60例食管胃结合部腺癌临床病例分析

Analysis of 60 cases with adenocarcinoma in esophagogastric junction

目的比较伴有食管下端癌和贲门癌在临床特点、手术治疗、病理特点和预后的异同,探讨影响生存的因素以指导临床工作。方法回顾性分析,巢湖市第二人民医院普外科、胸外科2005年1月～2010年12月间收治的食管胃结合部腺癌病例资料。对比两组病例的性别、年龄、确诊时间、症状、肿瘤Borrmann分型、术前肿瘤标记物、有无远处转移、手术方式、消化道重建方式、手术根治度、术后病理资料、生存率等之间的差异并进行统计学分析。结果食管下端癌出现吞咽困难者多于贲门癌(P=0.02),淋巴结清扫范围贲门癌大于食管下端癌(P=0.045),手术根治度-贲门癌高于食管下端癌(P=0.008),肿瘤最大径-贲门癌小于食管下端癌(P=0.008),肿瘤浸润层次-贲门癌超过食管下端癌(P=0.043),c-erbB-2的表达-食管下端癌多于贲门癌(P=0.019)。影响食管胃结合部腺癌病人预后的因素包括肿瘤病理分期、AEG分型和手术根治度,三者强度依次递减。结论食管胃结合部腺癌在症状、免疫组化、肿瘤大小、浸润层次方面存在一定的差异,据此选择相应的淋巴结清扫范围有利于提高手术根治度。食管胃结合部腺癌分型、手术根治度和术后病理分期是影响病人预后的因素。

Objective To investigate the differences between the clinical features,operative manners,pathological characteristics of the bottom of esophagus cancer and cardia cancer and to identify the influential factors of the prognosis and treatments.Methods We made a retrospective analysis on all the cases of the bottom of esophagus cancer and cardia cancer from Jan.2005 to Dec.2010 in the general surgical ward of the Second People’s Hospital of Chaohu.To compare the age,gender,the time to make definitive diagnosis,symptoms,Borrmann’s classification,tumor markers metastasis,operative manners,reconstruction of alimetary tract,radical cure rank,postoperative pathological data and survival rate of two types and make statistical analysis.Results Dysphagia was more common in the bottom of esophagus cancer than in cardia cancer.The range of lymphadenectomy was more extended in cardia cancer than in the bottom of esophagus cancer.The radical cure rank was better in cardia cancer than in the bottom of esophagus cancer.The maximum diameter was smaller in cardia cancer than in cardia cancer with the bottom of esophagus cancer.The depth of invasion was larger in cardia cancer than in the bottom of esophagus cancer.The expression of c-erbB-2 increases in the bottom of esophagus cancer.The influential factors of the Adenocarcinoma of the esophagogastric junction patients’ prognosis include staging,classification and the radical cure rank with degressive trend（P〈0.05）.Conclusions Between the two types,there are differences in the symptoms,immunohistochemical index,tumor size and depth of invasion based on which is good for improving the radical cure rank.The radical cure rank,pathological phase and the classification of AEG are the influential factors to prognosis.