5402例食管癌术后切缘癌分析  

Analysis of Residual Cancer at excision margin of Esophageal Carcinoma:A Report of 5402 Patients

作　　者：赵一电 郭梅[1] 

机构地区：[1]河南省安阳市肿瘤医院,455000

出　　处：《实用癌症杂志》2005年第6期601-603,606,共4页The Practical Journal of Cancer

摘　　要：目的分析食管癌术后发生切缘残留癌(简称切缘癌)的原因,寻找降低切缘癌发生率切实可行的对策.方法回顾性分析5 402例食管癌根治术病例的临床病理资料.复阅病理切片,将切缘癌分为原位癌、浸润癌、切缘黏膜下层见有脉管内癌栓(简称切缘癌栓)等类型进行观察.结果5 402例病例中,男3 191例,女2 211例,年龄28～86岁,中位年龄55岁.按原发癌不同分为:颈段癌29例,胸上段癌751例,胸中段癌3 964例,胸下段癌539例,多灶癌90例,双原癌29例.5 402例标本按年计算切缘癌发生率为5.4%～7.9%,平均发生率为6.7%(361/5 402),上切缘癌发生率为5.5%(299/5 402),下切缘癌发生率为0.9%(47/5402),上、下切缘癌发生率为0.3%(15/5 402).颈段食管癌、多灶癌的上切缘癌发生率分别为17.2%(5/29)、13.3%(12/90).双原癌病例下切缘浸润癌的发生率为27.6%(8/29).切缘癌中原位癌、切缘癌栓、浸润癌的构成比分别为41.0%(154/376)、7.7%(29/376)、51.3%(193/376).结论食管癌术后上、下切缘都有发生切缘癌的可能,少数情况下可以同时发生,双原癌者下切缘癌发生率较大,其它食管癌均以上切缘癌发生率较大.食管癌术后切缘癌的发生与病变到切缘的距离负相关,但单纯增加距离不能完全避免切缘癌,常规术中切缘冷冻切片检查,可望真正降低切缘癌的发生率.Objective To analysis the reason for residual cancer at excision margin of esophageal carcinoma and how to prevent it. Methods The data of 5 402 cases of esophageal carcinomas（ECs） were retrospectively azlalysed. Results There were 29 cases of cervical ECs,751 cases of upper thoracic ECs,3 964 cases of middle thoracic ECs,539 eases of lower thoracic ECs,90 cases of multifocal carcinoma, and 29 cases of concurrent cancer. The rate of residual cancer of the 5 402 eases were 5.4 % - 7.9 %, with an average of 6.7 % （361/5 402）. The rates of the residual cancer at the upper,lower excision margin and both of them were 5.5 % （299/ 5 402）, 0.9 % （47/5 402）, 0.3 % （ 15/5 402）, respectively. The residual cancer included carcinoma in situ （ 41.0 %, 154/376）, emboli of cancer（7.7% ,29/376）,infiltrative cancer（51. 396,193/376）. The rate of residual cancer at the lower excision margin in concurrent cancer was 27.6 % （8/29）. Conclusion The residual cancer is negative correlation with the distance from the lesion to the excision margin, Intraoperative frozen section may be helpful to reduce the incidence of residual cancer at the excision margin.

关 键 词：食管癌 切缘残留癌 病理分型 冷冻切片 

分 类 号：R735.1[医药卫生—肿瘤]