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目的探讨病理大切片上食管鳞状细胞癌的特点,为放疗临床靶区的勾画提供参考标准。方法52例食管癌患者在我院接受根治性切除术,术后病理均为鳞状细胞癌。术前胸部CT用VRX-16扫描仪扫描到三维适形放疗计划系统,在三维重建的CT图像上勾画食管病变并计算病灶体积。每例患者手术切除标本均制成病理大切片,采用等比回缩法将显微镜下长度换算成术中实际长度。观察大切片上食管病变所显示的病理特征如多中心起源、重度不典型增生、壁内浸润并进行统计学分析。结果(1)不同检查方法显示的病变长度互不相同,CT片显示的最长。(2)52例患者中多中心起源15例,多中心起源病灶与主瘤距离加多中心起源病灶本身的长度近端(3．02±1．45)cm,远端(2．60±2．44)cm；重度不典型增生28例,重度不典型增生与主瘤距离加重度不典型增生本身的长度近端为(2．45±1．30)cm,远端为(3．24±2．19)cm；壁内浸润者41例,壁内浸润长度近端为(2．80±1．52)cm,远端为(2．02±1．51)cm,近端者较远端者要长。(3)发生血管瘤栓者6例,淋巴管浸润者36例,淋巴管漫润或分期较晚者壁内浸润的发生率均较高分别为86%和91%。结论食管鳞状细胞癌具有多中心起源、重度不典型增生及壁内浸润特点,并且多中心起源和壁内浸润的发生与淋巴管浸润有关。肉眼可见病变上端需外扩5cm,下端需外扩7．5cm才能包括95%的亚临床病灶,同样上端需外扩4．5cm,下端需外扩5．0cm才能包括90%的亚临床病灶。
Objective To investigate the characteristics of esophageal squamous cell carcinoma (ESCC) on major pathological sections and to provide a reference standard for the outline of clinical target area of radiotherapy. Methods Fifty-two patients with esophageal cancer underwent radical resection in our hospital. All the pathological changes were squamous cell carcinoma. Preoperative chest CT scan with VRX-16 scanner to a three-dimensional conformal radiotherapy planning system, three-dimensional reconstruction of CT images of esophageal lesions outline and calculate the lesion volume. Surgical resection of each patient specimens were made pathological large sections, using the method of equal reduction retraction under the microscope to the actual length of surgery. Observation of large sections of esophageal lesions showed pathological features such as polycentric origin, severe dysplasia, wall infiltration and statistical analysis. Results (1) Different examination methods showed different length of lesions, CT films showed the longest. (2) Among the 52 patients, 15 had polycritical origin. The distance between the polyclinic origin and the main tumor was more than that of the multinocentric lesions (3.02 ± 1.45 cm, 2.60 ± 2 .44) cm; severe atypical hyperplasia in 28 cases, severe atypical hyperplasia and dysplasia of atypical hyperplasia itself length of (2.45 ± 1.30) cm, distal (3.24 ± 2.19 cm; 41 infiltration in the wall, the infiltration length of the wall in the proximal (2.80 ± 1.52) cm, the distal (2.02 ± 1.51) cm, the proximal is far The end should be long. (3) There were 6 cases with angioma suppository and 36 cases with lymphatic invasion. The rates of infiltration of wall in patients with diffuse lymphatic vessels or later stage were respectively 86% and 91% higher. Conclusions Esophageal squamous cell carcinoma has the characteristics of polycentric origin, severe dysplasia and intramural infiltration. The origin of multiple centers and the infiltration of the wall are related to the infiltration of lymphatic vessels. Macroscopic lesions need to expand the upper end of 5cm, the outer need to expand 7.5cm lower to include 95% of subclinical lesions, the same need to expand 4.5cm upper end, the lower end of the need to expand 5.0cm to include 90% of subclinical lesions.