Papachristou D N, Karas M, Fortner J G
Br J Surg. 1979 Sep;66(9):609-12. doi: 10.1002/bjs.1800660904.
Gastric adenocarcinomas often spread to the distal oesophagus. Failure to control the disease in this area during total and proximal subtotal gastrectomy results in recurrence at the oesophageal anastomosis. The incidence of recurrence in a series of 351 such patients was 10 per cent and was influenced by the location of the main lesion, the stage of the disease, the presence of tumour at the margin of resection and the length of clearance of the oesophageal margin. Recurrence were prevented only with in vivo margins greater than 12 cm. Dysphagia combined with radiological signs of oesophageal obstruction was diagnostic of anastomotic recurrence regardless of the results obtained by oesophagoscopy and biopsy. Treatment was seldom effective in patients developing recurrence. Complete excision of the entire recurrent process offered the only hope for a long survival in these patients. Prevention by obtaining adequate oesophageal clearance at the time of gastrectomy is the only reasonable approach to this problem. The adequacy of resection cannot be judged accurately by intraoperative palpation of the oesophagus or by frozen section examination of the surgical margins.
胃腺癌常扩散至食管远端。在全胃切除术和近端胃次全切除术中若未能控制该区域的疾病，会导致食管吻合口复发。在一系列351例此类患者中，复发率为10%，且受主要病变部位、疾病分期、切除边缘有无肿瘤以及食管边缘切缘长度的影响。仅当体内切缘大于12 cm时才能预防复发。吞咽困难伴有食管梗阻的影像学征象可诊断为吻合口复发，而无论食管镜检查和活检结果如何。复发患者的治疗很少有效。彻底切除整个复发过程是这些患者长期生存的唯一希望。通过在胃切除时获得足够的食管切缘来预防是解决该问题的唯一合理方法。不能通过术中触诊食管或手术切缘的冰冻切片检查准确判断切除是否充分。
