同时发生的下咽-胸段食管多原发癌的外科治疗(附7例报告)

目的 分析同时发生的下咽-胸段食管多原发癌(MPC)的发病特点、诊断及外科手术方式的选择与疗效。方法 回顾性分析2002年1月至2008年1月7例下咽-胸段食管MPC患者的临床资料,包括采取的辅助检查手段、临床分期和病理类型以及手术方式的选择、术后并发症情况和远期疗效等。结果 术前有6例明确为MPC,另外1例经术后病理证实。所有病例均为鳞状细胞癌,胸段食管癌均为高分化鳞状细胞癌,下咽癌中高分化4例、中分化3例。所有病例均采用全喉全下咽全食管切除胃咽吻合术,无一例围手术期死亡,术后均恢复良好的吞咽功能。2例发生术后并发症:胸腔积液1例,伤口感染1例,经保守治疗后治愈；随访至今,1例无瘤生存超过5年,3例术后3年现仍健在,2例术后2年复发死亡,1例术后10个月局部复发出血死亡。结论 下咽-胸段食管同时性MPC病史特点相似,应该常规应用各种辅助检查手段,以免术前漏诊；全下咽全食管切除胃咽吻合术具有操作相对简单的优点,是治疗下咽-胸段食管同时性MPC的首选术式。

Surgical treatment of multiple primary hypopharyngeal cancer and thoracic esophageal cancer: a report of 7 cases

Objective To investigate the clinicopathological characteristics, diagnosis and surgical treatment of multiple primary hypopharyngeal cancer and thoracic esophageal cancer. Methods Seven male patients with multiple primary hypopharyngeal cancer and thoracic esophageal cancer underwent surgical treatment during Jan. 2002 to Jan. 2008. Their clinical data, including the adjuvant examination method, clinical staging, pathological types, and operative methods, postoperative complications, and long-term outcomes, were retrospectively analyzed. Results Six patients were confirmed to have the disease before operation, and one patient was pathologically confirmed after operation. All patients had squamous cell carcinoma, with all the thoracic esophageal lesions and four hypopharyngeal lesions being well-differentiated, and three hypopharyngeal lesions being moderately differentiated. All cases underwent total laryngectomy, total hypopharyngectomy and total esophagectomy, and were reconstructed with gastropharyngostomy. There was no perioperative death and the swallowing function recovered satisfactorily after operation in all cases. One patient had postoperative pleural effusion and one had postoperative wound infection, which were cured after conservative treatment. All patients were followed up. One patient survived tumor-free for five years, two patients died two years after operation due to recurrence, and one died 10 months after operation due to local recurrence and bleeding. Conclusion Multiple primary hypopharyngeal cancer and thoracic esophageal cancer have similar characteristics, and various adjuvant examinations should be used routinely to avoid missed diagnosis. Total hypopharyngectomy and total esophagectomy combining reconstruction with gastropharyngostomy are easy to perform; they can be the first choice for the condition.