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1954年至1981年共行贲门癌切除术527例,手术切除标本断端阳性者117例(22％)。本文对440例Ⅰ-Ⅱ期患者中断端阳性88例进行分析。在区域淋巴结无转移而断端阳性患者的预后稍逊于阴性患者,但其差别无统计学的显著性;在仅有第一站淋巴结转移时,断端阴性者其预后亦略优于阳性者,但亦无统计学意义;而第二站淋巴结有转移时,断端阳性患者的预后则明显低于阴性患者(P<0.05)断端阳性117例中,5例(4.3％)发生吻合口瘘,而断端阴性患者410例中,23例(5.6％)发生吻合口瘘,二者相似,故断端有癌细胞存在并未增加吻合口瘘的机会。但我们认为应尽可能多切除癌周所谓正常组织,即切缘至少为3cm为宜。
From 1954 to 1981, a total of 527 cardiac cancer resections were performed. 117 cases (22%) were surgically resected specimens with positive stumps. This article analyzes 880 cases of stage I-II positive patients with interrupted ends. The prognosis of patients with regional metastasis without metastasis and positive stumps was slightly less than that of negative patients, but the difference was not statistically significant; in the case of metastasis to the first metastatic sites only, those with negative stumps had slightly better prognosis than those with positive ones. However, it was not statistically significant. However, when metastasis was found at the second site, the prognosis was significantly lower in the patients with positive stumps than in the negative patients (P<0.05). Among the 117 patients with positive stumps, anastomoses occurred in 5 patients (4.3%). Of the 410 patients with negative ends, 23 (5.6%) had anastomotic leakage. The two are similar, so there is a chance that the cancer cells at the stump do not increase the anastomotic leakage. However, we believe that the normal tissue should be removed as much as possible during the cancerous period, that is, the margin should be at least 3cm.