经内镜栓塞术联合套扎术治疗食管胃底静脉曲张出血的疗效观察

目的探讨胃底静脉曲张栓塞术联合内镜下食管静脉曲张套扎术（EVL）治疗肝硬化上消化道出血的疗效。方法经急诊胃镜检查发现活动性胃底静脉曲张出血合并Ⅱ°以上食管静脉曲张且排除其他病因的上消化道出血患者共156例,分为治疗组和对照组,治疗组胃底静脉曲张组织粘合剂栓塞同时食管静脉EVL治疗;对照组胃底静脉曲张组织粘合剂栓塞治疗2个月后行食管静脉EVL。结果两组均未发生与治疗相关的并发症。止血成功率治疗组为96．3％（77／80）,对照组为97．4％（74／76）,（P〉0．05）;近期再出血率治疗组为6．4％（5／78）,对照组为21．3％（16／75）,两组差异有统计学意义（P〈0．05）;两组患者随访6个月,再出血率分别为13．0％（9／69）、25．4％（17／67）,差异有统计学性意义（P〈0．05）。胃底静脉曲张改善总有效率治疗组和对照组分别为61．6％、59．1％,食管曲张静脉改善总有效率为74．0％、67．9％,差异均无统计学意义。结论胃底静脉曲张栓塞联合EVL是治疗肝硬化胃底静脉曲张出血并食管静脉曲张的安全有效方法,同时联合治疗更能降低再出血率。     

健康志愿者和胃食管反流病患者食管动力的性别差异

背景：食管动力受多种因素影响，性别因素对食管动力的影响尚不清楚。目的：探讨健康志愿者、非糜烂性反流病（NERD）和反流性食管炎（RE）患者食管动力的性别差异。方法：83例健康志愿者以及具有典型胃食管反流症状的NERD患者196例和RE患者104例纳入本研究。受试者行食管测压，测定下食管括约肌压力（LESP）和食管体部运动功能（包括食管体部各段蠕动收缩波幅、蠕动波传导速度和湿咽成功率）。结果：RE组男性患者比例显著高于NERD组（69．2％对43．4％，P〈0．05）。健康对照组和NERD组男性基础LESP较女性显著降低（P〈0．05），男性健康志愿者食管体部近端蠕动收缩波幅显著低于女性（P〈0．05），男性RE患者湿咽成功率显著低于女性患者（P〈0．05）。男性NERD患者LESP降低发生率显著高于女性患者（45．9％对29．7％，P〈0．05），男性RE患者食管体部运动功能障碍发生率显著高于女性患者（68．1％对46．9％，P〈0．05）。结论：无论是胃食管反流病（GERD）患者还是健康志愿者，男性的食管动力均较女性差，男性性别是GERD发病的危险因素之一。     

影像引导放疗联合替吉奥治疗老年胃食管结合部癌的疗效观察

目的观察影像引导放射治疗（IGRT）联合替吉奥（S-1）治疗老年胃食管结合部癌患者的近期疗效及不良反应。方法将76例老年胃食管结合部癌患者随机分为治疗组40例、对照组36例,两组均接受IGRT和一般支持治疗,治疗组加服S-1化疗。完成放疗及2个周期化疗后,评估两组近期疗效、生活质量、不良反应发生率及生存率。结果治疗组、对照组梗阻症状缓解率分别为92．5％、83．3％,生活质量总有效率分别为80．0％、83．3％,两组比较P均〉0．05;近期临床治疗总有效率分别为75．0％、50．0％,两组比较P〈0．05。治疗组1、2年生存率分别为75．0％、47．2％,高于对照组的45．0％、27．8％（P均〈0．05）;治疗组血液学毒性及消化道反应较对照组重,但两组比较P均〉0．05。结论IGRT联合S-1治疗老年胃食管结合部癌可改善患者的生活质量,提高近期疗效,延长生存期。     

Paxillin和PTEN在胃腺癌组织中的表达及其临床意义

目的研究正常胃黏膜和胃腺癌组织中桩蛋白（Paxillin）及张力蛋白同源的磷酸酶基因（PTEN）的表达及其临床意义。方法应用免疫组织化学sP法分别检测Paxillin和VrEN在40例正常胃黏膜组织、88例胃腺癌组织中的表达,并探讨其与胃腺癌临床病理特征的关系以及二者之间表达的相关性。结果胃腺癌组织中Paxillin阳性表达率（72．5％）明显高于正常胃黏膜（32．5％）（P〈0．05）;PTEN阳性表达率（47．7％）明显低于正常胃黏膜（100％）（P〈0．05）。胃腺癌组织中PaxiUin和PTEN的表达与胃腺癌浸润深度、分化程度、淋巴结转移及临床分期有关（P〈0．05）,与年龄和性别无关（P〉0．05）。经Spearman相关分析,胃腺癌组织中Paxillin与PTEN的表达呈显著负相关（r=-0．369,P〈0．05）。结论胃腺癌组织中Paxillin蛋白水平的高表达与PTEN蛋白水平的低表达可能与胃腺癌的浸润和淋巴结转移等恶性生物学行为相关,二者联合检测可能成为一组能够有效判断胃癌恶性程度和患者预后的指标。     

内镜组织黏合剂注射联合套扎序贯治疗食管胃静脉曲张疗效观察

背景：临床上对胃静脉随张（GV）合并食管静脉曲张（EV）的内镜治疗方法和治疗时机选择尚未统一。目的：探讨内镜组织黏合剂注射联合套扎序贯治疗食管胃静脉曲张的疗效及其最佳时机。方法：2007年1月。2009年6月南京医科大学第一附属医院56例内镜检查确诊为GV活动性出血合并中重度EV者纳人研究,其中26例于GV组织黏合剂注射1周后行EV套扎（A组）,30例注射后立即行EV套扎（B组）。回顾性分析两组患者的止血率、治疗相关并发症发生情况、治疗后1个月内和6个月内再出血率以及食管胃静脉曲张改善有效率。结果：A组与B组问止血率（96．2％对96．7％）和食管胃静脉曲张改善总有效率（GV：72．7％对72．0％;EV：81．8％对84．0％）无明显差异,A组治疗后1个月内和6个月内再出血率均显著高于B组（1个月内：26．1％对10．3％,P〈0．05;6个月内：45．5％对32．O％,P〈0．05）。两组均无明显治疗相关并发症发生。结论：内镜GV组织黏合剂注射后立即行EV套扎序贯治疗食管胃静脉曲张安全、有效．值得在临床上推广应用。     

心得安、硬化剂及两者联合预防食管胃底静脉曲张再出血的研究

目的比较心得安、硬化剂及两者联合预防食管胃底静脉曲张再出血的临床疗效。方法115例食管胃底静脉曲张破裂出血患者,随机分为三组,其中接受心得安治疗40例,硬化剂治疗35例,硬化剂联合心得安治疗40例,比较三组患者3个月、6个月、1年、2年不同时间段的再出血率、死亡率和并发症情况。结果3个月和6个月内三组患者再出血率比较,差异均无统计学意义（P〉0．05）;1年和2年内硬化剂联合心得安组再出血率均低于心得安组,差异有统计学意义（P〈0．05）;1年内硬化剂组与心得安组的再出血率无明显差异（P〉0．05）,而2年内硬化剂组再出血率低于心得安组,差异有统计学意义（P〈0．05）,三组患者的死亡率和并发症比较,无明显差异（P〉0．05）。结论硬化剂联合心得安预防再出血疗效最好,硬化剂次之,心得安最差。     

进展期胃癌术前冲击化疗联合术中腹腔内温热化疗疗效观察

目的观察术前短程冲击化疗联合术中即时腹腔内温热灌注化疗治疗进展期胃癌的临床疗效。方法136例进展期胃癌随机分术前短程冲击化疗联合术中腹腔内温热灌注化疗组（治疗1组）、术前短程冲击化疗组（治疗2组）和单纯手术组（对照组）,比较三组患者的手术并发症发生率和术后长期生存率。结果治疗1组的3a生存率为88．1％,明显高于治疗2组（68．1％）和对照组（42．6％）（P〈0．05）,治疗1组2a内无复发,治疗2组、对照组复发率为17．0％、38．3％,差异有统计学意义（P〈0．05）。结论进展期胃癌术前短程冲击化疗联合术中即时腹腔内温热灌注化疗能提高患者生存率,延缓肿瘤复发。     

和肝汤治疗胃食管反流病40例

[目的]观察方和谦教授经验方和肝汤治疗胃食管反流病（GERD）临床疗效。[方法]80例GERD随机分为2组,每组40例,对照组口服奥美拉唑,治疗组加服和肝汤治疗,疗程均8周,疗后6、12个月各随访1次。[结果]2组患者症状疗效比较：总有效率治疗组92．5％,对照组77．5％（P〈0．05）。2组内镜疗效比较：总有效率治疗组97．5oA,对照组95．0％（P〉0．05）。2组复发率比较：治疗组治疗6、12个月分别为12．5％,22．5％;对照组分别为22．5％,55．0％（P〈0．05）。[结论]和肝汤治疗GERD具有显著改善临床症状,减轻内镜下食管黏膜组织的病损程度,降低复发率及延长复发时间的功效。     

联合介入与外科手术预防肝硬化胃食管静脉出血的对照研究

目的探讨胃底静脉栓塞联合部分性脾动脉栓塞预防肝硬化食管胃底曲张静脉破裂出血的有效性。方法将125例肝硬化门脉高压患者随机分为胃底静脉栓塞联合部分性脾动脉栓塞组（A组，60例）和胃底静脉断流加脾切除组（B组，65例）分别进行治疗，对比两组治疗前后内镜下食管胃底曲张静脉变化、血清ALT、总胆红素水平、再出血率、术后并发症发生率及术后死亡率等。结果治疗后1个月A、B两组共112例患者接受胃镜复查，两组食管胃底曲张静脉消失率（分别为90．9％和87．7％）差异无统计学意义（P〉0．05）。治疗后1周，B组血清ALT、总胆红素水平（分别为156U／L和86μmol／L）显著高于A组（分别为65U／L和34μmol／L）及治疗前（分别为51U／L和45μmol／L）。A、B两组曲张静脉破裂再出血率分别为7．3％和12．3％，差异无统计学意义（P〉0．05），但术后并发症发生率（分别为3．3％和18．5％）、Child-Pugh C级患者死亡率（分别为1／15和6／11）及急性胃黏膜出血发生率（分别为20．0％和45．6％）差异有统计学意义（P〈0．05）。结论胃底静脉栓塞联合部分性脾动脉栓塞预防肝硬化食管胃底静脉曲张破裂出血的近期疗效优于胃底静脉断流加脾切除术。该技术对患者创伤小、并发症少、手术死亡率低，特别对于肝功能较差、不能耐受外科手术的患者是较为理想的选择。     

Paxillin、FAK和PTEN在胃腺癌组织中的表达及其临床意义

背景：研究表明Paxillin、黏着斑激酶（FAK）和PTEN在许多肿瘤的发生、发展、侵袭、转移中发挥重要作用,但联合检测三者在胃癌中表达的报道罕见。目的：研究正常胃黏膜和胃腺癌组织中Paxillin、FAK和PTEN的表达及其临床意义。方法：以免疫组化SP法分别检测40例正常胃黏膜组织和88例胃腺癌组织中Paxillin、FAK和PTEN表达,并分析其与胃腺癌临床病理特征的关系以及Paxillin与PTEN表达之间的相关性。结果：与正常胃黏膜组织相比,胃腺癌组织Paxillin（65．9％对32．5％,P〈0．05）、FAK（56．8％对17．5％,P〈0．05）阳性表达率显著增高,PTEN阳性表达率显著降低（47．7％对100％,P〈0．05）。Paxillin、FAK和PTEN表达与胃腺癌分化程度、浸润深度、淋巴结转移和TNM分期有关（P〈0．05）．与性别和年龄无关。胃腺癌组织中Paxillin表达与PTEN表达呈显著负相关（r=-0．369,P〈0．05）。结论：Paxillin、FAK高表达和PTEN低表达可能与胃腺癌的浸润、淋巴结转移等恶性生物学行为相关,联合检测三者可能有助于判断胃腺癌恶性程度和患者预后。     

Pancreaticoduodenectomy following chemoradiotherapy for locally advanced adenocarcinoma of the pancreatic head

Objectives: The aim of this study was to assess oncological outcomes in patients treated with pancreaticoduodenectomy for advanced pancreatic head adenocarcinoma after preoperative chemoradiotherapy and to compare these with outcomes in patients treated with surgery alone.Methods: From 2004 to 2009, patients treated with pancreaticoduodenectomy for pancreatic head adenocarcinoma were included in a retrospective comparative study. Patients with locally advanced adenocarcinoma were treated with preoperative chemoradiotherapy (CRT group) and were compared with those treated with surgery alone (SURG group).Results: A total of 111 patients were included; these comprised 72 patients in the SURG group and 39 patients in the CRT group. The median follow-up was 21 months. Patients in the CRT group presented with a more advanced tumoral status. Microscopic resection rates were similar in both groups, but nodal status and vascular or lymphatic emboli were lower in the CRT group. At 3 years, the SURG and CRT groups exhibited similar overall (36% and 51%, respectively) and disease-free (35% and 37%, respectively) survival (P = 0.10).Conclusions: In patients with advanced pancreatic head adenocarcinoma, a good response after preoperative chemoradiotherapy results in a survival rate similar to that in patients treated with surgery alone in whom the initial prognosis is better.     

Resection surgery with neoadjuvant chemoradiotherapy improves outcomes of patients with T4 esophageal carcinoma

The prognosis of patients with T4 esophageal carcinoma is poor, and thus an effective treatment needs to be established. The present study assessed the effect of chemoradiotherapy (CRT), postoperative morbidity and mortality, and survival time in 41 patients with T4 esophageal carcinoma. Of these, 24 received CRT followed by surgery (group A) and the remaining 17 were treated with CRT alone (group B). Postoperative complications in group A were compared with 251 patients (group C) who underwent surgery without CRT during the same period. Postoperative complications were more frequent in group A than group C (29.2% vs 8.4%, P < 0.05). The overall median survival of group A was statistically longer than that of group B (13.8 months and 3.3 months respectively, P < 0.001). Complete histologic response (grade 3) was documented in 4 group A patients (16.7%). The overall median survival of grade 3 patients was statistically longer than the rest of group A (38.9 months vs 8.8 months, P < 0.05). The data confirm that chemoradiotherapy creates tumor regression in some patients and allows resection surgery in T4 esophageal carcinoma. Moreover, surgery with CRT confers a survival advantage in T4 esophageal carcinoma.     

Extensive surgery after high-dose preoperative chemoradiotherapy for locally advanced recurrent rectal cancer

PURPOSE: This was a pilot study of high-dose preoperative concurrent radiation and chemotherapy before extensive surgery in patients with locally advanced recurrent rectal cancer. Here we report on curative resectability, acute toxicities during chemoradiotherapy, surgical complications, local control, and three-year survival rates achieved with this aggressive multimodal regimen. METHODS: Between 1994 and 1997, 35 previously nonirradiated patients with pelvic recurrence of rectal cancer were entered in the study. All patients presented with tumor contiguous or adherent to adjacent pelvic organs and were not deemed amenable to primary curative surgery. A total radiation dose of 50.4 Gy with a small-volume boost of 5.4 to 9 Gy was delivered in conventional fractionation (single dose, 1.8 Gy). 5-Fluorouracil was scheduled as a continuous infusion of 1,000 mg/m²/day on Days 1 to 5 and 29 to 33. Six weeks after completion of chemoradiotherapy, patients were reassessed for resectability, and radical surgery was attempted whenever feasible. RESULTS: After preoperative chemoradiotherapy 28 of 35 patients (80 percent) underwent resection with curative intent. In 16 of 35 patients (57 percent) extended resection of adjacent organs was performed. Resections with negative margins were achieved in 17 patients (61 percent); 9 patients had microscopic, and 2 patients had gross residual disease. There was no postoperative mortality. Fourteen patients (44 percent) experienced postoperative complications. Toxicity from chemoradiotherapy occurred mainly as diarrhea (National Cancer Institute Common Toxicity Criteria Grade 3; 23 percent), dermatitis (Grade 3; 11 percent), and leucopenia (Grade 3; 11 percent). One patient died of tumortoxic multiple organ failure during chemoradiotherapy. With a median follow-up of 27 months, local re-recurrence after curative resection was observed in only three patients (18 percent); six patients developed distant metastases. Three-year actuarial survival rate was significantly improved after complete resection (82 percent) as compared with noncurative surgery (38 percent;P=0.03). CONCLUSION: A combination of high-dose preoperative chemoradiotherapy followed by extended surgery can achieve clear resection margins in more than 60 percent of patients with recurrent rectal tumor not amenable to primary surgery. An encouraging trend evolved for this multimodal treatment to improve long-term local control and survival rate.Presented at the meeting of the German Society for Radiation Oncology, Radiation Biology and Medical Physics (DEGRO), Nürnberg, Germany, November 7 to 10, 1998.     

Locally advanced adenocarcinomas of the gastric cardia: results of pre-operative chemoradiotherapy

Overall prognosis of adenocarcinomas of the gastro-esophageal junction remains poor as most patients present with advanced disease. AIM: To examine the effects of preoperative chemoradiotherapy in locally advanced adenocarcinomas of the gastro-esophageal junction. METHODS: Forty-two consecutive patients received a course of radiotherapy (45 Gy, administred in 25 fractions) with concurrent infusion of 5-Fluorouracil and cisplatin, followed by surgery. Endoscopic ultrasonography was used to assess response to chemoradiotherapy. A transhiatal or a transthoracic approach was used for surgical resection. Tumor size, node invasion and margins of resection were analyzed. RESULTS: Thirty-eight patients underwent subsequent surgery and complete resection (RO) was achieved in 34. Operative mortality was 13.2% (5/38). A histological complete response was observed in 6 patients. Median survival was 23 months (range: 15-31) and median disease-free survival was 19 months (range: 15-23). At one and two years, 70.7 and 45.6% of the patients were alive, respectively. The pTNM status, node involvement and tumor size were predictors of survival. CONCLUSIONS: Pre-operative chemoradiotherapy is effective in patients with locally advanced carcinoma of the gastro-esophageal junction, resulting in high resection rates. However it seems to increase operative morbidity and mortality. Certain prognostic factors such as resection margins, need to be examined in further detail.     

术前联合放化疗与单纯手术治疗食管癌疗效的Meta分析

目的:比较术前联合放化疗联合手术与单纯手术对可切除食管癌患者的影响.方法:使用计算机及手工检索两种方法在Pubmed和Embase中搜索相关随机对照实验,以确保无文献遗漏.结果:共纳入包含1544名患者的12篇文献.术前联合放化疗较单纯手术明显提高了患者的1年、3年和5年生存率,其OR(95%CI,P值)分别为1.28(1.01-1.64,P=0.05);1.84(1.29-2.63,P=0.00);1.53(1.17-2.00,P=0.00).术前放化疗增加了术后死亡率,但并不增加术后的并发症发生率,其OR(95%CI;P值)分别为1.71(1.06-2.76,P=0.03)和1.15(0.89-1.49,P=0.28).术前放化疗降低了肿瘤局部复发率,但对远处转移无影响,其对应的OR(95%CI,P值)分别为0.64(0.41-0.99,P=0.04)和0.94(0.58-1.31,P=0.73).结论:术前放化疗联合手术可显著改善食管癌患者的生存率,值得临床应用推广.     

Gastroesophageal junction cancer with hepatic metastasis: Effective Treatment using microsphere embolization combined with transarterial infusion chemotherapy

PurposeTo determine the safety and efficacy of microsphere embolization plus transarterial infusion chemotherapy for the treatment of gastroesophageal junction cancer with hepatic metastasis.MethodsSixty patients with gastroesophageal junction cancer and hepatic metastasis were randomly divided into two groups: group A (treatment group), which was treated with transarterial infusion chemotherapy plus microsphere embolization for gastroesophageal cancer, and with transarterial chemoembolization for hepatic metastasis; and group B (control group), which was treated with transarterial infusion chemotherapy for gastroesophageal cancer, and with transarterial chemoembolization for hepatic metastasis. The chemotherapy regimen used consisted of oxaliplatin plus FUDR. The embolization agent used for gastroesophageal cancer and the hepatic metastasis were Embosphere and ultra-liquefied lipiodol, respectively.ResultsThe median survival time of patients in group A was 19 months, with survival rates at 12, 18, and 24 months of 93.3%, 60.0%, and 23.3%, respectively. The median survival time of patients in group B was 13 months, with survival rates at 12, 18, and 24 months of 60.0%, 30.0%, and 3.3%, respectively. There was a significant difference in survival between the two groups (P = 0.00). One month after treatment, the severity of dysphagia was significantly less in group A, as compared to that in group B (p < 0.001).ConclusionTreatment of gastroesophageal junction cancer with hepatic metastasis by transarterial infusion chemotherapy plus microsphere embolization can rapidly reduce tumor size near the gastroesophageal junction. This treatment is an effective therapeutic option for these patients as it can relieve dysphagia and improve long-term survival rate.     

The Impact of Splenectomy on Outcome After Resection for Colorectal Cancer: A Multicenter, Nested, Paired Cohort Study

Purpose This study was designed to determine whether incidental splenectomy for iatrogenic injury affects long-term cancer-specific survival in patients having resection of an adenocarcinoma of the sigmoid or rectum. Methods A retrospective case-matched review of patients undergoing surgery for colorectal cancer with incidental splenectomy between January 1, 1990 and December 31, 1999 was undertaken. Data were analysed for age, American Society of Anesthesiologists physical status, gender, disease stage, operation type, and outcome. These cases were matched with patients from the same center, of the same age and gender, with the same stage of disease and operation, who did not require a splenectomy at the time of their surgery. Results Fifty-five patients were identified who had an iatrogenic splenectomy. Matched gender, stage, and American Society of Anesthesiologists-matched controls were identified. Follow-up from time of surgery to death or last follow-up ranged from 2 to 205 (median, 43) months. A Kaplan-Meier survival analysis using the Cox proportional hazards model to define the statistical significance found a significant difference between the groups favoring those without splenectomy (hazard ratio, 1.8; 95 percent confidence interval (CI), 1–3.3; P = 0.0399). Cancer-specific survival at five years was 70 vs. 47 percent and at ten years was 55 vs. 38 percent. Discussion Patients with colorectal cancer who had splenectomy as a result of iatrogenic damage of the spleen while undergoing resection of the sigmoid or rectum for adenocarcinoma had a significantly worse prognosis. Reprints are not available.     

Prognostic factors of radiotherapy in patients with node-positive thoracic esophageal squamous cell carcinoma after radical surgery

The aim of this study was to retrospectively analyze and assess the outcomes and prognostic factors of radiotherapy in patients with node-positive thoracic esophageal squamous cell carcinoma after radical surgery. One hundred twenty-six patients with node-positive thoracic esophageal squamous cell carcinoma who had undergone adjuvant therapy (postoperative radiotherapy alone or postoperative sequential chemoradiotherapy without receiving postoperative concurrent chemoradiotherapy) after radical surgery, were retrospectively reviewed from January 1996 to December 2003. Univariate and multivariate analyses were performed using log-rank and Cox proportional hazard models, and survival curves were estimated using the Kaplan-Meier method. The 1-, 3- and 5-year overall survival rates of all 126 patients were 71.4, 39.1, and 22.0%, and disease-free survival rates were 64.3, 36.4, and 21.5%, respectively. Lymph node ratio (the ratio of the number of metastatic lymph nodes to the number of lymph nodes removed, LNR) ≥0.2 ( P = 0.006), pT3 + pT4 ( P = 0.06) and sequential chemoradiotherapy ( P = 0.08) were associated with a poorer survival by univariate analysis. In multivariate analysis, LNR ( P = 0.01, hazard ratio = 0.57, 95% confidence interval, 0.37–0.87) and tumor depth of invasion ( P = 0.03, hazard ratio = 0.62, 95% confidence interval, 0.41–0.96) were the independent predictors of survival. Sequential chemoradiotherapy receded survival tendency without significant difference ( P = 0.09, hazard ratio = 0.64, 95% confidence interval, 0.37–1.08). Therefore, LNR and tumor depth of invasion were the independent prognostic factors of radiotherapy in patients with node-positive thoracic esophageal squamous cell carcinoma after radical surgery. The addition of chemotherapy does not seem to confer a survival benefit.     

A retrospective study of different treatments of limited‐stage small‐cell esophageal carcinoma and associated prognostic factor analysis

Primary, small‐cell esophageal carcinoma (SCEC) is a rare but highly malignant tumor. Due to lack of randomized, controlled, prospective studies, there are currently no unified treatment modalities for SCEC. This study retrospectively analyzed the outcomes of different treatments and prognostic factors that influence overall survival in patients with limited‐stage SCEC. The study included 106 patients pathologically diagnosed with limited‐stage SCEC at Huai'an First People's Hospital, Nanjing Medical University (Huai'an, China), between 1998 and 2007. There were 66 males and 40 females, with a median age of 58 years (range: 45–77 years). Fourteen patients received surgery alone, 42 received surgery and postoperative chemotherapy, 11 received radiotherapy alone, and 39 received concurrent chemoradiotherapy. Combined modality treatment with and without chemotherapy yielded 5‐year survival rates (5YSRs) of 27.2% and 0%, respectively. Associated median survival times were 22 months and 11 months, respectively, with a hazard ratio (HR) of 2.30 (95% confidence interval [CI]: 1.42–3.73, P = 0.001). Among patients treated with surgery plus postoperative chemotherapy or with concurrent chemoradiotherapy, the 5YSRs were 31.0% and 23.1%, respectively. Median survival times were 26 months and 18 months, with an HR of 1.25 (95% CI: 0.75–2.09, P = 0.725). Multivariate survival analysis using Cox regression model showed that chemotherapy was a positive independent prognostic factor for SCEC (HR 2.92, 95% CI: 1.25–6.80). Chemotherapy‐based combined modality treatment appears to increase the long‐term survival of patients with limited‐stage SCEC. Similar overall survival rates results are achieved with surgery combined with chemotherapy as with concurrent chemoradiotherapy, with chemotherapy being an independent prognostic factor. Randomized, controlled, prospective studies are needed to identify optimal chemotherapy regimens for treating SCEC.     

老年人食管内镜黏膜下剥离术后胃食管反流的初步评价

目的评估老年人的食管病变在进行内镜黏膜下剥离术（endoscopic submucosal dissection,ESD）3个月后的胃食管反流情况。方法回顾性调查60岁及以上行食管ESD术后3个月及以上的患者烧心、反酸等症状的发生情况,用胃食管反流病症状量表进行评分。记录患者年龄、病变位置、大小和来源,分析软件SPSS17．0。结果共有144例患者完成了随访,其中男性86例,女性58例,中位年龄65岁（60—80岁）。食管病灶大小0．4-10cm,中位数2cm。病灶下缘距食管胃结合部0—21．5cm,25％和75％位数值分别为4．1cm和12．0cm,中位数值为8．0cm。有胃食管反流症状者40例（27．8％）,诊断为胃食管反流病者11例（7．6％）。女性较男性患者容易发生胃食管反流症状（P=0．028）,病灶下缘距离食管胃结合部〈2．0cm者较2．0cm以上的患者更容易发生胃食管反流病（P=0．011）。结论食管病变的ESD手术3个月后部分老年患者出现胃食管反流症状和食管炎,距离食管胃结合部2cm以内的病灶ESD术后患者可能容易发生胃食管反流病。