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目的 探讨食管癌手术的适宜切除长度。方法 将 70例食管鳞癌手术标本制成病理大切片 ,于显微镜下观察壁内浸润、多中心起源、跳跃式转移等情况。根据等比回缩法将镜下长度推算为术中实际长度。结果 本组 70例中 ,发现食管癌壁内浸润 5 1例 (72 .9% ) ,其中单纯近端浸润 15例 ,单纯远端浸润 12例 ,两端均有浸润 2 4例。食管癌近端壁内浸润长度均数为 0 .9± 0 .8cm ,最大值为 4 .0cm ;食管癌远端壁内浸润长度均数为 0 .5± 0 .3cm ,最大值为 2 .0cm。发现多中心起源 11例(15 .7% ) ,其中单纯近端 3例 ,单纯远端 6例 ,两端均有 2例。近端多中心起源病灶与主瘤距离加多中心起源病灶长度均数为 3.2± 1.5cm ,最大值为 4 .7cm ;远端多中心起源病灶与主瘤距离加多中心起源病灶长度均数为 3.6± 2 .4cm ,最大值为 9.1cm。9例 (12 .9% )患者发现有跳跃式转移灶 ,其中单纯近端转移 5例 ,单纯远端转移 2例 ,两端均有转移 2例。近端跳跃式转移灶与主瘤的距离加跳跃式转移灶的长度均数为 1.9± 0 .6cm ,最大值为 2 .9cm ;远端跳跃式转移灶与主瘤的距离加跳跃式转移灶的长度均数为 1.4± 1.0cm ,最大值为 2 .7cm。 70例患者中无残端癌发生。结论 对于食管癌手术的适宜切除长度 ,近端切缘距离肿瘤上缘应不少于 5cm
Objective To investigate the appropriate resection length of esophageal cancer surgery. Methods Seventy esophageal squamous cell carcinoma specimens were made into large pathological sections. The infiltration of the wall, the origin of multiple centers and the leaping metastasis were observed under the microscope. The length of the microscope was estimated as the actual intraoperative length according to the isometric retraction method. Results In the group of 70 cases, 51 cases (72.9%) of esophageal carcinoma were found infiltrated into the wall of the esophageal squamous cell carcinoma, including 15 cases of simple proximal infiltration, 12 cases of simple distal infiltration, and 24 cases of invasive infiltration at both ends. The average length of infiltrating proximal esophageal wall was 0.9 ± 0.8cm and the maximum was 4.0 cm. The mean infiltrating length of esophageal distal wall was 0.5 ± 0. 3 cm and the maximum was 2. 0cm. 11 cases (15.7%) were found to have multicentric origin, of which 3 cases were simple proximal and 6 cases were simple distal and 2 cases both ends. The distance between the origin and the main tumor of the proximal polyclinic origin and the origin of the polyp origin was 3.2 ± 1.5 cm and the maximum value was 4.7 cm. The distance from the origins of distal polycentric origin and the main tumor to the origins of multiple origin was 3.6 ± 2 .4cm, the maximum is 9.1cm. Nine patients (12.9%) were found to have leapfrog metastases, including 5 cases of simple proximal metastasis, 2 cases of simple distal metastasis and 2 cases of metastasis at both ends. The distance between the proximal leaping metastasis and the main tumor plus the length of the leaping metastasis was 1.9 ± 0.6cm and the maximum was 2.9cm. The distance between the distal leaping metastasis and the main tumor was increased by leaping metastasis The average length of 1.4 ± 1.0cm, the maximum value of 2. 7cm. 70 patients without stump cancer. Conclusion For resection of esophageal cancer suitable length, the proximal margin from the edge of the tumor should not be less than 5cm