食管癌上切缘残留癌及重度异型增生患者的内镜随访

Outcome of residual cancer or severe hyperplasia at proximal cut end of esophagus: an endoscopic study

目的追踪食管癌切除术后上切缘残留癌及重度异型增生的自然转归。方法对37例吻合口局部未作治疗、存活2年以上的上切缘残留癌及重度异型增生患者行内镜检查(距术后平均时间33.6月) ,并在吻合口缘处取活组织送检。结果重度异型增生8例中检出癌2例 ,原位癌22例中检出癌2例 ,浸润癌7例中检出癌2例。除外吻合口下方胃壁转移1例 ,仅有1例见吻合口明显新生物 ,其他吻合口有癌和重度异型增生者虽未见赘生物 ,但局部均有不同程度、范围的糜烂区或带替代 ,活检时质脆、易出血。结论上切缘残留癌消失或发展可能与癌残留的范围、长度及愈合过程中的坏死脱落有关。除外病期因素 ,切缘残留癌可能对近期疗效影响不大。吻合口早期癌及重度异型增生患者可严密观察 。

Objective The natural consequence of cancer or severe hyperplasia left at the proximal cut end of gullet was followed up. Methods Endoscopy was performed on 37 patients who had survived for 2 years and had residual cancerous or severe hyperplastic changes at the proximal side of anastomosis as reported by pathology. The site remained untreated since the primary surgery. Results Endoscopically around the anastomotic orifice congested, crisp and easy to bleed spots or bands could be viewed with no neoplastic growth. Biopsies revealed cancer cells in 2/8 patients with previous severe hyperplasia, in 2/22 cases with remnant cancer in situ and in 2/7 with left infiltrative cancer. Conclusion The disappearance or development of residual tumor or severe hyperplasia at proximal esophageal cut end remains obscure. It may be assumed that (1) the residual tumor might not influence the short term survival; (2) residual cancer in situ and severe hyperplasia should be followed up closely; (3) local treatment might be necessary for infiltrative case.