摘要目的 初步探讨术前超声内镜与染色标记技术结合的方法 定位食管胃结合部腺癌(ade-nocarcinoma of the esopha-gogastric junction,AEG)病灶的实际边界的临床效果.方法2015年9月1日至2017年10月30日,对18例食管胃结合部腺癌患者通过超声内镜与染色标记技术结合的方法定位食管胃结合部腺癌病灶的实际边界.男10例,女8例.所有患者完善术前检查后,于术前1～2天行超声内镜下染色标记定位病灶边缘.在距肿瘤纵轴最长浸润范围外1 cm处取两点注射纳米炭混悬液标记定位.术中依据纵轴染色浸润长度,决定是否行开胸手术.术中近端切缘送冰冻病理,依据冰冻结果 ,决定是否行追加手术.术后将肿瘤距切缘的标本分段制成石蜡切片,每段长约0.5 cm,显微镜下观察各段石蜡切片各层次是否有肿瘤细胞侵犯.结果术前超声内镜,下染色标记的平均用时(10.16±1.38)min,纳米炭扩散直径(1.43±0.41)cm.全组术中肉眼下均可清晰可见纳米炭染色标记区域,术中探查定位病灶的平均耗时(1.27±0.53)min.经胸腹联合手术5例,经腹手术13例.切缘距肿瘤的平均长度(4.74±1.12)cm,术中切缘的冰冻病理均为阴性,未行追加手术;术后常规病理证实所有标本的切缘均为阴性.结论 超声内镜下食管胃结合部腺癌肿瘤染色标记定位技术在临床上可行,可准确探测肿瘤边缘和浸润范围,可为AEG精准外科手术的顺利实施提供指导和保障,是一种安全、快速、有效的定位技术.

abstractsObjective Preliminary study on the clinical effect of preoperative ultrasound endoscopy combined with stai-ning labeling technique to locate the actual boundary of esophageal and gastric cancer Methods From September 1, 2015 to October 30, 2017, 18 patients with esophageal adenocarcinoma were enrolled in this study. The actual boundaries of esophage-al and gastric-derived adenocarcinoma lesions were localized by endoscopic ultrasonography and staining. There were 10 males and 8 females. After completing the preoperative examination, 1-2 days before operation, endoscopic ultrasonography was used to locate the edge of the lesion. Two point injection of carbon nano suspension was used to mark the location of 1cm at the lon-gest distance from the longitudinal axis of the tumor. According to the length of longitudinal axial staining, the thoracotomy was performed. Intraoperative proximal margin resection was used to send frozen pathology. According to the results of freezing, the operation was decided. After the operation, the specimens from the margin of the tumor were segmented into paraffin section, which was about 0. 5cm in each segment, and the tumor cells were observed under the electron microscope at all levels of the paraffin sections. Results The average time of preoperative endoscopic ultrasonography staining was(10. 16 ± 1. 38) min, and the diameter of nano carbon diffusion was(1.43 ±0.41)cm. All patients in the operation could clearly see the nano carbon staining area under the naked eye. In the field, the average time of locating lesions was(1.27 ±0.53)min. 5 patients under-went thoracoabdominal surgery and 13 underwent abdominal surgery. The average length of the cut margin of the tumor was(4. 74 ±1.12)cm, and the frozen pathology of the incision margin was negative, and no additional operation was performed. The routine pathology confirmed that all the specimens were negative. Conclusion The staining and labeling technique for adeno-carcinoma of the esophagogastric junction under endoscopic ultrasonography can detect the tumor edge and the scope of invasion accurately. It provides guidance and guarantee for the smooth implementation of AEG precision surgery. It is a safe, rapid and effective positioning technique.