定位困难的早期食管贲门癌的术前检查和术中处理

Preoperative Examination and Operating Managment of the Early Esophageal and Cardiac Cancer of Being Difficultly Localized

早期食管贲门癌仅有粘膜的病理改变,而肌层尚未受到侵犯,故术前定位检查较为困难,往往给外科手术带来麻烦。采用低张气钡双重造影多轴位电视透视,可较为清晰的观察食管贲门粘膜的病理生理改变。在全程拉网的基础上,再分两段拉网,简便易行,定位诊断率可达80%以上。内窥镜检查可靠性较高,但存在有一定误差,检查过程中应对可疑部位做多点刷片活检。术前定位不够明确者,术中应根据术前综合检查结果,做仔细的触摸检查,必要时可做切开涂片活检或术中拉网检查。对术中确实定位困难的患音,术中可根据癌细胞分类选择手术方式。

Twelve patients with early cancer of the esophagus and cardia were analysed.The early esophageal and cardiac cancer showed changes only on the mucous membrane,and did not invade the smooth muscles.The preoperative location was difficult.It often brought trouble to the operation.The anomaral mucous changes could be observed clearly by the air-burium low-tention fluoroscopy.The accurate rate of location diagnosis was above 80% by the cost-off cells in section.Esophagoscopy could provide reliable location,but sometime it made a few mistakes.The biopsy to the suspicious place should be done during esophagoscopy.The caring touch was necessary for patients to be difficultly lo- cated during operation.The biopsy and cost-off cells exersis,if necessary,should be done during opera- tion.The operation mode depended on the kind of cancer-cell when location was difficult during the operation.