食管癌手术适宜切除长度的研究

目的　探讨食管癌手术的适宜切除长度。方法　将 70例食管鳞癌手术标本制成病理大切片 ,于显微镜下观察壁内浸润、多中心起源、跳跃式转移等情况。根据等比回缩法将镜下长度推算为术中实际长度。结果　本组 70例中 ,发现食管癌壁内浸润 5 1例 (72 .9% ) ,其中单纯近端浸润 15例 ,单纯远端浸润 12例 ,两端均有浸润 2 4例。食管癌近端壁内浸润长度均数为 0 .9± 0 .8cm ,最大值为 4 .0cm ;食管癌远端壁内浸润长度均数为 0 .5± 0 .3cm ,最大值为 2 .0cm。发现多中心起源 11例(15 .7% ) ,其中单纯近端 3例 ,单纯远端 6例 ,两端均有 2例。近端多中心起源病灶与主瘤距离加多中心起源病灶长度均数为 3.2± 1.5cm ,最大值为 4 .7cm ;远端多中心起源病灶与主瘤距离加多中心起源病灶长度均数为 3.6± 2 .4cm ,最大值为 9.1cm。9例 (12 .9% )患者发现有跳跃式转移灶 ,其中单纯近端转移 5例 ,单纯远端转移 2例 ,两端均有转移 2例。近端跳跃式转移灶与主瘤的距离加跳跃式转移灶的长度均数为 1.9± 0 .6cm ,最大值为 2 .9cm ;远端跳跃式转移灶与主瘤的距离加跳跃式转移灶的长度均数为 1.4± 1.0cm ,最大值为 2 .7cm。 70例患者中无残端癌发生。结论　对于食管癌手术的适宜切除长度 ,近端切缘距离肿瘤上缘应不少于 5cm

Giant pathologic section in the study of optimal length of surgical resection for esophageal carcinoma

OBJECTIVE: To study the optimal surgical resection length for esophageal carcinoma. METHODS: Specimens of seventy patients with esophageal squamous cell carcinoma resected and collected in our hospital 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 51 (72.9%) patients, 39 proximal and 36 distal to the tumor. The mean length of direct intramural infiltration was 0.9 +/- 0.8 cm (4.0 cm maximum) proximally and 0.5 +/- 0.3 cm (2.0 cm maximum) distally. Multicentric carcinogenic lesion was found in 11 (15.7%) patients, 5 proximally, 8 distally and 2 on both sides. Proximal to the tumor, the mean distance between the multicentric carcinogenic lesion and the main lesion plus the length of the multiple carcinogenic lesion was 3.2 +/- 1.5 cm (4.7 cm maximum). Distal to the tumor, it was 3.6 +/- 2.4 cm (9.1 cm maximum). Leaping metastasis was found in 9 (12.9%) 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 1.9 +/- 0.6 cm (2.9 cm maximum) proximally and 1.4 +/- 1.0 cm (2.7 cm in maximum) distally. CONCLUSION: The optimal surgical resection length for esophageal carcinoma should be at least 5 cm proximal to the tumor and total length on the distal side.