摘要
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，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（∥。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。
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 parenehyma or cancer cells infiltrated along the peripheral space of vagus nerve. Relationship between nerve invasion and clinicopathologieal 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, I0. 368, 0. 249, P 〈 0.05）. Conclusion Vagus nerve invasion is correlated with Siewert classification, intravaseular cancer emboli and degree of tumor differentiation. The range of vagus nerve invasion is restricted under the upper incis
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2013年第4期298-301,共4页
Chinese Journal of Digestive Surgery
基金
安徽省高校省级自然科学研究项目（KJ20122199）
关键词
食管胃结合部肿瘤
迷走神经
神经侵犯
Carcinoma of esophagogastric junction
Vagus nerve
Neural invasion
