食管鳞癌切除术后食管粘膜碘染色小片不染区的临床病理学研究

The clinic-pathological study on the mucosal unstained areas with Lugol's iodine solution in post-esophagectomy of esophageal squamous cell cancer.

目的 探讨食管鳞癌切除手术后食管标本粘膜碘染色小片不染区的临床病理学意义。方法 随机采取我院胸心外科自 2 0 0 4年 2月至 2 0 0 4年 5月因原发性食管鳞癌住院手术切除患者 ,共 46例 ,其中男性 3 2例 ,女性 14例。在食管切除后 2～ 5min内在食管粘膜上喷洒 1.2 5 %复方碘溶液。采取呈小片状食管粘膜碘染阳性区 (不染色或淡染 ) ,行常规HE组织病理学染色 ,观察其临床病理学征象。结果 在 46例染色标本中食管粘膜碘染阳性区 (呈小片状食管粘膜不染色或淡染区 )共 13 2处 ,除正常鳞状上皮外 ,发现异常病变的阳性率约为 81.8% (10 8/13 2 )。其中在主癌灶外另发现的小片状癌灶为 3 5处 ,食管慢性炎症 3 1处 ,轻度不典型增生灶 2 1处 ,中度不典型增生灶 10处 ,重度不典型增生灶 6处 ,原位癌 5处。结论 ①食管鳞癌患者普遍存在主要癌灶附近的第二癌灶或 /和癌前病变灶现象。②这些发现支持食管“田野癌发生”的概念。

Objective To investigate the clinic-pathological sign ificance on the mucosal unstained areas with Lugols iodine solution in post-car cinectomy of esophageal squamous cell ca rcinoma.Methods Selected randomly fo rty-six (46)patients,32 male,14 female,whom had been suffered from primary esophageal sq uamous cell carcinoma and undergone the esophagectomy in the department of cardi othoracic surgery,our hospital,from Februa ry to May,200 4.Spraied 1.25% Lugols iodine solution on the mucosas of the samples of esophag us in 2～5 minutes after esophagectomy.To ok unstained areas in the mocosa of esop hagus,and carried out routine staining w ith hematoxylin and eosin.And observed t he clinic-pathological significance.Results There were 132 unsta ined areas in the esophagus samples.Incl uded chronic esophagitis(31),mild dysplasia(21),moder ate dysplasia(10),severe dysplasia(6),ca ncer in situ(5),and early invasive carci noma and advanced carcinoma(35)81.8%(108 /132).Conclusion There are the sec ond site of carcinoma or/and precursors b esides the major one in the paients from primary esophageal squamous cell carcin oma.The findings support the concept of 'field carcinogenesis'.