食管癌或贲门癌nm23-H_1基因的表达

目的:本文的目的是探索nm23-H_1基因在食管癌贲门癌形成演化及转移方面的作用。方法:应用原位杂交技术检测129例食管癌、贲门癌组织中nm23-H_1基因表达情况。结果:人食管癌、贲门癌中nm23-H_1表达率高达58.1％(75/129),其中食管鳞癌为68.9％(42/61)、贲门腺癌为51.7％(31/60),食管小细胞癌为25％(2/8)。在鳞癌中表达率最高,小细胞食管癌中表达最低(P<0.05);伴有淋巴结转移者,阳性表达率为48.1(38/79),明显低于无淋巴结转移者,其阳性率为72％(36/50),差异显著(P<0.01);而且nm23-H_1表达与肿瘤分化程度高低及临床病理分期早晚呈显著正相关。结论:本组资料表明:nm23-H_1基因在食管癌、贲门癌的形成、演化及转移方面起重要作用,可望成为评价食管癌、贲门癌预后的一项新指标。     

食管癌肉瘤的免疫组织化学研究

目的 探讨食管癌肉瘤的组织发生学。方法 应用免疫组织化学ＬＳＡＢ法检测２０例食管癌肉瘤的石蜡切片中Ｋｅｒａｔｉｎ，ＥＭＡ，Ｖｉｍｅｎｔｉｎ，Ａｃｔｉｎ，Ｄｅｓｍｉｎ，Ｍｙｏｇｌｏｂｉｎ，ＮＳＥ，Ｓ－１００，ＭＡＣ ３８７，α１－ＡＣＴ和Ｌｙｓｏｚｙｍｅ１２种标记。结果 癌肉瘤中的癌成份上皮性标记均为阳性。１６例鳞癌Ｋｅｒａｔｉｎ＋＋＋，２例腺样衰性癌Ｋｅｒａｔｉｎ＋＋，ＥＭＡ＋＋；１例粘液表皮样癌     

高龄食管癌82例临床分析

目的探索高龄食管癌的疾病特点和最佳治疗方案。方法对82例高龄食管癌患者临床资料进行回顾性分析。结果误诊39例。术后近期并发症共19例，远期并发症共8例。治愈33例，好转30例，未治12例，自动出院6例，死亡1例。结论手术治疗仍是高龄食管癌的首选治疗方式，其次为带膜食管支架置入和化疗。详细的病史询问、对高龄食管癌疾病特点的充分认识、规范的住院医疗制度是避免误诊、漏诊的重要措施。围手术期治疗规范与否是防治高龄食管癌术后并发症的关键所在。     

Esophageal lipomatosis: another consequence of the use of steroids

After we incidentally found on CT extensive esophageal fat accumulations in a patient with long-term use of steroids, we prospectively evaluated during a 6-month period all CT studies of the chest for esophageal lipomatosis and related the findings to the possible use of steroids. The diagnosis of esophageal fat on CT was made by density measurements or if too small for reliable density measurements by comparison with mediastinal fat. In 21 of 1320 exclusively older male patients the diagnosis of esophageal lipomatosis was definite in 7 and likely in 14 patients. All fat accumulations were located in the upper third of the esophagus (mean length 22 ± 6 mm) and presented ring-like (n = 10), irregular (n = 3), or as a horseshoe sparing the posterior border (n = 8). In 20 patients there was an unequivocal history of steroid treatment. Associated centripetal fat infiltration was found in 11 patients. None of the patients had swallowing problems. Prolonged use of steroids, either orally or inhalationally administered, is associated with esophageal lipomatosis. The predisposition for the upper esophagus might be related to the presence of striated muscle cells in this part of the esophagus; moreover, inhalational steroid therapy may adversely affect the upper esophagus. Received: 3 April 2000; Accepted: 2 May 2000     

金属硫蛋白在食管鳞癌中的表达及其与增殖凋亡的关系

目的:探讨金属硫蛋白在食管鳞癌中的表达及其与癌细胞增殖、凋亡的关系。方法:采用免疫组化法检测92例食管鳞癌组织中的金属硫蛋白(MT)、增殖细胞核相关抗原(Ki-67抗原)的表达,并用TUNEL法检测细胞凋亡指数。结果:92例食管鳞癌标本中65例MT呈阳性表达,阳性率为70.6%,明显高于正常食管粘膜上皮组织(3/20,P<0.01);MT表达与食管鳞癌患者年龄、性别、浸润深度及病变长度无关,而与组织分化程度、TNM分期、淋巴结转移密切相关,MT与Ki-67抗原表达强度呈正相关,Pearson列联系数=0.227(P<0.05)。随MT表达强度的增加,癌组织凋亡指数逐渐降低。结论:MT表达与食管鳞癌的发生、发展密切相关,MT能促进癌细胞增殖,抑制细胞凋亡,可作为食管鳞癌治疗的新靶点。     

Recent improvements in the management of esophageal anastomotic leak after surgery for cancer

Anastomotic leakage following total gastrectomy or esophagectomy is a significant complication that considerably increases postoperative mortality. The location of the anastomosis together with the anatomy of the esophagus explains the severity of this complication. Surgical knowledge should include general and specific predictive factors of leakage to avoid any technical-related cause of leakage.Clinical presentations may vary from minimally symptomatic to life-threatening situations. Investigations should be undertaken as soon as the diagnosis is suspected because delay greatly worsens the prognosis. CT scans with oral contrast and low insufflation early endoscopy are the preferred diagnostic tools and can also aid in therapeutic procedures.Communication and multidisciplinary teamwork are the cornerstones of treatment. When the leak occurs early with acute and important sepsis, the recommendation is surgical treatment. On the contrary, if the leak is late, non-symptomatic or minimally symptomatic, conservative management with intensive surveillance could be proposed. When the situation is in between these two extremes, endoscopic treatment is often proposed.Based on a review of the literature and experience from high volume centers, in this educational review, we present the incidence, predictive factors, clinical presentations, diagnostic tools, management, and therapeutic algorithms for anastomotic leaks following elective esophagectomy and total gastrectomy for cancer.