噴門部癌の問題点
食道浸潤例の切除線決定に対する検討
1976 年 9 巻 4 号 p. 443-449
詳細
1976 年 9 巻 4 号 p. 443-449
A clinico-pathological studies were made to analyse the invasive patterns of the esophagus on 50 cases of the cardiac carcinomas in the 1st department of surgery during 1970 to 1974. The following results were obtained:
1) Macroscopically, the esophageal invasion of cardiac carcinomas was seen in 23 cases, while microscopically, it was seen in 28 cases out of 50.
2) Sixteen out of 28 cases which were invasive cardiac carcinomas showed ow (+), inculuding 12 ow (+) out of 24 OW (-) cases.
3) The distances from the esophago-cardiac junction to the margin of cardiac carcinomas were measured macroscopically and microscopically.The difference between them was that 19 cases showed longer and 9 showed shorter in microscopic distance than macroscopic one.
4) In the studies on the comparison between the invasive patterns of the cardiac carcinomas and eliminated error.It was shown greater eliminated error that of cancer cells invaded in the sm to pm or in the whole layer at the esophago-cardiac junction than in other layers of esophagus.While at the margin of the cardiac carcinoma, it was shown greater eliminated error that of cancer cells in sm and pm than in other layers of the esophagus.Further, 2 out of 4 which cancer cells invaded in pm were shown 1.7cm or 2.5cm in the eliminated error.
5) In the studies on the comparison between Borrmann's classification and eliminated error, all of Borrmann I or II types namely localizing type showed less than 0.5cm in eliminated error, and about 69% of Borrmann III, IV types namely infiltrating type showed more than 0.5cm in eliminated error.
6) In the studies on the comparison between the distance from the magin of the carcinomas to the transection line and Borrmann's classification in the cases of Borrmann I or II type when the distance was longer than 2cm, and in the cases of Borrmann III or IV types when the distance was longer than 4 cm, no ow (+) cases were seen.
The present results are supporting that in the cases of Borrmann I or II types, the transection line should be determined at more than 2cm far, and in the cases of Borrmann III or IV types, at more than 4cm far from the margin of carcinomas, when surgical operation was performed for the patient of the esophageal invasive cardiac carcinomas.
