CAJ | 학술논문

目的　分析放射治疗后食管癌的死亡原因，提高对非肿瘤性穿孔的认识及治疗。方法　回顾性分析本院行放射治疗的食管癌死亡并有完整尸检资料病例32例。一程放射治疗26例，二程放射治疗6例。放射治疗总剂量6～200?Gy。结果　局部无癌占28.1%，肿瘤残存占71.9%。总剂量 41～59、60～80?Gy 局部无癌分别占5/9、3/9，肿瘤残存分别占13．0%、47.8%。单次剂量<180、 180～210 、＞210 ?cGy 无肿瘤残存分别占2/9、3/9、4/9，肿瘤残存分别占52.2%、39.1%、8.7%。穿孔周围组织中有大量的急慢性炎性细胞浸润，甚至有脓腔的形成及纤维素的段裂。淋巴结转移占46.9%。上段食管癌隔下淋巴结转移占50.0%，下段食管癌隔下淋巴结转移占12.5%。全身脏器转移率为37.5%。以穿孔死亡为主要原因占75.0%，其中无肿瘤穿孔死亡占33.3%，以食管主动脉瘘为主占62.5%。全组无5年生存。1、3年生存率分别为15.6%（5/32）、3.1%（1/32）。结论　食管癌放射治疗后以局部复发造成的食管穿孔死亡为主，但要警惕有一部分病例，因局部无癌造成非癌性穿孔死亡。
목적　분석방사치료후식관암적사망원인，제고대비종류성천공적인식급치료。방법　회고성분석본원행방사치료적식관암사망병유완정시검자료병례32례。일정방사치료26례，이정방사치료6례。방사치료총제량6～200?Gy。결과　국부무암점28.1%，종류잔존점71.9%。총제량 41～59、60～80?Gy 국부무암분별점5/9、3/9，종류잔존분별점13．0%、47.8%。단차제량<180、 180～210 、＞210 ?cGy 무종류잔존분별점2/9、3/9、4/9，종류잔존분별점52.2%、39.1%、8.7%。천공주위조직중유대량적급만성염성세포침윤，심지유농강적형성급섬유소적단렬。림파결전이점46.9%。 상단식관암격하림파결전이점50.0%，하단식관암격하림파결전이점12.5%。전신장기전이솔위37.5%。이천공사망위주요원인점75.0%，기중무종류천공사망점33.3%，이식관주동맥루위주점62.5%。전조무5년생존。1、3년생존솔분별위15.6%（5/32）、3.1%（1/32）。결론　식관암방사치료후이국부복발조성적식관천공사망위주，단요경척유일부분병례，인국부무암조성비암성천공사망。
Objective　 To analyze the death reason of esophageal carcinoma treated by external beam radiotherapy alone, and to enrich knowledge of perforation without evidence of residual tumor at the primary site.Methods　Thirty-two esophageal carcinoma patients who had been treated from 1958 to 1985 by radiotherapy alone were autopsied. This paper presents the findings from their complete records ,which includes 26 patients with the first course of treatment and 6 second course. The total doses ranged from 6～200 Gy.Results　On autopsy,28.1% of patients did not have any residual tumor at the primany site,but 71.9% of patients did have persistent tumor locally. The incidences of disease-free patients in relation to the total dose were: 41 to 59 Gy—5/9 and 60 to 80 Gy—3/9 while those having persistent tumor on these two dose levels were 13.0% and 47.8%. The incidence of disease-free patients in relation to the size of each radiation fraction were<180 cGy —2/9,180～210 cGy —3/9 and >210 cGy —4/9 while those with persistent tumor on these three dose levels were 52.2%,39.1% and 8.7%. Pathologically,extensive inflammatory infilfration was observed in the peri-perforation tissues with abscess formation.Fragmentation of fibrils was observed. Of all cases,46.9% had lymph node metastasis, 50% of the upper segment lesions developed subdiaphragmatic lymphatic metastasis in contrast to 12.5% from lesion in the lower segment. Generalized metastases were present in 37.5% of cases. 75.0% of patients died chiefly of perforation, among whom 33.3% did so of disease-free perforation. Esophago-aortic fistula observed frequently was most deadly. No one among these 32 patients had survived over five years but their 1-and 3-year survival rates were 15.6%(5/32) and 3.1%(1/32).Conclusions　The couse of death after receiving radiotherapy for esophageal carcinoma is due to local persistent tumor leading to perforation. Yet ,one must be aware of death due to non-cancerous perforation which may be due to infection and abscess formation.