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例1,患者女性,55岁。3年前开始感上腹部不适,伴反酸暖气。6月前出现食后呃逆,伴食欲减退。近2月来食后有梗塞症状,逐日加重。既往患过血吸虫病并接受过治疗。体检:一般情况尚可,腹平软,剑突下轻度压痛,未扪及包块。胸水涂片找到癌细胞。食道X线钡剂检查,提示食道下段癌。胃镜检查:距门齿35cm处食道粘膜隆起,表面糜烂出血。胃贲门处有一直径约3cm溃疡。取食道粘膜活检,证实为高分化腺癌。未作胃粘膜活检。在硬膜外麻醉了,切除食道下段及胃底,作胸内食道胃吻合术。标本大体检查:食道下段有一蕈伞型肿块向腔内隆起,约1×1×0.5cm。另于胃贲门部前壁及后壁各有一渍疡型肿块.前壁渍疡距食道肿块约4.5cm,范国为3×3cm。后壁渍疡距食道肿块约5cm,范围为2×2cm。前后壁二处渍疡相距约4cm。三处病灶之间粘膜未见异常。镜检:食道肿块处为高分化腺癌,侵及肌层。胃贲门二处均为高分化腺癌,侵及肌层。三处癌肿间组织全部取材制片,
Example 1, female patient, 55 years old. 3 years ago began to feel abdominal discomfort, with acid reflux heating. After 6 months, there was hiccup after eating, with loss of appetite. After the onset of food in recent February, there are symptoms of infarction that increase daily. Previously had schistosomiasis and received treatment. Physical examination: The general condition is acceptable, the abdomen is soft, and the tenderness under the xiphoid process is slight, and the palpation is not palpable. Pleural smears find cancer cells. Esophageal X-ray tincture examination showed that the lower esophageal cancer. Gastroscopy: The mucosa of the esophagus bulges 35 cm from the incisor and the surface bleeds. There is an ulcer about 3cm in diameter at the gastric cardia. Take esophageal mucosa biopsy, confirmed as well-differentiated adenocarcinoma. No gastric biopsy was performed. After epidural anesthesia, the lower esophagus and the fundus were resected for intrathoracic esophageal gastric anastomosis. Specimens were examined roughly: There was an umbrella-shaped mass in the lower esophagus that bulged into the cavity, about 1 x 1 x 0.5 cm. In addition, there was a lump-type lump on the anterior and posterior walls of the gastric cardia. The anterior wall stain was about 4.5 cm from the esophageal mass, and Fan was 3 x 3 cm. The posterior wall stain was approximately 5 cm from the esophageal mass, with a range of 2 x 2 cm. Before and after the wall two spots away from about 4cm. There was no abnormality in the mucosa between the three lesions. Microscopic examination: Esophageal masses were well-differentiated adenocarcinomas that invaded the myometrium. Both of the gastric cardias were well-differentiated adenocarcinomas that invaded the myometrium. All three cancerous tissues were obtained from