Simultaneous detection of esophageal and gastric carcinomas

The case histories of six patients are presented where the diagnosis of carcinoma of the esophagus and the stomach was made at the same time by barium studies. The clinical history was elusive in two patients. In four of the six patients, histological proof of squamous carcinoma of the esophagus and adenocarcinoma of the stomach was obtained, but in the other two biopsy of the gastric lesion was not possible because of the extensive esophageal cancer.     

食道鳞状上皮乳头状瘤23例报告并文献复习

目的：探讨食道鳞状上皮乳头状瘤与食道癌癌前病变的关系。方法：回顾性分析23例食道鳞状上皮乳头状瘤的内镜表现及12例5年追踪随访资料。结果：食道鳞状上皮乳头状瘤是一种罕见的良性肿瘤。结论：食道鳞状上皮乳头状瘤似乎不能作为食道癌的癌前病变，与人类乳头状瘤病毒感染无关，是否具有潜在的恶性损害有待进一步研究。     

皮瓣和肌皮瓣在食管外科中的应用

食管切除后常用胃或结肠来进行重建,但对于一些病变位置过高、合并胃或结肠病变、胃或结肠已做过手术、局限性严重食管狭窄患者,可选择其他方法重建或修复。能用于修复及重建食管皮瓣、肌皮瓣有十余种,根据血供来源分为游离皮瓣及带蒂肌皮瓣。游离皮瓣需血管吻合,一旦出现血管阻塞,易发生皮瓣坏死,以选择带蒂肌皮瓣修复及重建食管为宜。胸大肌皮瓣及背阔肌皮瓣尽管血运丰富,但肌皮瓣臃肿,且难以形成管状重建全周食管。颈阔肌皮瓣面积大,多源性血液供应,单侧可用于修复颈段食管缺损,双侧能重建全周颈段食管,手术操作简便,疗效可靠,长期随访皮瓣无溃疡及毛发生长,且能耐受放疗,值得推广应用。     

Early Regenerative Response in the Intrathoracic Porcine Esophagus—The Impact of the Inflammation

In order to improve the treatment of children born with long‐gap esophageal atresia, a porcine model was developed for studying esophageal regrowth using a bridging graft composed of a silicone stented Biodesign mesh. The aim of the study was to investigate how leakage and contact between the native muscle and Biodesign mesh affected the early healing response. Resection of 3 cm of intrathoracic esophagus was performed in 10 newly weaned piglets. They were fed through a gastrostomy 8–10 days prior to sacrifice. In order to achieve nonleaking anastomoses, the silicone stent and suturing technique had to be adjusted between the first four and second six piglets. The technical adjustment decreased leakage. A nonleaking anastomosis could not be achieved when the native muscle layers were sewn less central on the bridging graft compared with the mucosa. If there was leakage, the inflammatory response increased, with islets of perivascular T‐lymphocytes and infiltration of macrophages in the native muscle layers. In the bridging area, new vessels were seen in the submucosa in 9 of 10 piglets between 4 and 10 days after surgery. Smooth muscle cells also appeared to move from the cut muscle edges of both the muscularis mucosa and the lamina muscularis and were seen as a layer of several cells under newly formed mucosa. Double staining of the basal membrane of the ingrowing vessels and the pericytes showed that the basal membrane was thinner over some of the pericytes, but there was no accumulation of immature‐looking cells in the submucosa of the bridging area. In this porcine model, where esophageal regrowth was studied by using a bridging graft composed of a silicone stented Biodesign mesh, we can conclude that leakage increased the inflammatory response in early healing. Ingrowth of new vessels was seen in the bridging area and movement of smooth muscle cells was found under newly formed mucosa.     

Esophageal squamous cell carcinoma: MRI evaluation of mediastinum

Thirty-two patients with esophageal spinocellular (squamous cell) carcinoma were studied with superconductive magnet in order to evaluate local and extraluminal extent, as well as mediastinal lymph node spread of the disease. In the absence of adenopathy, the localized tumors were considered susceptible to surgical treatment. All patients were operated on within 21 days. The resectability criteria were correctly evaluated in 75% of cases; sensitivity and specificity were 86 and 67%, respectively. Unsatisfactory results were obtained in the evaluation of mediastinal adenopathies. We conclude that magnetic resonance imaging (MRI) is useful in the preoperative evaluation of resectability criteria in patients with esophageal squamous cell carcinoma.     

食管癌术后发生急性肾损伤危险因素分析及处理

目的探讨食管癌术后急性肾损伤(acute kidney injury,AKI)的危险因素、临床意义及围手术期处理。方法回顾性分析397例食管癌手术患者的临床资料,统计术后AKI的发生情况,按有无AKI发生分为AKI组和非AKI组,将发生AKI患者与非AKI患者进行相关因素比较分析。结果本组研究397例食管癌手术患者中25例发生AKI,其中Ⅰ期15例,Ⅱ期4例,Ⅲ期6例,总患病率为6.3%。25例发生AKI的患者中,出院时存活21例(占84%),死亡4例(占16%)。AKI与非AKI的相关因素比较:年龄、冠心病、慢性阻塞性肺疾病、术前血肌酐、术前化疗、淋巴结清扫数、术中失血量、手术时间、术后呼吸机应用时间等因素差异,无统计学意义(P0.05);糖尿病、高血压、术后肺部感染及肾外器官衰竭差异有统计学意义(P0.05)。Logistic多因素回归分析结果显示,糖尿病、高血压、术后肺部感染及肾外器官衰竭是食管癌术后并发AKI的独立危险因素。结论 AKI是食管癌患者术后常见的并发症且易被忽视,须注意引起AKI的常见原因,对于存在AKI危险因素的患者加强围手术期管理,严密监测肾功能。一旦发生AKI,预后极差,因此,要早期选择最佳的治疗方案,提高食管癌患者术后生存率,减少病死率。