改良“隧道式”食管胃吻合术

本文报告了３６例改良“隧道式”腔内食管胃吻合的方法在食管外科中重建消化道的应用体会。其中弓上吻合２０例、弓下吻合１６例。全组无手术死亡，无吻合口瘘、吻合口狭窄等吻合口并发症发生，抗返流效果良好。文中对手术步骤及术中注意事项做了较为详尽的叙述。并对手术效果进行了讨论。     

食管内支架置入术并发症分析及防治

目的：分析食管内钛镍记忆合金支架置入术并发症的可能原因及防治方法。方法：共52例病人，食管癌、贲门癌29例，食管胃吻合口狭窄21例，自发性食管破裂2例，共置入各种钛镍记忆合金支架54枚。随访观察3～36个月。结果：内支架置入全部成功，术后患吞咽困难症状均改善。术后出现的并发症包括支架移位3例，支架堵塞9例。吸入性肺炎3例，呕血7例，残余漏2例，疼痛和异物感24例，严重返流症状5例。经过相应的治疗，除2例大呕血患外，其余并发症均得到纠正。结论：虽然食管内钛镍记忆合金支架置入术后有不可忽视的并发症，但经过相应治疗，一般均可纠正，它是治疗食管恶性狭窄和自发性食管破裂有效的方法。     

中国食管癌高发区食管原发性腺癌组织病理学研究Ⅰ．食管原发性腺癌的临床病理学分析

中国食管癌高发区河南省近１５年（１９８０～１９９４）病理确诊的７３６４例食管癌中，其中食管原发性腺癌（ＰＥＡ）２３９例，占３．２５％。通过对２３９例ＰＥＡ手术标本（包括早期癌２０例，其余为中、晚期癌）切片系统观察，指出中国食管癌高发区ＰＥＡ主要起源于食管固有腺体的各级导管部分。ＰＥＡ的病理组织学可分６型：腺导管癌（１０９例）、腺鳞癌（５４例）、腺样囊性癌（２９例）、粘液表皮样癌（２０例）、基底细胞样癌（１５例）、胃型腺癌（１２例）。每型的组织图象及预后均各有特点，提示ＰＥＡ组织学再分型有意义。     

Cancer risk due to occupational exposure to polycyclic aromatic hydrocarbons

Polycyclic aromatic hydrocarbons (PAHs) demonstrate carcinogenic activity in animal models. Although some epidemiologic studies have implicated PAHs as risk factors for human cancer, the evidence reported to date has not been consistent. The purpose of this report is to describe the associations between occupational exposure to PAHs in the workplace and each of 14 types of cancer. A population-based, case-control study was carried out in Montreal to investigate associations between a large variety of environmental and occupational exposures on the one hand, and several types of cancer on the other. A detailed job history was obtained from each subject along with information on a number of potential confounders. Each job history was reviewed by a team of experts, who used this information to construct a corresponding history of occupational exposures. Among the PAH exposures considered were benzo(a)pyrene (B(a)P) and five categories of PAHs defined on the basis of the source material, namely, wood, petroleum, coal, other sources, and any source. Altogether, 3,730 cancer patients and 533 population controls were interviewed and their job exposure histories coded. For each of 14 types of cancer analyzed, three control groups were available: other cancer patients, population controls, and the pooled set of cancer and population controls. The associations between 14 cancer types and 6 PAH exposures were analyzed using logistic regression methods. For most types of cancer evaluated, there was no evidence of excess risk due to PAHs at the levels encountered in the occupations in which PAH exposure has been prevalent in the Montreal area. For a few cancer sites–the esophagus, the pancreas, and the prostate gland–there were suggestions of excess risk; these observations are noteworthy hypotheses for further investigation. For lung cancer, there appeared to be an increased risk due to PAHs among nonsmokers and light smokers, but not among heavy smokers.     

炭素纤维人工食管材料对体外培养细胞的影响

本文报道了应用细胞培养方法研究炭素纤维人工食管材料对细胞的毒性作用。实验结果表明,该材料对于体外培养细胞的形态、细胞的增殖等方面均无不良影响及毒性作用,从而为炭素纤维人工食管材料的应用提供了细胞学根据。     

Response of lower esophageal contractility to changing concentrations of halothane or isoflurane: A multicenter study

A multiple-center study was performed to determine the relationship between lower esophageal contractility, clinical signs, and anesthetic concentration as expressed by minimum alveolar concentration (MAC). One hundred four American Society of Anesthesiologists Class I through III patients were exposed to isoflurane (with and without nitrous oxide) or halothane in concentrations of 0.5, 1.0, and 1.5 MAC. Heart rate and systolic blood pressure were continuously monitored. Both the amplitude and frequency of spontaneous and provoked lower esophageal contractions were measured in situ by using a 24-F probe equipped with provoking and measuring balloons. Combined results demonstrated statistically significant correlations (P<0.001) between lower esophageal contractility and MAC. Spontaneous lower esophageal contractions decreased from 1.10±0.12 (SEM) contractions per minute (0.5 MAC) to 0.42±0.05 (1 MAC) to 0.18±0.05 (1.5 MAC). Provoked lower esophageal contractility values decreased from 45±4 mm Hg (0.5 MAC) to 29±3 (1 MAC) to 19±2 (1.5 MAC). Heart rate changes did not correlate with MAC, and systolic blood pressure correlated in only one of three centers. Intracenter and intercenter analyses failed to demonstrate a significant relationship between lower esophageal contractility and heart rate or systolic blood pressure. No intracenter differences in either amplitude or frequency of lower esophageal contractions were observed, despite differences in volatile agents, induction techniques and agents, patient populations, and duration of anesthesia. Our studies indicate that lower esophageal contractility may be an indicator of anesthetic depth as reflected by MAC, but further studies are needed to quantify the effects of surgical stimulus, intravenous anesthetics, vasodilators, anticholinergics, calcium channel blockers, beta-adrenergic agonists, and the presence of a nasogastric tube.     

血管生成素-2在食管鳞癌中的表达及意义

目的初步探讨血管生成素-2(Angiopoietin-2,Ang-2)在食管鳞状细胞癌组织中的表达及其与肿瘤病理分级、浸润和转移的关系。方法采用S-P免疫组织化学方法,对85例食管鳞癌及22例正常食管组织中的Ang-2表达水平进行检测,并与肿瘤病理分级、浸润深度及淋巴结转移情况进行统计学分析。结果85例食管鳞癌组织中,57例Ang-2表达呈阳性,阳性率为67.06%,显著高于Ang-2在正常食管组织中的表达(P<0.05)。Ang-2表达与肿瘤病理分级和淋巴结转移显著相关(P<0.05)。结论Ang-2的表达与食管鳞癌的临床分期及病理分级呈正相关,提示Ang-2促进肿瘤新生血管形成,参与食管鳞癌的发生和发展,可作为反映食管癌进展的生物学指标。     

高位食管癌切除颈部胃食管重建术的临床应用和初步评价

本文报道了我院自1988年至1994年间采用高位食管癌切除颈部胃食管重建术治疗高位食管癌23例的结果，其中男14例，女9例，年龄35－70岁，平均年龄52岁，病变位于颈段者11例，上胸段者12例。2，3，5年生存率分别为62．5％，55．1％，33．3％。同时介绍了手术要点和该术式的优点，并提出了吻合口瘘的预防措施。     

食管癌与贲门癌术后胃排空障碍15例临床分析

目的：探讨食管癌、贲门癌术后胃排空障碍的病因、诊断及防治。方法：回顾性分析15例食管癌、贲门癌术后胃排空障碍的病因，区分功能性及机械性胃排空障碍的诊断，提出防治措施。结果：15例患者中11例功能性胃排空障碍，经保守治疗治愈。4例机械性胃排空障碍经手术治愈。常规行幽门成形术者，无胃排空障碍发生。结论：食管癌、贲门癌术后胃排空障碍的发生与手术方式、术中操作及迷走神经干的切断等因素有关。应规范手术操作，常规行幽门成形术及辅以胃肠动力药物等进行治疗。