食管癌术后围手术期死亡原因的探讨

1990年 1月至 1999年 12月我们为 5 6 6例食管癌病人施行根治性切除 5 34例 ,切除率 94 3% (5 34/5 6 6 ) ,术后因发生吻合口瘘、肺部感染、心血管疾病、胃残端瘘、呼吸窒息而死亡 17例 ,死亡率为 3 18% (17/5 34)。本文就该组资料进行回顾性分析 ,并对手术死亡原因进行讨论 ,以进一步降低手术死亡率。1　临床资料本组 17例食管癌术后死亡患者中 ,均为男性 ,年龄 4 4～ 6 8岁 ,平均 6 1 0岁。食管上段癌 3例 ,中段癌7例 ,下段癌 7例。根治性切除术 14例 ,姑息性切除术3例。 15例为胃代食管重建消化道 ,1例为肿块切除 ,食管、胃造瘘术 ,1例…     

32例食管胃、食管空肠吻合口瘘的再手术治疗

我院从 1989年 2月至 1999年 6月 ,10年来采用二次开胸手术治疗食管癌、贲门癌切除术后吻合口瘘 32例 ,其中食管中段癌术后 9例 ,食管下段癌术后 2例 ,贲门癌 2 1例 ,存活 2 6例 ,成功率 82 %。1　临床资料1.1　一般资料　 32例中 ,男 2 8例 ,女 4例 ,平均年龄 5 9岁 ,主动脉弓上食管胃吻合 11例 ,主动脉弓下食管胃吻合 16例 ,食管空肠吻合 5例 ,病理类型 :食管鳞癌 11例 ,贲门腺癌 2 1例。1.2　吻合口瘘发生时间　早期吻合口瘘发生手术后 1～ 3天 ,有 7例 ;中期吻合口瘘发生手术后 4～ 14天 ,有 19例 ;晚期吻合口瘘发生手术后 14天以后有 6…     

残胃状态下食管癌与贲门癌的外科治疗策略

目的：探讨残胃状态下食管癌及贲门癌的外科治疗策略。方法：本院自2005年1月-2012年12月共收治残胃状态下食管癌及贲门癌患者8例,均行外科根治性手术治疗。结果：本组8例确诊患者的残胃状态时间平均为11.7年,其中BillrothI式吻合术者2例;BillrothII式吻合术者6例;2例食管癌患者行三切口食管癌切除联合结肠代食管术,6例贲门癌患者均经腹部手术切口,2例行贲门癌下段食管切除联合间置空肠代食管吻合术,4例行贲门癌残胃全切除联合P形空肠袢代胃Roux-en-Y式吻合术。结论：对于胃大部切除后残胃状态下的患者,早期或局部晚期的食管癌与贲门癌亦可行根治性手术,手术前需根据患者病变情况,选择合适的个体化手术方案,同样可以达到理想的治疗效果。     

经腹全胃切除P型空肠袢代胃术治疗贲门部癌

目的　探讨治疗贲门癌手术入路新方法及不同胃切除范围的的综合疗效。方法　自 1992 -0 1～ 2 0 0 2 -0 1共经腹手术治疗贲门癌 78例 ,其中全胃切除P型空肠袢代胃术 3 0例 ,近端胃大部切除术 48例 ,术后随访时间 6个月～ 5年。结果　切除肿瘤上方食管 >5cm ,切缘无癌残留 ,清除的纵隔下部淋巴结转移率达 18 4%。全胃组 5年存活率大于近侧胃大部切除术组 ,返流性食管炎发生率明显低于近侧胃大部切除术组。结论　对Ⅲ期肿瘤患者或Ⅱ期发现No5、6组淋巴结有转移者应行根治性全胃切除术 ,P型空肠袢代胃术符合生理要求 ,并发症少。经腹手术安全彻底 ,但有一定的适应症     

食管癌和贲门癌切除应用器械吻合198例临床分析

目的总结食管、贲门癌切除术中应用吻合器行食管胃端侧器械吻合的经验和体会。方法对198例食管癌和贲门癌切除后应用吻合器行食管胃端侧器械吻合进行回顾性分析。术前,198例患者均进行过经上消化道的钡餐造影和纤维胃镜病理检查,最终确诊为贲门腺癌53例,食管鳞癌123例,食管腺癌22例。病变长度0.5-11cm。本文回顾性分析2010-02至2012-02食管癌和贲门癌患者198例的临床资料。结果全组病人均痊愈出院,其中吻合口瘘3例,发生率1.52%(3/198),均经通畅引流、营养支持等内科保守治疗治愈。术后平均住院15天。结论器械吻合提高了食管胃的吻合质量,减少术后吻合口瘘等发生率,具有重要的临床实用价值。     

残胃代食管在食管癌根治消化道重建中的作用

目的探讨胃大部切除术后残胃代食管在食管癌根治消化道重建中的作用。方法12例均采用经左胸后外侧切口癌切除,将残胃或连同脾脏、胰尾移于胸腔,行食管残胃吻合术。主动脉弓上吻合8例,弓下吻合4例：手工吻合2例,器械吻合10例。结果全组无吻合口瘘和手术早期死亡。结论采用将残胃或连同脾脏和胰尾移入胸腔,行食管残胃吻合,可增加残胃上移高度,保证食管残胃的无张力吻合。此术操作简单、创伤小、并发症少,可作为胃大部切除术后食管癌根治消化道重建的方式之一。’     

残胃食管吻合术治疗胃大部切除术后食管癌3例报道

自2001年7月至2006年2月，我院胸外科采取切除胸段食管癌病灶后，利用残胃与胸段食管在主动脉弓上或弓下吻合手术，共治疗3例胃大部切除术后患食管胸中段和胸下段癌的病人，近期效果良好，随访两年均健在。复习文献，就残胃食管癌手术重建消化道的术式选择探讨如下。3例患者均为男性，年龄为63、68、73岁，分别因消化性溃疡作胃大部切除术（BillrothⅡ式）后17、23和31年，出现吞咽困难2—6个月不等。2例肿瘤位于食管胸下段，分别长6cm和7cm，肿瘤上端距主动脉弓下5cm，另一例肿瘤位于食管胸中段，长3cm，肿瘤上端距主动脉弓下4cm，     

经右胸入路食管癌根治术两种吻合方式治疗中下段食管癌的疗效对比

目的比较经右胸入路食管癌根治术食管胃胸腔内吻合、食管胃颈部吻合两种吻合方式治疗中下段食管癌的疗效。方法选取2015年2月-2016年2月于我院行经右胸入路食管癌根治术治疗的中下段食管癌患者70例,根据手术吻合方式不同分为对照组和观察组,各35例。对照组行食管胃胸腔内吻合,观察组行食管胃颈部吻合。统计两组患者手术相关情况、食管切除长度及切端癌残留率、术后并发症和术后随访情况。结果两组手术时间、术中出血量、淋巴结清扫数比较差异均无统计学意义(P0.05)。观察组术后住院时间、术后放管时间明显少于对照组(P0.05)。观察组食管切除长度明显长于对照组,食管切端癌残留率明显低于对照组(P0.05)。两组术后切口感染、胃排空障碍、乳糜胸发生率比较差异均无统计学意义(P0.05)。观察组术后肺部感染、吻合口瘘、喉返神经损伤发生率明显高于对照组(P0.05)。两组反酸、嗳气、胸痛、吻合口狭窄发生率及术后1年、2年生存率比较均无统计学差异(P 0.05)。观察组术后第3年生存率明显高于对照组(P0.05)。结论对于经右胸入路食管癌根治术治疗的中下段食管癌而言,食管胃颈部吻合能够达到与胸腔内吻合相当的治疗效果,尽管术后并发症相对较多,但其手术切除范围更广,切缘阳性率更低,远期生存率更高。     

近端胃次全切除间置空肠贲门重建治疗胃贲门癌19例临床分析

目的探讨消化道重建方式,减少胃贲门癌术后并发症,提高患者术后的生活质量。方法对19例近端胃贲门癌患者采用保留幽门的胃次全切除术,在食管与残胃之间,间置一段空肠,在食管空肠吻合口下方2~3 cm处折叠缝合空肠浆肌层2针重建贲门。结果全部病人恢复顺利,无吻合口瘘及吻合口狭窄,无明显胆汁和食物反流,无营养不良及倾倒综合征发生。3年以上生存率与国内报告一致。结论该术式并发症少,病人生活质量明显提高,且不影响术后生存率。     

胃食管舌状吻合胃底成形术治疗食管癌

1990年以来我院手术治疗食管瘤182例,其中60例采用胃食管舌状吻合、胃底成形术。未发生吻合口瘘及狭窄,术后病人随访3～6个月,未见返流症状。现报告如下。1 临床资料1.1 一般资料 本组60例中男45例,女15例。年龄35～76岁。食管胸下段癌21例,贲门癌16例,食管胸中段癌18例,食管胸上段癌5例。经左胸入路一切口55例,经右胸左颈腹正中入路3例,经左胸颈入路两切口2例。采取胃食管主动脉弓下吻合37例,主动脉弓上吻合18例,颈部吻合5例。1.2 手术方法1.2.1 左胸后外侧切口经第7肋床进胸游离食管切除肿瘤,打开隔肌,游离胃,根据瘤体的大小部位及切除范围,可切除食管行主动脉弓上、弓下或颈部吻合;1.2.2 经右胸腋下直切口第6肋间进胸游离肿瘤及胸段食管     

人源性宫颈癌、子宫内膜癌、卵巢癌异种移植动物模型的建立

目的构建人来源的宫颈癌(cervical cancer,CC)、子宫内膜癌(endometrial cancer,EC)、卵巢癌(ovarian cancer,OC)人源性肿瘤异种移植动物模型,为研究和开发新药及个体化治疗提供实验模型。方法收集2018年2月至2019年4月新疆医科大学第一附属医院CC、EC、OC患者各5例的新鲜手术切除标本,移植至重度免疫缺陷(immunodeficiency,NOG)小鼠和非肥胖糖尿病/重症联合免疫缺陷(non-obese diabetes/severe combined immunodeficiency,NOD/SCLD)小鼠皮下,监测荷瘤小鼠体重和肿瘤体积,对长至500~1 000 mm^3大小的肿瘤进行传代移植,通过苏木精-伊红染色法(hematoxylin-eosin staining,HE)染色及免疫组化(immunohistochemistry,IHC)验证移植肿瘤组织与患者肿瘤组织的病理学一致性。结果本研究收集并移植15例CC、EC、OC肿瘤标本,成功构建CC、EC、OC PDX模型8例,建模成功率为53%。结论模型较好地保留了原发肿瘤的特征,为后续研究开发CC、EC、OC新的治疗方案、临床药物筛选以及个体化治疗提供了实验平台。     

Persisting risk of nickel related lung cancer and nasal cancer among Clydach refiners

Objective

To evaluate the risk of lung cancer and nasal cancer among workers employed at the Clydach nickel refinery, South Wales since 1930 by combining data from the two most recently published papers on this cohort.

Methods

Observed and expected numbers of cancer deaths were extracted for workers who had a minimum of five years service and were employed for the first time between 1902 and 1992. Standardised mortality ratios (SMR) were calculated for subgroups according to year of employment, time since first employment, and process work.

Results

A persisting excess of respiratory cancer was found for workers employed in the period 1930–92, with a lung cancer SMR of 133 (95% CI 103 to 172) and a SMR for nasal cancer of 870 (95% CI 105 to 3141). The lung cancer excess was most clearly seen 20 years or more after first employment and seemed to be confined to process workers. There was no indication of a further reduction in risk since 1930.

Conclusion

The extreme nickel related cancer hazard at the refinery before 1920 was greatly reduced during subsequent years. Some of the carcinogenic exposures seem to have remained after 1930, producing an elevated risk of nasal cancer and a 30% excess of lung cancer in the workforce. There was evidence of a persisting risk among process workers first employed since 1953.     

番茄红素抗癌作用研究现状

许多流行病学研究表明，番茄制品可以降低癌的危险性，尤其是胃肠道和前列腺癌。番茄红素是番茄制品的主要类胡萝卜素，本文对番茄红素的分子结构、代谢等生物学特征、番茄红素的抗癌作用及其机制进行了综述。     

肺癌及癌旁组织中微量元素含量分析

目的 :探讨肺癌患者的癌、癌旁和正常组织中微量元素含量的变化。方法 :收集 2 0例肺癌患者癌组织、癌旁组织及正常组织 ,用等离子体发射光谱仪测定Se、Zn、Cu、Fe、Mg、Mn含量。结果 :肺癌患者的正常组织、癌旁组织、癌组织Se、Zn、Mg的含量和Se/Zn的比值逐渐降低 ,但Cu、Fe、Mn的含量和Cu/Zn、Fe/Zn、Mn/Zn的比值则相反而逐渐升高 (P <0 .0 1)。结论 :微量元素含量的变化与肺癌发生、发展有一定的关系 ,对癌变过程的研究和临床治疗的指导具有重要意义     

Community knowledge of cancer

Since major opportunities for the prevention and early detectionof cancer rely on changing the behaviour of individuals, publiceducation is a major focus of many cancer control organizations.Some public education messages in Australia have been constantfor over a decade. Despite this, many people still do not followrecommendations for cancer prevention and early detection. Littleinformation is available on the extent to which the communityhas assimilated the educational messages produced by cancereducation agencies. A randomly selected community sample (n=76)were surveyed regarding their knowledge of five common cancers;lung bowel, melanoma, breast and cervical Areas of knowledgecommonly included in educational material were considereth thelifetime risk of developing each cancer, five year survival,preventable risk factors and the methods for early detectionof each cancer. Results indicate that respondents tended tooverestimate the lifetime risk of developing each cancer. Survivalfrom lung cancer was greatly overestimated by a high proportionof respondents. Smoking as a risk factor for lungcancerwa.swell recognized, as was sun exposurefor the risk of developingmelanoma. Despite this, these two cancers were not viewed aspreventable by a high proportion of respondents. Symptoms formelanoma, bowel cancer and breast cancer were well known, however,the tests to detect these cancers were not equally well known.The importance of early detection for increased survival waswell recognized. The implications of these results for publkeducation strategies are discussed.     

Formaldehyde and cancer: a critical review

Formaldehyde is a naturally occurring chemical found in every human cell. It has been in widespread use for over a century as a disinfectant and preservative agent, and more recently in a number of industrial products. Animal studies indicate that formaldehyde is a rat carcinogen at high levels (>_ 10 ppm) of exposure. Results for lower levels of exposure show less clear-cut carcinogenic effects, and some species, such as mice and hamsters, appear much less sensitive to any carcinogenic potential of formaldehyde. Epidemiologic studies of the effects of formaldehyde exposure among humans provide inconsistent results. In general, these nonexperimental studies suffer from a number of biases and flaws. The epidemiologic studies fall into three categories: formaldehyde industry workers, case-control studies, and studies of professionals who use formaldehyde. Studies of industry workers with known exposure to formaldehyde report little evidence of an excess cancer risk. Nasopharyngeal cancer, the one cancer considered most strongly linked to formaldehyde among humans, appears after close examination to be likely a result of multiple subgroup analyses and misclassification. The case-control studies usually lack any direct measure of formaldehyde exposure and rely instead on hypothetical exposure based on occupational exposure matrices. Most of these studies, after adjustment for confounding factors, fail to find a significant association with putative formaldehyde exposure. The studies that do report a significant association suffer from methodologic problems limiting their interpretation. The investigations of professionals who use formaldehyde in their work, such as embalmers, pathologists, and anatomists, have the advantage over case-control studies of a much higher likelihood of actual formaldehyde exposure. The findings among these individuals, however, are at odds with those of the other two groups, with excesses of deaths from cancer of the brain and leukemia. The inconsistency between professionals and formaldehyde industry workers in cancer risk patterns suggest that formaldehyde is not the etiologic agent. When the epidemiologic data on formaldehyde and human cancer are examined in light of the widely accepted causal criteria of strength of the association, consistency and specificity of results, dose-response effects, and biologic coherence and plausibility, the studies published so far fail to provide credible causal evidence.     

胃癌患者复发恐惧及其与抑郁的相关性研究

目的 探讨胃癌患者癌症复发恐惧及其与抑郁之间的关系,为进一步干预提供依据。方法 采用一般资料问卷、癌症患者恐惧疾病进展简化量表（FoP - Q - SF）、抑郁自评量表(SDS)对212例胃癌患者进行调查分析。结果 胃癌患者癌症复发恐惧总得分(35.43±10.44)分,抑郁程度得分为（57.05±9.52）分。FoP - Q - SF各维度与SDS各维度均呈正相关;多重线性回归分析显示患者年龄、病程、家庭人均收入、FoP - Q - SF是抑郁的影响因素,可解释总体变异度的58.5%,其中FoP - Q - SF独立影响抑郁水平总体变异的36.7%。结论 本研究中胃癌患者癌症复发恐惧处于中等水平,推测可通过降低复发恐惧水平来降低抑郁的发生。     

Oropharyngeal cancer epidemic and human papillomavirus

A growing body of research shows that human papillomavirus (HPV) is a common and increasing cause of oropharyngeal squamous cell carcinoma (OSCC). Thus, the International Agency for Research against Cancer has acknowledged HPV as a risk factor for OSCC, in addition to smoking and alcohol consumption. Recently, in Finland, the United Kingdom, the Netherlands, the United States, and Sweden, incidence of OSCC has increased, and an increase in the proportion of HPV-positive tumors was noted. On the basis of these data and reports indicating that patients with HPV-positive cancer have their first sexual experience at a young age and have multiple partners, we postulate that increased incidence of OSCC in the United States and some countries in northern Europe is because of a new, primarily sexually transmitted HPV epidemic. We also suggest that individualized treatment modalities and preventive vaccination should be further explored.