食管贲门癌切除术后切缘残留癌——附39例临床分析

Residual Carcinoma along Incisal Margin after the Resection of Cancer of Esophagocardia: A Clinic Analysis of 39 Cases

我院1975年9月至1989年10月行食管贲门癌切除347例,切缘有残留癌39例,阳性率为11.2％。分析结果表明:残留癌对患者预后的影响无论是早期还是远期都非常严重,必须高度重视。产生残留癌的主要原因是切除范围不够,尤其是食管端,上切缘残留癌占64.1％,其次为肿瘤因素。为了避免切缘残留癌,应扩大肿瘤两端切除范围,对有局部淋巴结转移的较晚期的患者以及考虑为弥漫型硬癌者,应将切缘经快速切片检查证实无残留癌后再行消化道重建。

From Sept. 1975 to Oct. 1989, 347 cases of carcinoma of esopha-gocardia had undergone surgery in tumour hospital of Hubei Province, 39 of which developed residual carcinoma along incisal margin with a positive rate of 11.2 percent. The above findings indicate that residual carcinoma has a severe effect on prognosis, whether at its early stage, in the near future or at its remote stage. This effect of residual carcinoma, which results mainly from a resec-tal zone not wide enough, especially at the upper part of esophagus and also from carcinoma factors, deserves much attention. The former cause accounts for 64.1 per cent of all cases of residual carcinoma along incisal margin. Therefore, to avoid residual carcinoma along incisal margin, the zone to be resected at both ends of carcinoma of esophagocardia should be enlarged. A fast slice should be made for patients with advanced local lymphonodual metastasis, and those suspected of diffuse sclerotic carcinoma. Only after residual carcinoma hasn't been detected by pathological studies can the reconstruction of digestive tract be performed.