内镜黏膜下剥离术治疗直肠类癌

目的 对直肠类癌行内镜黏膜下剥离术(ESD),观察其疗效及安全性。方法 以超声内镜指导选择符合内镜黏膜下剥离术指征的14例直肠类癌,病变直径0.5cm-1.5cm,标记切除范围、黏膜下注射、沿标记钩刀切开病灶周围黏膜、剥离病灶、处理创面及术后追踪。结果 14例直肠类癌均成功经内镜切除,ESD手术时间为25min-50min,5例术中创面出血,3例电凝后止血,2例钛夹止血。无术后大量出血,未发生皮下气肿或穿孔。4周-8周后复查超声内镜,创面愈合良好,未见肿瘤残留和复发,随访3月-38月,均无复发。结论 超声内镜指导内镜黏膜下剥离术治疗直肠类癌准确、安全,值得临床推广。     

内镜黏膜下剥离术与内镜下黏膜切除术治疗早期胃癌的效果及术后出血的影响因素分析#br#

目的比较内镜黏膜下剥离术（ESD）与内镜下黏膜切除术（EMR）治疗早期胃癌的效果,分析两种手术后出血的影响因素。方法选取2017年8月至2019年5月首都医科大学附属北京天坛医院收治的92例早期胃癌患者,按治疗方法的不同将其分为ESD组（52例）与EMR组（40例）,比较两组治疗效果及术中、术后并发症发生情况;按术后出血情况,将本组92例患者分为出血组（8例）与未出血组（84例）,比较两组的临床资料,采用多因素Logistic回归分析术后出血的危险因素。结果两组患者均顺利完成手术。ESD组的完整切除率高于EMR组（904% vs. 700%）,治愈性切除率高于EMR组（769% vs. 550%）,差异有统计学意义（P<005）。ESD组的手术时长及切除病灶直径大于EMR组,差异有统计学意义（P<005）;ESD组的术后出血发生率与EMR组比较差异无统计学意义（96% vs. 75%,P>005）,术中穿孔发生率两组比较差异无统计学意义（P>005）;与未出血组比较,出血组患者长期使用抗凝药史比例高,病灶直径大,手术时间长,病灶位置为胃上1/3的比例高（P<005）。多因素Logistic分析结果显示,长期使用抗凝药物、病灶直径大、病灶位置为胃上1/3及手术时间长是影响早期胃癌患者术后出血的危险因素（P<005）。结论ESD治疗早期胃癌的病灶切除率高于EMR,长期使用抗凝药物、手术时间过长、胃上1/3部位病变及病变直径大于4 cm是早期胃癌患者行ESD或EMR术后出血的危险因素。     

内镜下黏膜剥离术治疗早期食管癌1例

内镜黏膜切除术（endoscopic mucosal resection,EMR）是内镜治疗的一种方法,常用来治疗消化道扁平型腺瘤或早期癌,适用于〈2cm的病变。而近些年发展起来的内镜黏膜下剥离术（endoscopic submucosa dissection,ESD）主要应用于消化道早期癌,并使得〉2cm的病变也能在内镜下一次完整性切除。     

内镜下治疗上消化道黏膜下肿瘤426例的临床观察

目的 观察经内镜治疗食管、胃和十二指肠的黏膜下肿瘤（SMT）的疗效和安全性以及术后病理组织学诊断情况。方法 共入组426例上消化道SMT患者,其中位于食管346例,胃79例,十二指肠1例。经超声内镜诊断SMT 位于黏膜肌层284例,黏膜下层87例,固有肌层55例。病变最大直径为0.4～6cm,平均（0.90±0.03）cm。426例SMT中333例行黏膜切除术（EMR）,37例行黏膜剥离术（ESD）,47例行黏膜挖除术（ESE）,9例行全层切除术（EFR）。结果 EMR组中314例完整切除病变,完整切除率为94.3％。ESD组、EFR组均完整切除病灶,完整切除率100.0％。ESE组44例病灶完整切除,完整切除率93.6％（44／47）,3例治疗失败转行外科手术。ESD组穿孔和出血各1例,发生率为2.7％;ESE组穿孔2例,出血2例,发生率为 4.25％。EFR组为实现病灶完整切除,均将瘤体以及与之相连的固有肌层一并切除,实施主动穿孔,术后完全缝合胃壁缺损。术后病理组织学结果显示平滑肌瘤326例,间质瘤58例,异位胰腺、脂肪瘤、潴留囊肿、颗粒细胞瘤、血管机化、淋巴管瘤、血管瘤和神经鞘瘤共42例。患者术后均随访2年,无一例复发。结论 经内镜治疗上消化道SMT安全、有效。     

大肠息肉内镜下治疗的临床研究

目的 根据大肠息肉的不同大小、形态、病理类型,探讨其内镜下治疗方法的不同.方法 对288例患者行结肠镜下息肉摘除术405颗,根据不同大小、形态、病理类型与内镜下治疗方法的临床资料进行回顾性分析.结果 非肿瘤性息肉共52颗,热活检钳以及高频电凝电切除术摘除49颗,内镜下黏膜切除术(EMR)摘除3颗;肿瘤性息肉中隆起型息肉260颗,热活检钳以及高频电凝电切除术摘除250颗,内镜下黏膜切除术(EMR)摘除10颗;平坦型和凹陷型息肉共85颗,热活检钳以及高频电凝电切除术摘除66颗,EMR摘除19颗;早期癌8颗,高频电凝电切除术摘除3颗,EMR摘除4颗,内镜下黏膜剥离术(ESD)摘除1颗.结论 大肠息肉治疗根据息肉不同大小、形态、病理类型可采取不同的内镜下治疗方法.     

EMR和ESD治疗早期结直肠癌的临床疗效分析

目的：探讨内镜下黏膜切除术（endoscopic mucosal resection,EMR）和内镜黏膜下剥离术（endoscopic submucosal dissection,ESD）治疗早期结直肠癌的临床效果及安全性。方法：回顾性分析2015年5月至2021年12月在福建省立医院南院行内镜治疗的早期结直肠癌患者的资料。根据治疗方法不同,分为EMR和ESD两组,比较两组患者手术时间、整块切除率、完全切除率、并发症发生率及复发率。结果：共纳入167例患者,其中EMR组74例,ESD组93例。ESD组的手术时间均长于EMR组（P<0.05）。病变直径≥20 mm时,ESD组病灶整块切除率、完全切除率高于EMR组（P<0.05）;病变直径<20 mm时,EMR组和ESD组病灶整块切除率及完全切除率差异无统计学意义（P>0.05）。在EMR组中,病变直径≥20 mm的整块切除率和完全切除率均低于病变直径<20 mm(P<0.05)。ESD组术后并发症发生率高于EMR组（P<0.05）。ESD组术后复发率低于EMR组,差异无统计学意义（P>0....     

高频超声内镜在食管癌高发区早期癌及癌前病变诊治中的价值

  目的  探讨超声内镜在食管癌高发区早期癌及癌前病变诊断及治疗中的价值。  方法  回顾分析2008年6月至2010年6月在食管癌高发区涉县、磁县进行普查发现的118例早期食管癌及癌前病变患者, 所有病例均行超声内镜(endoscopic ultrasonography, EUS)检查, 符合镜下治疗标准的内镜辅以碘染色并行内镜下黏膜切除术(endoscopic mucoscal resection, EMR), 余手术治疗。对所有行EMR术及手术治疗的患者术前EUS及术后病理结果进行对照分析。  结果  EUS判断食管早期癌及癌前病变影像学结果显示: 黏膜层癌97例、黏膜下层癌21例, EUS与病理检查结果对照判断浸润深度, 结果相符者103例, 准确率87%, 其中对黏膜层癌判断的准确率90%, 对黏膜下层癌判断的准确率76%。  结论  EUS准确评估病灶内镜可切除性, 使得内镜下黏膜切除手术更为安全有效, 对指导高发区早期食管癌和癌前病变内镜下治疗具有重要价值。      

内镜下切除结直肠癌后追加根治手术相关风险探究

[目的]探讨评估结直肠肿瘤行内镜下切除后患者需追加根治手术的相关风险因素。[方法]2005年1月至2012年6月宁波市第二医院肌肠外科行内镜黏膜下剥离术（ESD）和内镜黏膜切除术（EMR）治疗结直肠肿瘤患者其186例,其中追加根治性手术患者共63例,包括ESD41例。EMR22例。回顾性统计资料包括患者的性别、年龄、肿瘤部位、数目、直径、形态、切除方式、浸润深度、组织分化、切缘特点等．随访术后恢复情况．探讨内镜下治疗临床早期结直肠癌需追加根治性手术的相关风险因素。[结果]根据有无追加根治性手术分为两组,即单纯内镜治疗组和内镜治疗＋追加手术组．两组患者性别、年龄方面无显著统计学差异。单因素危险分析结果显示,肿瘤部位、大小、肿瘤形态和切除方式是影响早期结直肠癌患行内镜治疗效果的危险因素。[结论]抬举征阳性、肿瘤位于结肠近侧、隆起型和分块切除是影响内镜下切除结直肠癌后根治性切除重要的因素,有必要积极追加手术。     

内镜黏膜下剥离术治疗早期胃癌的可行性研究

目的探讨内镜黏膜下剥离术(ESD)治疗早期胃癌的可行性。方法选取142例早期胃癌患者作为研究对象,观察ESD与EMR(内镜黏膜切除术)治疗早期胃癌的临床疗效。结果 ESD组一次性完全切除率、治愈性切除率均显著高于EMR组(P<0.05);ESD组可能治愈性切除率、非治愈性切除率显著低于EMR组(P<0.05);ESD组肿瘤复发率显著低于EMR组(P<0.05);ESD组术中出血率和穿孔率分别为3.53%和2.35%,均显著低于EMR组的19.30%和8.77%(P<0.05);ESD组3年生存率显著高于EMR组(P<0.05)。结论 ESD治疗早期胃癌具有病灶切除彻底、复发率低、并发症少等优点,具有较好的应用前景。     

内镜黏膜下剥离术治疗消化道黏膜下肿瘤22例临床分析

目的 探讨内镜黏膜下剥离术(ESD)治疗消化道黏膜下肿瘤(SMT)的疗效和安全性.方法 选取据其临床表现及经内镜超声检查结果确诊为SMT的患者22例,肿瘤直径0.5 ～3.0 cm,均行ESD治疗,术后进行3个月、6个月、12个月及24个月的随访及内镜复查.结果 22例SMT患者行ESD均一次性完整切除,基底和切缘均未见病变累及.病理学诊断:食管平滑肌瘤6例,早期食管癌2例,胃平滑肌瘤3例,胃高级别上皮内瘤变4例,胃黏膜内癌2例,直肠腺瘤癌变4例,结肠脂肪瘤1例.手术时间(自进镜开始至完整剥离病变)35 ～ 116 min,平均53 min.22例患者均未出现皮下气肿、纵隔气肿、隔下游离气体等穿孔体征,无大出血及迟发性出血等严重并发症.所有患者术后住院时间为4～7d,平均5.5d.术后均随访3个月、6个月、12个月及24个月,复查胃肠镜,均未见复发.结论 ESD是治疗SMT的一项简单有效、并发症少、费用低、术后恢复快、安全可靠的治疗手段,在提供完整的病理学诊断资料的同时还可以完整切除病变,值得临床推广.     

Bacteria and cancer--antagonisms and benefits

There is considerable historical and recent evidence concerning the antagonisms between acute bacterial infections or their toxins and cancer and allied diseases. These data provide renewed incentives to undertake clinical programmes with mixed bacterial vaccines in many countries at the present time.     

Religiosity and physical and emotional functioning among African American and White colorectal and lung cancer patients

The literature suggests that religiosity helps cope with illness. The present study examined the role of religiosity in functioning among African Americans and Whites with a cancer diagnosis. Patients were recruited from an existing study and mailed a religiosity survey. Participants (N = 269; 36% African American, 56% women) completed the mail survey, and interview data from the larger cohort was utilized in the analysis. Multivariate analyses indicated that in the overall sample religious behaviors were marginally and positively associated with mental health and negatively with depressive symptoms. Among women, religious behaviors were positively associated with mental health and negatively with depressive symptoms. Religiosity was not a predictor of study outcomes for men. Among African Americans, religious behaviors were positively associated with mental health and vitality. Among Whites, religious behaviors were negatively associated with depressive symptoms. These findings suggest a mixed role of religious involvement in cancer outcomes. The current findings may have applied potential in the areas of emotional functioning and depression.     

Genetic polymorphisms of alcohol and aldehyde dehydrogenases and risk for esophageal and head and neck cancers

Alcoholic beverages are causally related to cancer of the oral cavity, pharynx, larynx and esophagus. Ethanol is oxidized to acetaldehyde and then to acetate by alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH), both of which have genetic polymorphisms. A review of case-control studies of the effects of ALDH2, ADH2 and ADH3 genotypes shows consistently positive associations between inactive heterozygous ALDH2 and the less-active ADH2 genotypes and the risk for esophageal cancer in East Asian heavy drinkers and this enzyme-related vulnerability may extend to light-to-moderate drinkers. Some studies suggest similar associations with the risk for head and neck cancer in moderate-to-heavy-drinking Japanese. An established carcinogen in experimental animals, acetaldehyde can interact with human DNA. ALDH2-associated cancer susceptibility fits into a scenario in which acetaldehyde plays a critical role in the development of human cancer. Alcohol flushing and drinking behavior may partly explain this carcinogenic effect in carriers of less-active ADH2 genotypes. Whether the ADH3 genotype influences head and neck cancer risk in Western nations is controversial. Professional and public education about risky conditions connected to the ALDH2 and ADH2 genotypes and environmental factors is important in a new strategic approach to the prevention of alcohol-related cancers in East Asians. The use of simple tests to identify inactive ALDH2 on the basis of alcohol flushing responses could benefit many people, by helping them to identify their own cancer risks. Such testing could also help clinicians diagnose esophageal cancer earlier, through the use of endoscopic screening in the high-risk population.     

Religiosity and Physical and Emotional Functioning Among African American and White Colorectal and Lung Cancer Patients

The literature suggests that religiosity helps cope with illness. The present study examined the role of religiosity in functioning among African Americans and Whites with a cancer diagnosis. Patients were recruited from an existing study and mailed a religiosity survey. Participants (N = 269; 36% African American, 56% women) completed the mail survey, and interview data from the larger cohort was utilized in the analysis. Multivariate analyses indicated that in the overall sample religious behaviors were marginally and positively associated with mental health and negatively with depressive symptoms. Among women, religious behaviors were positively associated with mental health and negatively with depressive symptoms. Religiosity was not a predictor of study outcomes for men. Among African Americans, religious behaviors were positively associated with mental health and vitality. Among Whites, religious behaviors were negatively associated with depressive symptoms. These findings suggest a mixed role of religious involvement in cancer outcomes. The current findings may have applied potential in the areas of emotional functioning and depression.     

Renal irradiation and the pharmacology and toxicity of methotrexate and cisplatinum

We used a rat model to study the effects of renal irradiation on the pharmacology of methotrexate (MTX) and cisplatinum (cis-Pt). Unanesthetized rats were given bilateral kidney irradiation (20 Gy in 9 fractions). At 9 months after irradiation, 3% of the animals had died and survivors showed moderately impaired renal function. At 15 months, 30% of the animals had died and survivors showed severely impaired renal function. Some animals were given i.v. MTX 1 week to 15 months after irradiation. In irradiated rats, the area under the MTX plasma clearance curve equaled that of controls through 6 months, and was significantly above controls from 9 months on. Other animals were given i.p. cis-Pt 1 week to 9 months after irradiation. The acute toxicity of cis-Pt was the same in control and irradiated rats when cis-Pt was given immediately before or after irradiation. Beginning 3 months after irradiation there was a progressive increase in cis-Pt toxicity and a simultaneous decrease in urinary platinum excretion. Irradiated animals that survived cis-Pt treatment showed increased radiation nephritis; the greatest effect occurred when cis-Pt was given 3 months or more after irradiation. MTX and cis-Pt clearance decreased when renal dysfunction was first observed and changes in renal function preceded changes in drug clearance and toxicity.