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目的追踪食管癌切除术后上切缘残留癌及重度异型增生的自然转归。方法对37例吻合口局部未作治疗、存活2年以上的上切缘残留癌及重度异型增生患者行内镜检查(距术后平均时间33.6月) ,并在吻合口缘处取活组织送检。结果重度异型增生8例中检出癌2例 ,原位癌22例中检出癌2例 ,浸润癌7例中检出癌2例。除外吻合口下方胃壁转移1例 ,仅有1例见吻合口明显新生物 ,其他吻合口有癌和重度异型增生者虽未见赘生物 ,但局部均有不同程度、范围的糜烂区或带替代 ,活检时质脆、易出血。结论上切缘残留癌消失或发展可能与癌残留的范围、长度及愈合过程中的坏死脱落有关。除外病期因素 ,切缘残留癌可能对近期疗效影响不大。吻合口早期癌及重度异型增生患者可严密观察 ,浸润癌局部治疗为宜
Objective To track the natural outcome of residual cancer and severe dysplasia at the margins of esophageal cancer after resection. Methods Thirty-seven patients with anastomosis at the anastomotic site who survived for more than 2 years underwent resection of the upper margin and severe dysplasia underwent endoscopy (mean time from surgery was 33.6 months) Check Results Among the 8 cases with severe dysplasia, 2 cases were detected in cancer, 2 cases were detected in 22 cases of carcinoma in situ and 2 cases were detected in 7 cases of invasive carcinoma. In addition to the anastomotic gastric wall metastasis in 1 case, only 1 case of an obvious new anastomosis, other anastomotic cancer and severe dysplasia although no vegetation, but the local have varying degrees, the scope of the erosion zone or with alternative Biopsy crisp, easy bleeding. Conclusion The disappearance or development of residual cancer at the margin of the margin may be related to the extent and length of residual cancer and the necrosis in the process of healing. Except the stage of illness, residual margin cancer may have little effect on the short term efficacy. Anastomotic early cancer and severe dysplasia patients can be closely observed, local treatment of invasive carcinoma is appropriate