Wittekind C
Pathologisch-anatomisches Institut, Universität Erlangen-Nürnberg.
Zentralbl Chir. 1993;118(9):500-7.
Different organ tumours of the gastrointestinal tract show variations in invasion patterns which are partly dependent on the biological characteristics of the tumour and partly dependent on the anatomical situation of the involved organ. It is important for the surgeon to have knowledge of the local invasion behaviours in making a precise indication for surgery, in the planning and in the technical accomplishment of the operation. Residual tumour has been shown to be a particular important prognostic factor. This paper investigates a large series of patients with different organ tumours in order to find in which location a R1 situation must be expected and which surgical consequences should be thus derived. The percentage of R0 resections in all patients who underwent resection differed in the individually examined organs: oesophagus, 65%; stomach, 80%; pancreas, 77%; colon, 81%; rectum, 84%. R1 resections also showed differences in incidence: oesophagus, 17%; stomach, 7%; pancreas, 13%; colon, 3%; rectum, 4%. Residual tumour was most frequently found in the lateral (superficial or free) resection margins: oesophagus, 79%; stomach, 67%; pancreas, 86%; colon, 78%; rectum, 74%. The other resection margins were significantly less-frequently involved.
胃肠道不同器官的肿瘤在侵袭模式上存在差异，这部分取决于肿瘤的生物学特性，部分取决于受累器官的解剖位置。对于外科医生来说，了解局部侵袭行为对于准确判断手术指征、规划手术以及实施手术技术都非常重要。残留肿瘤已被证明是一个特别重要的预后因素。本文对大量患有不同器官肿瘤的患者进行了研究，以确定在哪些部位可能出现R1情况以及由此应得出哪些手术后果。在接受手术切除的所有患者中，R0切除的百分比在各个检查的器官中有所不同：食管为65%；胃为80%；胰腺为77%；结肠为81%；直肠为84%。R1切除的发生率也存在差异：食管为17%；胃为7%；胰腺为13%；结肠为3%；直肠为4%。残留肿瘤最常出现在外侧（浅表或游离）切缘：食管为79%；胃为67%；胰腺为86%；结肠为78%；直肠为74%。其他切缘受累的频率明显较低。
