原發性食道小細胞癌之臨床經驗

Clinical Experience of Primary Small Cell Carcinoma of the Esophagus

張耿源(Keng-Yung Chang) ； 陳邦基(Pang-Chi Chen) ； 方昆敏(Kuen-Miin Fang) ； 黃俊彥(Chun-Yeh Huang) ； 吳錫賢(Shyi-Shane Wu) ； 王式鴻(Shyn-Horng-Wang) ； 吳正雄(Cheng-Shyong Wu) ； 薛綏(Swei Hsueh)

《中華民國消化系醫學會雜誌》 10卷3期 (1993/09) Pp. 196-203

https://doi.org/10.6557/GJTa.199309_10(3).0001

摘要

本院自民國72年至81年共發現7例原發性食道小細胞癌。性別爲6男1女，平均年齡63歲（46-82歲），主訴均爲吞嚥困難(100%)，2例併有有聲音嘶啞。病變部位在食道上段者1例，中段者4例，下段者2例，腫瘤侵犯長度從3到10公分不等（平均5公分）。診斷時4例有淋巴轉移，1例骨骼轉移，另2例犯及局部主動脈了；五例實施電子顯微鏡檢查，其中3例細胞內有具分泌性之緻密核顆粒。
僅接受支持療法者有3例，平均存活4個月（3-5月）。另4例接受化學療法，其中1例於單一種化學治療(5-Fu)後2個月死於敗血症。1例接受YAG雷射治療，吞嚥困難症狀改善，不幸在接受化學治療(5-Fu)時死於敗血症，存活3個月。2例接受多種藥物化學治療(Cisplatin + Mitomycin)，已分別存活7及10個月。目前文獻報告多認爲只有多種藥物之化學療法才可提高小細胞癌患者存活率，此與本院經驗相似。

關鍵字

小細胞癌 ； 食道

並列摘要

Patients with small cell carcinoma were retrospectively analyzed in a 20-year period from 1973 to 1992. This rare and rapidly progressive disease was seven out of 898 (0.81%) of all admitted patients with esophageal malignancy during the period. They were one woman and six men, aged from 46-82 years with a mean of 63 years. All of them had dysphagia, and two had hoarseness. The lesions in the esophagus were one in the upper third, 4 in the middle third and 2 in the lower third. The size of the lesions were 3-10 cm in the largest diameter. Evidence of metastasis was noted in all patients and regional lymph node involvement in 4. Esophagoscopy revealed a polypoid mass in 3, a polypoid mass with ulcers in 3 and ulcers in one. Of 5 patients receiving electron microscopic examinations, undifferentiated tumor cells with scanty cytoplasma and scattered membrane bound neurosecretory granules were noted in 3. The 6-month survival was 28% with a mean survival of 4 months in 3 patients receiving supportive treatment, and 2.5 months in 2 patients receiving chemotherapy with 5-Fluorouracil. Two patients receiving chemotherapy with mitomycin and cisplatiin are still alive for 7 and 10 months. The results suggested a possible benefit by the treatment of combination chemotherapy.

並列關鍵字

small cell carcinoma ； esophagus