经左胸颈两切口行食管癌切除术（附125例报告）

采用左胸颈两切口、经食管床全胃移植颈部吻合术治疗食管癌１１２５例,手术成功率９８．３１５,残端癌发生率１．７８％,手术后淋巴结分组标记转移者４８４例（４３．０２％）颈胸腹三组淋巴结转移率分别为４．５％、４０．３６％和１７．８％。术后一般并发症１８．７６％,术后ＥＫＧ异常较术前增另２４．０４％,全组手术死亡率为１．６９％。对本术式的优点、手术适应证及特有并发症的发生原因和处理进行了讨论。     

经左胸颈两切口行食管癌切除术(附1125例报告)

采用左胸颈两切口、经食管床全胃移植颈部吻合术治疗食管癌1125例,手术成功率9831%,残端癌发生率178%,手术后淋巴结分组标记转移者484例(4302%),颈、胸、腹三组淋巴结转移率分别为45%、4036%和178%。术后一般并发症1876%,术后EKG异常较术前增加2404%。全组手术死亡率为169%。对本术式的优点、手术适应证及特有并发症的发生原因和处理进行了讨论。     

胸段食管癌术后复发、淋巴结转移部位规律观察

目的：探索胸段食管癌术后复发、淋巴结转移部位的规律,旨在为术后预防性照射的靶区设计提供依据。方法选择食管癌术后复发患者182例,回顾性分析其原发肿瘤部位、术后分期与食管癌术后复发、淋巴结转移部位的关系。结果182例食管癌术后复发患者最常见的复发部位为1区／2区淋巴结（112例）、锁骨上淋巴结（45例）;胸上段、胸中段、胸下段食管癌1区／2区淋巴结转移率分别为64．3％、61．4％、60．0％,锁骨上区淋巴结转移率分别为28．6％、23．6％、25．0％,各段1区／2区、锁骨上区淋巴结转移率比较P均＞0．05。Ⅱa、Ⅱb、Ⅲ期食管癌术后1区／2区淋巴结转移率分别为11．3％、28．6％、49．1％,锁骨上区淋巴结转移率分别为9．4％、26．8％、45．3％,各期1区／2区、锁骨上区淋巴结转移率比较P均＜0．05。结论1区／2区淋巴结及锁骨上区是食管癌术后常见复发、淋巴结转移部位,应将其作为重要的术后预防性照射靶区。     

胸段食管鳞癌淋巴结转移规律及淋巴结清扫方式探讨

目的探讨胸段食管鳞癌淋巴结转移规律及术中淋巴结清扫方式。方法 480例行根治术的胸段食管鳞癌患者,标记各部位清扫淋巴结分别送检,进行临床病理资料分析。结果本组386例患者有淋巴结转移。全组清扫淋巴结5 424枚,平均每例清扫11.3枚,689枚淋巴结有转移。22例患者出现跳跃性淋巴结转移,其中胸上段3例、中段9例、下段1例。胸上段食管鳞癌颈部淋巴结转移率47.6%,高于胸中段（10.5%）和胸下段（1.3%）,P均〈0.05。胸下段食管鳞癌向腹腔淋巴结转移率为33.1%,高于胸中段（19.4%）和胸上段（3.8%）,P均〈0.05。胸中段食管鳞癌有上纵隔淋巴结（23.5%）及下纵隔淋巴结（29%）和腹腔淋巴结（19.4%）的双向转移趋势,隆突下淋巴结转移多见,转移率54.2%。结论 胸上段食管癌淋巴结转移以颈段食管旁、锁骨上、上中纵隔转移多见,胸中段食管癌淋巴结转移具有明显的上下双向转移和跳跃性转移特点,胸下段食管癌淋巴结转移以腹部、中下纵隔转移多见。胸上段食管癌行颈、胸、腹三野淋巴结清扫,重点清扫颈段食管旁及锁骨上、下界包括隆突下淋巴结;胸下段食管癌可行胸、腹两野淋巴结清扫,重点清扫隆突下、下胸段食管旁、胃左动脉旁淋巴结;胸中段食管癌淋巴结清扫方式应根据具体情况设定。     

非开胸食管拔脱胃上提治疗颈段食管癌(附19例报告)

目的 探讨非开胸食管拔脱切除颈段食管癌及胃上提食管重建的治疗经验。方法 共行非开胸食管拔脱切除颈段食管癌胃上提食管重建19例(T2N02例，T2N01例，T3N04例，T3N14例，T4N04例，T4N14例)，均为鳞状细胞癌。19例均清扫颈部及上纵隔气管食管旁淋巴结，7例喉侵犯严重者作全喉切除。甲状腺叶切除术12例。术前或术后肿瘤患者给予放疗。结果 T2期3、5年生存者分别为3／3例、1／1例,T3、T4期患者3、5年生存者分别为6／14例和3／8例。喉功能保留率63．16％(12／19)。术后拔管率72．73％(8／11，1例未做气管切开术)。并发症发生率为26．32％(5／19)，包括咽瘘2例次，颈部吻合口狭窄1例次，吻合口瘘1例次。腹壁切口裂开1例次。结论 颈段食管癌可以行非开胸食管拔脱一期切除肿瘤及周围受侵组织，并尽可能保留喉功能。利用胃上提重建食管，联合放射治疗，可以提高患者的术后生存率和生存质量。     

食管癌切除,食管床全胃移植颈部吻合术（附335例分析）

施行食管癌切降，食管床全胃移植颈吻合术３３５例，其中３１０例采用颈胸以切口，本术式优点为：（１）切除病灶广泛，残端阳性率低；（２）手术操作方便，创伤小，可减少手术污染；（３）全胃移植经食管床径路最短，较符合正常的生理解剖，术后对心脏功能的影响；（４）一旦发生吻合口瘘，可短期内的治愈，还提出了本术式应当注意的几个问题。     

颈胸腹三切口食管癌切除术462例体会

1993年5月～2005年5月,我们对462例食管癌患者行一次铺巾,右胸、右或左颈、腹正中三切口食管癌切除术（以下简称三切口术）,取得良好效果。现介绍体会。临床资料：本组462例食管癌患者,男270例,女192例;年龄35～74岁,平均54．1岁。肿瘤位于食管胸上段396例,胸中段66例。合并慢性支气管炎肺气肿49例,冠心病22例,糖尿病19例。均行三切口术,其中行根治性切除术435例,姑息性切除术27例。术中行左颈吻合34例,右颈吻合428例。     

不同部位食管癌术后乳糜胸发生率比较

目的比较中上段食管癌与下段食管癌术后乳糜胸的发生率。方法回顾分析3661例不同部位食管癌术后乳糜胸发生情况。结果食管癌术后乳糜胸的发生率为1．12％,其中中上段食管癌术后乳糜胸发生率为1．48％,下段食管癌为0．68％（P〈0．05）。中上段食管癌术后4d确诊乳糜胸23例（76．7％）,再手术率为93．3％;下段为5例（45．5％）,再手术率为63．3％（P〈0．05）。结论中上段食管癌术后乳糜胸的发生率、再手术率均高于下段食管癌。     

残胃癌与Hp的关系

目的探查Hp与残胃癌复发的相关性研究，进一步了解Hp与残胃癌的关系．方法选择不同时期的胃癌术后患者73例为研究组，其中胃癌病例27例，男18例，女9例；贲门癌21例，男14例，女7例；食管癌25例，男21例，女4例。采用QPentexEC—2930F型电子激光内镜用ELISA检测血清抗Hp-IgG抗体，药盒为上海益生研究所提供，将Hp抗体水平分为2个等级，Hp-IgG抗体浓度升高提示胃癌的危险性随之增加，复发的可能性增大．结果经内镜检查及病理证实的高分化型胃腺癌11例，Hp阳性率为41％（11／27）；低分化型胃腺癌7例，Hp阳性率25．3％（7／27）；胃粘液细胞癌9例，Hp阳性率为33．3％（9／27）；贲门癌（术后）8例，Hp阳性率为38．5％；食管癌术后10例，Hp阳性率为40％（10／25）．残胃癌研究组患者抗HP-IgG抗体水平检测，明显高于对照组，P＝0．0054有显著差异．结论Hp的感染能诱发冒粘膜上皮细胞的一系列反应，导致粘膜腺体萎缩与肠上皮化生，Hp感染后，尤其胃癌手术后残胃粘膜诱导多形核白细胞与Hp及其分泌物相作用，引起氧化反应，吞噬细胞产生的氧化剂在癌的发生中起促进作用．     

改良左胸小切口食管癌、贲门癌切除术临床应用观察

目的观察改良左胸小切口食管癌、贲门癌切除术的临床应用效果。方法将60例同期行食管癌、贲门癌切除术患者随机分为观察组和对照组各30例,分别采用改良左胸小切口及传统左胸小切口施术。结果与对照组比较,观察组出血量及术后胸液量减少,术后住院时间缩短,术后并发症发生减少（P均〈0.05）。结论 改良左胸小切口食管癌、贲门癌切除术具有创伤小、并发症少等优点。     

Effect of bilateral supraclavicular postoperative radiotherapy in middle and lower thoracic esophageal carcinoma

AIM: To evaluate whether postoperative radiotherapy is an alternative to neck lymph node surgery and if it provides a survival benefit for those receiving two-field, chest and abdomen, lymphadenectomy.METHODS: A total of 530 cases with middle and lower thoracic esophageal carcinoma in our hospital from January 2008 to April 2009 were selected and analyzed, of which 219 cases received right chest, upper abdominal incision Ivor-Lewis surgery and simultaneously underwent mediastinal and abdominal two-field lymphadenectomy. If regional lymph node metastasis occurred within the recurrent laryngeal nerve, the patients would receive bilateral supraclavicular radiotherapy (DT = 5000cGy) to be adopted at postoperative 4-5 wk (Group A) or cervical lymphadenectomy at postoperative 3-4 wk (Group B). If there were no regional lymph node metastases within the recurrent laryngeal nerve, the patients only underwent two-field, chest and abdomen, lymphadenectomy (Group C).RESULTS: In 219 cases who underwent two-field lymphadenectomy, 91 cases were diagnosed with regional lymph node metastasis within the recurrent laryngeal nerve. Of them, 48 cases received cervical radiotherapy, and 43 cases underwent staging lymphadenectomy; 128 patients were not given the follow-up treatment of cervical radiotherapy because there was no regional lymph node metastasis within the recurrent laryngeal nerve. Five-year survival rates in group A and B were 47% and 50%, respectively, with no statistical difference between them, and the rate in group C was 58%.CONCLUSION: For patients with middle and lower thoracic esophageal carcinoma combined with lymph node metastasis within the recurrent laryngeal nerve, cervical radiotherapy can be a substitute for surgery and provide benefit.     

食管癌环氧化酶-2的高表达与淋巴转移的关系

目的　探讨环氧化酶 -2 (COX -2 )在食管癌中的表达情况及其与淋巴结转移的关系。方法　应用免疫组织化学方法(SP法 ) ,检测 1999～ 2 0 0 1年手术切除的 76例食管癌病人中COX -2的表达。其中有食管旁淋巴结转移者 18例 ,胃左动脉旁淋巴结转移者 11例。结果　COX -2在食管癌中的表达率为 81 6 %,主要为癌组织的表达 ,而在癌旁组织几乎不表达 ;食管癌旁和胃左动脉旁淋巴结转移组COX -2的表达水平均高于未转移组 (P <0 0 0 1)。结论　食管癌中COX -2的高度表达与食管癌的发生、发展及淋巴结转移有关 ,提示COX -2可能是防治食管癌的一个靶位。     

VEGF和CD44v6过表达与乳腺癌浸润转移的关系

目的检测血管内皮生长因子(VEGF)和转移相关黏附分子44v6(CD44v6)在乳腺癌中的表达情况,探讨两者与淋巴结转移的关系。方法采用免疫组化SP法检测92例乳腺浸润性癌中VEGF、CD44v6的表达情况。结果 VEGF在正常乳腺组织和乳腺癌中的阳性表达率分别为6.7%(3/45)和90.2%(83/92),且VEGF在淋巴结转移组中的阳性表达率(53/55)明显高于无淋巴结转移组(P<0.05)。CD44v6在正常乳腺组织及乳腺癌中的阳性表达率分别为8.9%(4/45)和85.9%(79/92),而且CD44v6在淋巴结转移组中的阳性表达率(51/55)明显高于无淋巴结转移组(P<0.05)。VEGF和CD44v6表达呈正相关关系(r=0.497,P<0.05)。结论 VEGF、CD44v6在乳腺癌组织中高表达,且均与淋巴结转移有关(P<0.05),两者可能在乳腺癌的远处转移中起协同作用。     

Expressions of p53, VEGF C,p21: could they be used in preoperative evaluation of lymph node metastasis of esophageal squamous cell carcinoma?

The prognosis of esophageal squamous cell carcinoma is primarily determined by staging. Although radiological methods have revealed lymph node metastasis preoperatively, these radiological findings cannot be correlated with pathological staging. The aim of this study was to compare the expressions of p53, vascular endothelial growth factor C (VEGF C) and p21 with lymph node metastasis in preoperative endoscopic biopsy and postoperative resection material. Tissue samples were taken from 40 patients who had undergone endoscopic biopsies and radical esophagectomies. The expressions of p53, VEGF C and p21 proteins in these sections were immunohistochemically examined. The expression of each antibody was characterized as a negative or positive reaction according to the pattern and intensity of semiquantitative immunostaining. The staining pattern of antibodies was divided into three groups: < 10% cancer cells were accepted to be (-), 10-50% were (+), heterogenous and > 50% were (+ +), homogenous. For each antibody, statistical correlation with conventional prognostic parameters such as localization, microscopic grade, stage, pathological lymph node metastasis and survival, were investigated. p53 expression was observed in 65.5% (19/29) of lymph node positive cases, whereas p53 was in 50% (20/40) of cases. VEGF C was in 65% (26/40) and p21 was in 15% (6/40) of cases. p53 has the specificity of 90.9% and sensitivity rate of 65.5% in detecting lymph node metastasis and positive predictive value was 95%. Expression of p53 was significantly correlated with stage and lymph node metastasis (P = 0.02 and P = 0.03, respectively). Prediction of lymph node metastasis by p53 was correlated independently and in coexpression with VEGF C (P < 0.01). There was no relation detected between p21 and other parameters. In esophageal squamous cell carcinoma (SCC), p53 and VEGF C expressions were correlated with pathologically positive lymph nodes. When preoperative staging has been insufficient in esophageal carcinoma cases, immunohistochemical analysis of p53 and VEGF C staining in tissues could be an aid to clinicians regarding lymph node metastasis.     

STAT3和Cyclin D1在胰腺癌中的表达及其临床意义

目的探讨信号转导和转录激活因子-3(STAT3)、磷酸化STAT3(PSTAT3)及Cyclin D1 的蛋白在胰腺癌中表达情况及活化STAT3的蛋白表达与胰腺癌临床病理特征的关系。方法用免疫组化法检测41例手术切除的胰腺癌组织和10例正常胰腺组织中STAT3、PSTAT3、Cyclin D1的蛋白表达。结果在41例胰腺癌标本中有31例(75.6%)STAT3、29例(70.7%)PSTAT3和25例(61.0%) Cyclin D1的蛋白表达阳性,明显高于正常胰腺组织。STAT3主要在细胞质表达,PSTAT3和Cyclin D1 主要在细胞核内表达。PSTAT3和Cyclin D1蛋白的阳性表达呈正相关(P<0.001)。PSTAT3在临床分期较晚和有淋巴结转移的胰腺癌中呈高表达(P<0.05),Cyclin D1的表达与淋巴结转移有关(P< 0.05)。结论本研究结果表明胰腺癌组织中存在STAT3、PSTAT3和Cyclin D1的过表达,并与临床病理分期和淋巴结转移有关,PSTAT3过表达与Cyclin D1的表达呈正相关,提示PSTAT3可能通过上调Cyclin D1表达,在胰腺癌的发生发展中起重要作用。     

Effectiveness of preoperative chemotherapy using carboplatin (CBDCA) and surgery against an esophageal small cell carcinoma

A 63-year-old man presented to our hospital with persistent dysphagia. Radiologic and endoscopic examination disclosed a 2.0-cm exophytic tumor in the middle third of the esophagus. An endscopically obtained biopsy specimen was found to represent undifferentiated small cell carcinoma. Computed tomography of the chest, abdomen, and cervical region was performed, as were gallium and bone scintigraphy. Metastasis to an adjacent lymph node was detected, without metastasis to distant organs. After neoadjuvant chemotherapy with carboplatin (CBDCA) (400 mg/m2) and etoposide (VP-16) (100 mg/m2), endoscopy and barium-swallow esophagography showed regression. Thoracic esophagectomy then was performed with mediastinal, abdominal and cervical lymph node dissection. The resected tumor was polypoid, measuring 0.5 x 0.5 cm. The lesion consisted mainly of small anaplastic cells, but included a small focus of squamous cell carcinoma. The patient has survived for more than 7 months with no further treatment and no evidence of recurrent disease.     

CCR7和L-选择素在大肠癌组织中的表达及意义

目的探讨CC趋化因子受体7(CCR7)和黏附分子L-选择素在大肠癌组织中的表达及二者与大肠癌淋巴转移的关系。方法采用免疫组织化学方法检测63份大肠癌组织(大肠癌组)、44份癌旁正常组织(癌旁组)和31份转移灶组织(转移组)中CCR7和L-选择素的表达。结果大肠癌组、转移组CCR7、L-选择素阳性率明显高于癌旁组(P<0.01);CCR7与L-选择素表达显著相关(r=0.653,P<0.01);有淋巴结转移者明显高于无转移者,P<0.05。结论 CCR7与L-选择素在大肠癌中的表达与大肠癌的发生和淋巴转移有关,二者可能共同参与了大肠癌发生及淋巴结转移过程;检测二者表达情况有助于判断大肠癌患者的预后。     

Management of T1 colorectal carcinoma with special reference to criteria for curative endoscopic resection

Background and Aim: In guidelines 2010 for the treatment of colorectal cancer from the Japanese Society for Cancer of the Colon and Rectum (JSCCR), the criteria for identifying curable T1 colorectal carcinoma after endoscopic resection were well/moderately differentiated or papillary histologic grade, no vascular invasion, submucosal invasion depth less than 1000 µm and budding grade 1 (low grade). We aimed to expand these criteria. Methods: A total of 499 T1 colorectal carcinomas, resected endoscopically or surgically, were analyzed. Relationships between clinicopathologic findings and lymph node metastasis were evaluated. Results: Lymph node metastasis was found in 41 (8.22%) of the 499 cases. The incidence of lymph node metastasis was significantly higher in lesions featuring poorly differentiated/mucinous adenocarcinoma, submucosal invasion ≥ 1800 µm, vascular invasion, and high‐grade tumor budding than in other lesions. Multivariate logistic regression analysis showed all of these variables to be independent risk factors for lymph node metastasis. When cases that met three of the JSCCR 2010 criteria (i.e. all but invasion < 1000 µm) were considered together, the incidence of lymph node metastasis was only 1.2% (3/249, 95% confidence interval: 0.25–3.48%), and there were no cases of lymph node metastasis without submucosal invasion to a depth of ≥ 1800 µm. Conclusions: Even in cases of colorectal carcinoma with deep submucosal invasion, the risk of lymph node metastasis is minimal under certain conditions. Thus, even for such cases, endoscopic incisional biopsy can be suitable if complete en bloc resection is achieved.