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目的探讨食管胃同时性双原发癌的综合治疗方法。方法对2006年10月至2013年2月期间江苏省中医院消化系肿瘤外科诊治的8例食管胃同时性双原发癌患者的治疗过程进行分析,探讨其综合治疗经验。结果 8例食管胃同时性双原发癌患者均经胃镜活检病理学检查明确诊断。根据CT和超声内镜检查结果进行术前分期,T1a期以下的病灶行内镜下黏膜切除6例(食管癌4例,胃癌2例),行手术切除1例(食管癌);T2期及以上的病灶行术前新辅助放化疗、手术、术后辅助放化疗等8例(食管癌2例,胃癌6例),行单纯手术切除1例(食管癌)。8例患者均获随访,随访时间为10~76个月,平均41.3个月。1例在术后7个月死亡,1例在术后20个月发现肿瘤转移,余6例患者随访期间均无复发和转移。结论应根据食管胃同时性双原发癌的不同病情制定个体化治疗方案,包括根治性胃食管癌切除术、内镜下黏膜切除术、术前新辅助放化疗、术后化疗等,过度追求手术治疗并不能取得理想的效果。
Objective To explore the comprehensive treatment of simultaneous esophageal and gastric dual primary cancer. Methods From October 2006 to February 2013 in Jiangsu Provincial Hospital of Traditional Chinese Medicine digestive cancer diagnosis and treatment of 8 cases of esophageal simultaneous treatment of patients with primary cancer were analyzed to explore the experience of its comprehensive treatment. Results 8 cases of esophageal simultaneous gastric primary biopsy were confirmed by gastroscopy biopsy. According to the results of CT and EUS, preoperative staging was performed. In T1a stage, endoscopic mucosal resection was performed in 6 cases (4 cases of esophageal cancer and 2 cases of gastric cancer) and 1 case of esophageal cancer (esophageal cancer) The lesions were treated with neoadjuvant chemoradiation, surgery and postoperative adjuvant radiotherapy and chemotherapy in 8 cases (2 cases of esophageal cancer and 6 cases of gastric cancer). One case (esophageal cancer) underwent simple surgical resection. All 8 patients were followed up for 10 ~ 76 months with an average of 41.3 months. One patient died at 7 months after operation, one patient had tumor metastasis at 20 months after operation, and no recurrence and metastasis occurred in the other 6 patients during follow-up. Conclusions Individualized treatment regimens should be developed according to the different conditions of esophagogastric concurrent double primary cancer, including radical gastrectomy, endoscopic mucosal resection, neoadjuvant chemoradiation and postoperative chemotherapy, and excessive pursuit Surgical treatment does not achieve the desired results.