医疗课件-食管疾病.pptVIP

The esophagus is a tubular structure that extends from the pharynx at the level of C6 to the stomach, which it joins within the peritoneal cavity opposite the body of Tll (Fig. 27-1). It measures approximately 35 to 40 cm from the incisor teeth to the esophagogastric junction in the adult. The upper esophagus curves slightly to the left behind the great vessels and returns to the midline at the level of the aortic arch. It then inclines to the right as it continues in the posterior mediastinum. Ultimately, it crosses the thoracic aorta to the left of the midline and angles anteriorly to pass through the diaphragmatic hiatus, a noose of fibers made up predominantly of the right crus of the diaphragm, with varying contribution from the left crus. Histologically, the esophageal wall consists of an inner circular layer of muscle and an outer longitudinal layer without a serosal covering (Higgs et al.,1965). The muscle layers consist of both striated and smooth muscle. The upper 5% of the esophagus consists solely of striated muscle, and the lower 54 to62% consists of smooth muscle; a mixture constitutes the wall of the remaining esophagus in between * * * * * 食 管 疾 病 * 第一节 食 管 癌（esophageal carcinoma） 一、流行病学特点： 食管癌发病率占全世界恶性肿瘤发病率的 第9位 发病率地区差异最大，高发区／低发区可相差60倍。高发区：亚洲、东南非洲和法国北部。美国低发 病理类型：高发区以鳞癌最常见，男＞女，与吸烟饮酒相关；低发区腺癌最常见(北美、西欧)，与胃食管反流性疾病有关 * 二、病因 1、吸烟、重度饮酒 2、长期食物刺激，饮食中含 亚硝酸盐，微量元素，烟酒热饮） 3、遗传 * 三、病理 1、分段：颈段（入口－胸廓入口），胸段（上－胸郭入口至气管分叉平面，中段至下肺静脉水平，下段——下肺以下水平通常包括腹段） 2、分型： 早 期：斑块型，糜烂型，隐伏型，乳头型 中晚期：髓质型，蕈伞型，溃疡型，缩窄型 3、扩散与转移 1、局部侵入：甲状腺，气管，主动脉（早期） 2、淋巴结：纵隔，锁骨上，腹腔（主要） 3、血运转移：肝，肺、骨（晚期） * 食管癌病变的分段标准 胸 段 颈 段 门齿15cm － 18cm 门齿18cm － 24cm 门齿24cm － 40cm 气管分叉 环状软骨下缘 胸骨上缘 食管穿过膈肌 * 食管癌区域淋巴结 颈段食管 斜角肌旁 颈静脉旁 上颈区和下颈区 食管旁 锁骨上区 胸段食管－上中下 上食管旁 （奇静脉以上） 隆突下 上颈区和下颈区 下食管旁 （奇静脉以下） 胃食管交界 下食管旁 （奇静脉以下） 膈肌旁 贲门旁 胃左侧 腹腔 * * Medullary-type tumor expanding