Takeda J, Hashimoto K, Umetani H, Tanaka T, Koufuji K, Kakegawa T
Department of Surgery, Kurume University School of Medicine, Japan.
Kurume Med J. 1992;39(2):77-82. doi: 10.2739/kurumemedj.39.77.
The best surgical procedure to treat a carcinoma in the gastric cardia remains a controversy because the carcinoma is often advanced and there are other unknown factors. In this article the incidence of invisible metastasis from cardia cancer to the diaphragm will be analyzed using an experimental cardia cancer model and clinical studies. An experimental cardia cancer was induced by an endoscopic injection of VX2 cancer cells into the submucosal layer of the esophago-gastric junction in rabbits using a 27G needle and an Olympus BF-4B2 bronchofiberscope. A total of 26 cardia cancer models for Borrmann type 2 or 3 were produced. Of these, six (23%) had visible cancer metastases in the diaphragm, including 4 cases with direct invasion and 2 cases with peritoneal dissemination on the surface of the diaphragm. Four (20%) of the remaining 20 were histologically found to have macroscopically-invisible cancer metastases mainly in the lymph vessels of the left hemidiaphragm. From 1985 to 1988, 22 clinical cases of cardia cancer were managed by a combined total gastrectomy with a partial diaphragm resection through a left thoracoabdominal approach. When widely resected, reconstruction was performed using a latissimus dorsi muscle flap. Six (27%) of these 22 were also histologically found to have macroscopically-invisible cancer metastases to the diaphragm, including 1 (11%) of the 9 well-differentiated type and 5 (39%) of 13 poorly-differentiated type adenocarcinomas.(ABSTRACT TRUNCATED AT 250 WORDS)
由于贲门癌往往已属晚期且存在其他未知因素，治疗胃贲门癌的最佳手术方法仍存在争议。在本文中，将通过实验性贲门癌模型和临床研究来分析贲门癌向膈肌的隐匿性转移发生率。采用27G针头和奥林巴斯BF - 4B2支气管纤维镜，通过内镜将VX2癌细胞注射到兔食管胃交界处的黏膜下层，诱导建立实验性贲门癌。共制作了26个Borrmann 2型或3型贲门癌模型。其中，6个（23%）在膈肌有可见癌转移，包括4例直接侵犯和2例膈肌表面腹膜播散。其余20个中，4个（20%）经组织学检查发现主要在左半膈肌淋巴管有肉眼不可见的癌转移。1985年至1988年，22例贲门癌临床病例采用经左胸腹联合入路行全胃切除加部分膈肌切除术治疗。广泛切除后，采用背阔肌肌瓣进行重建。这22例中，6个（27%）经组织学检查也发现有肉眼不可见的癌转移至膈肌，包括9例高分化型腺癌中的1例（11%）和13例低分化型腺癌中的5例（39%）。（摘要截断于250字）
