食管癌术前电化学治疗的临床病理研究

Clinical and pathological study of preoperative ECT in esophageal cancer

目的 :研究术前电化学治疗对食管癌的作用。方法 :5 0例经胃镜及病理诊断为食管鳞癌病人术前行电化学治疗 ,治疗电压 :5 6v ,电量 :2 5 0 35 0c ;全部病人予电化学治疗后 1 3天接受外科手术治疗 ;术后标本作肉眼观察及组织病理、电镜观察。结果 :经病理及临床观察研究发现 ,肿瘤表面与电极接触区阳极黑痂凝固性坏死 ,阴极区水肿性坏死 ,疗效以缩窄型最佳 ,其余类型均伴有正常食管壁损伤 ,电量达 30 0c时损伤达外膜层。结论 :1、电化学治疗为食管癌综合治疗提供了新手段 ,其操作简便、安全有效 ,尤其是不能手术或不能耐受手术的高龄、高危中晚期病人 ,宜积极行电化学治疗。 2、由病理及临床观察发现 ,现用电极对肿瘤未侵及食管全周者极易损伤正常食管壁 ,急需改进、完善电极。

Objective:To investigate the effect of preoperative electrochemical therapy (ECT) to esophageal cancer.Methods:50 cases of esophageal squamous carcinoma were performed preoperative ECT.Voltage of ECT:5 6 volt.Quantity of ECT:250 350c.Radical operations were managed in 1 3 days after ECT.Histopathological and electrical microscope examinations were used in all of the specimens.Results:1)Anodic fields shows coagulative necrosis;Cathodal fields shows swelling necrosis.2)Narrow type of esophageal cancer shows the best effect.Other types of cancer were all with injuring of adjacent normal wall of esophagus,in which,the injury was up to the fiberous membrane layer outside the layer of the muscle when electric quantity was higher than 300c.Conclusion:1)It is suggested that ECT is a new,safe,effective and simple method to the comprehensive treatment of esophageal cancer,especially for the patients aged or in advanced stage who cannot accept or bear the operation.2)Electrode we used is critically need to be improved in order to reduce complications and increase effects of the treatment.