中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2013年
4期
298-301
,共4页
食管胃结合部肿瘤%迷走神经%神经侵犯
食管胃結閤部腫瘤%迷走神經%神經侵犯
식관위결합부종류%미주신경%신경침범
Carcinoma of esophagogastric junction%Vagus nerve%Neural invasion
目的 探讨影响进展期食管胃结合部腺癌(AEG)侵袭迷走神经的因素.方法 收集2011年1月至2012年8月安徽医科大学第一附属医院收治的98例行根治性全胃切除+食管胃Roux-en-Y吻合术治疗的进展期AEG患者的手术标本,进行连续切片并标明上下切缘,对标本进行HE染色及S-100、细胞角蛋白免疫组织化学染色,镜下观察发现迷走神经周围间隙及迷走神经实质内有癌细胞存在或者癌细胞沿神经周围间隙扩散,即可确认为迷走神经侵犯.迷走神经侵犯和各种临床病理因素的关系采用x2检验或Fisher确切概率法；对迷走神经受侵犯的相关影响因素进行单因素及多因素Logistic回归分析.结果本组98例患者的标本迷走神经受侵犯的发生率为28.6％ (28/98),且肿瘤仅侵犯与其上缘同一高度的迷走神经.单因素分析结果显示:迷走神经侵犯与肿瘤的Siewert分型、有无脉管癌栓、有无淋巴结转移及其转移程度、临床分期、分化程度具有相关性(x2=14.156,14.552,5.454,10.706,6.919,14.767,P＜0.05).多因素分析结果表明:肿瘤Siewert分型、有无脉管癌栓及分化程度是迷走神经侵犯的独立危险因素(OR=3.667,10.368,0.249,P＜0.05).结论 迷走神经侵犯与肿瘤Siewert分型、脉管癌栓、分化程度具有高度相关性,且迷走神经受侵犯的范围未超出肿瘤的上缘.
目的 探討影響進展期食管胃結閤部腺癌(AEG)侵襲迷走神經的因素.方法 收集2011年1月至2012年8月安徽醫科大學第一附屬醫院收治的98例行根治性全胃切除+食管胃Roux-en-Y吻閤術治療的進展期AEG患者的手術標本,進行連續切片併標明上下切緣,對標本進行HE染色及S-100、細胞角蛋白免疫組織化學染色,鏡下觀察髮現迷走神經週圍間隙及迷走神經實質內有癌細胞存在或者癌細胞沿神經週圍間隙擴散,即可確認為迷走神經侵犯.迷走神經侵犯和各種臨床病理因素的關繫採用x2檢驗或Fisher確切概率法；對迷走神經受侵犯的相關影響因素進行單因素及多因素Logistic迴歸分析.結果本組98例患者的標本迷走神經受侵犯的髮生率為28.6％ (28/98),且腫瘤僅侵犯與其上緣同一高度的迷走神經.單因素分析結果顯示:迷走神經侵犯與腫瘤的Siewert分型、有無脈管癌栓、有無淋巴結轉移及其轉移程度、臨床分期、分化程度具有相關性(x2=14.156,14.552,5.454,10.706,6.919,14.767,P＜0.05).多因素分析結果錶明:腫瘤Siewert分型、有無脈管癌栓及分化程度是迷走神經侵犯的獨立危險因素(OR=3.667,10.368,0.249,P＜0.05).結論 迷走神經侵犯與腫瘤Siewert分型、脈管癌栓、分化程度具有高度相關性,且迷走神經受侵犯的範圍未超齣腫瘤的上緣.
목적 탐토영향진전기식관위결합부선암(AEG)침습미주신경적인소.방법 수집2011년1월지2012년8월안휘의과대학제일부속의원수치적98례행근치성전위절제+식관위Roux-en-Y문합술치료적진전기AEG환자적수술표본,진행련속절편병표명상하절연,대표본진행HE염색급S-100、세포각단백면역조직화학염색,경하관찰발현미주신경주위간극급미주신경실질내유암세포존재혹자암세포연신경주위간극확산,즉가학인위미주신경침범.미주신경침범화각충림상병리인소적관계채용x2검험혹Fisher학절개솔법；대미주신경수침범적상관영향인소진행단인소급다인소Logistic회귀분석.결과본조98례환자적표본미주신경수침범적발생솔위28.6％ (28/98),차종류부침범여기상연동일고도적미주신경.단인소분석결과현시:미주신경침범여종류적Siewert분형、유무맥관암전、유무림파결전이급기전이정도、림상분기、분화정도구유상관성(x2=14.156,14.552,5.454,10.706,6.919,14.767,P＜0.05).다인소분석결과표명:종류Siewert분형、유무맥관암전급분화정도시미주신경침범적독립위험인소(OR=3.667,10.368,0.249,P＜0.05).결론 미주신경침범여종류Siewert분형、맥관암전、분화정도구유고도상관성,차미주신경수침범적범위미초출종류적상연.
Objective To investigate the risk factors of vagus nerve invasion of advanced adenocarcinoma of esophagogastric junction (AEG).Methods The specimens from 98 patients with advanced AEG who underwent radical total gastrectomy and esophagogastric Roux-en-Y anastomosis from January 2011 to August 2012 at the First Affiliated Hospital of Anhui Medical University were collected.Serial section cutting was done and the upper and bottom incisional edges of every section were marked.The specimens were stained by hematoxylin-eosin solution,S-100 and CK immunohistochemistry.Vagus nerve invasion could be affirmed if cancer cells were observed in the peripheral space of vagus nerve and vagus nerve parenchyma or cancer cells infiltrated along the peripheral space of vagus nerve.Relationship between nerve invasion and clinicopathological factors was analyzed using chi-square test or Fisher exact probability.Factors related to vagus nerve invasion were analyzed using one-way analysis of variance and multi-factor logistic regression analysis.Results The incidence of vagus nerve invasion was 28.6％ (28/98),and the tumor only invaded the vagus nerve which had the same altitude as the upper incisional edge.The results of one-way analysis of variance showed that Siewert classification,intravascular cancer emboli,lymph node metastasis,the degree of lymph node metastasis,clinical staging,the degree of tumor differentiation were correlated with the vagus nerve invasion (x2 =14.156,14.552,5.454,10.706,6.919,14.767,P ＜ 0.05).The results of multi-factor logistic regression analysis showed that Siewert classification,intravascular cancer emboli and degree of tumor differentiation were the independent influencing factors of vague nerve invasion (OR =3.667,10.368,0.249,P ＜ 0.05).Conclusion Vagus nerve invasion is correlated with Siewert classification,intravascular cancer emboli and degree of tumor differentiation.The range of vagus nerve invasion is restricted under the upper incisional edge of tumor section.
