食管癌手术切除适宜长度的探讨

目的研究食管癌手术切除的适宜长度。方法手术切除140例食管鳞癌,用连续切片的方法将切除的标本制成病理切片,在镜下观察食管癌粘膜下浸润、跳跃式转移,肿瘤多源性等多方面情况。再用食管癌切除后,回缩法推算术中实际长度。结果 140例食管癌手术中,以肉眼观大体肿瘤为中心发现食管癌粘膜下浸润108例（77.1%）,以门齿为距仅有近端浸润32例,远端浸润26例,两端均有侵润50例,近端粘膜下浸润长度平均为3.5cm,最长浸润距离值为4.8cm;距门齿食管癌远端粘膜下浸润长度平均为3.2cm,最长距离值为4.1cm：发现肿瘤多源性25例（17.9%）,其中仅有近端病灶7例,仅有远端病灶13例,两端均有病灶5例。近端多源性病灶移与肉眼大体肿瘤距离加多源性病灶长度均数为3.9cm,最大距离为4.7cm;远端多源性病灶与肉眼大体肿瘤距离加多源性病灶长度均数为3.6cm,最大距离为8.5cm。140例患者中发现21例（15.0%）有跳跃式肿瘤转移,其中近端跳跃转移11例,远端跳跃转移5例,两端均有5例。近端跳跃式转移与肉眼大体肿瘤的距离加跳跃式转移的长度平均数2.3cm,最大距离3.1cm;远端跳跃式转移与肉眼大体肿瘤的距离加跳跃式生长的长度平均数2.4cm,最大距离2.8cm。140例患者中未发现残端癌。结论食管癌手术切除的适宜长度,应该是距门齿近端切缘至肿瘤上缘应不少于6cm,远端应将食管全部切除。

Optimal length of surgical resection for esophageal carcinoma

Objective To study the optimal surgical resection length for esophageal carcinoma.Methods Specimens of 70 patients with esophageal squamous cell carcinoma were made into pathologic giant sections.Direct intramural infiltration,multicentric carcinogenic lesion and leaping metastasis were observed in the large slice by microscope.The actual length during the operation was calculated by the ratio of shrinkage. Results Direct intramural infiltration was found in 108（77.1 %） patients,39 proximal and 36 distal to the tumor.The mean length of direct intramural infiltration was 3.5 cm（4.8cm maximum） proximally and 3.2 cm（4.1cm maximum） distally.Multicentric carcinogenic lesion was found in 11（17.9%） patients,5 proximally,8 distally and 2 on both sides.Proximal to the tumor,the mean distance between the multicentric cacinogenic lesion and the main lesion plus the length of the multiple cacinogenic lesion was 3.9cm（4.7 cm maximum）.Distal to the tumor was 3.6 cm（8.5 cm maximum）.Leaping metastasis was found in 21（15.0%） patients,7 proximally and 4 distally.The mean distance between the leaping metastasis and the main lesion plus the length of the leaping metastatic lesion was 2.3 cm（3.1 cmmaximum） proximally and 2.4 cm（2.8 cm in maximum） distally.Conclusion The optimal surgical resection length for esophageal carcinoma should be at least 6 cm proximal to the tumor and total length on the distal side.