、食管胃手工吻合术。肿瘤位于食管胸中段12例,胸下段31例。食管单纯腺癌14例,腺鳞(棘)癌29例。原发性食管腺癌的淋巴结转移率为65.1%,明显高于食管鳞癌的31.6%。食管腺癌的术后1、3、5年生存率分别为81.4%、46.5%和28.2%,低于食管鳞癌。结论原发性食管腺癌好发于食管下段,淋巴结转移率高,预后较食管鳞癌差。外科手术是其首选治疗方法,早诊断、早治疗以及肿瘤的根治性切除是改善预后的关键,合理的综合治疗有助于提高远期疗效。
Objective To summarize the clinical biological characteristics and surgical treatment of primary esophageal adenocarcinoma. Methods The clinical data of 43 patients with primary esophageal adenocarcinoma surgically treated between 1980 and 2000 were retrospectively analyzed. Results 43 cases of primary esophageal adenocarcinoma accounted for 0.8% of the 5638 cases of esophageal cancer underwent surgical resection in the same period. All patients underwent esophagectomy and esophagogastric partial resection. Tumor located in the middle of the esophagus in 12 cases, 31 cases of lower thoracic. Esophageal simple adenocarcinoma in 14 cases, adenosquam (spine) cancer in 29 cases. Lymph node metastasis rate of primary esophageal adenocarcinoma was 65.1%, which was significantly higher than that of esophageal squamous cell carcinoma (31.6%). The 1, 3, 5-year survival rates of esophageal adenocarcinoma were 81.4%, 46.5% and 28.2%, respectively, which were lower than those of esophageal squamous cell carcinoma. Conclusion Primary esophageal adenocarcinoma occurs in the lower esophagus with high rate of lymph node metastasis and worse prognosis than esophageal squamous cell carcinoma. Surgery is the treatment of choice, early diagnosis, early treatment and radical tumor resection is the key to improving prognosis, a reasonable combination of treatment will help to improve long-term efficacy.