食管平滑肌瘤的微创手术治疗

目的探讨微创手术在食管平滑肌瘤治疗中的临床应用价值. 方法回顾性分析1996年9月～2002年10月26例食管平滑肌瘤采用微创手术治疗的临床资料. 结果电视胸腔镜食管平滑肌瘤摘除术23例,其中3例(2例胸膜腔紧密粘连,1例肿瘤无法定位)中转开胸(胸腔镜辅助小切口);经颈部食管平滑肌瘤摘除术2例;经食管镜食管平滑肌瘤切除1例.26例手术顺利,术后恢复平稳,无手术死亡及严重并发症,术后病理诊断均为平滑肌瘤.随访2～73个月,平均32.3个月,无复发. 结论电视胸腔镜肌瘤摘除术可作为食管固有肌层平滑肌瘤的首选治疗方法,对于食管粘膜肌层的平滑肌瘤,可考虑经食管镜切除.     

电视胸腔镜手术治疗食管平滑肌瘤

目的探讨电视胸腔镜手术（video-assisted thoracoscopic surgery,VATS）治疗食管平滑肌瘤的应用价值。方法2000年7月-2007年10月应用VATS治疗食管平滑肌瘤19例,全身麻醉,侧卧位,根据食管肿瘤位置,选取3个1.5-2.0 cm胸壁切口,作为胸腔镜观察口及操作口,术中胃镜辅助操作。结果电视胸腔镜食管平滑肌瘤切除18例;1例术前诊断3cm×2 cm食管平滑肌溜,术中证实为巨大平滑肿瘤,中转开胸。术后恢复顺利,无手术死亡及严重并发症,术后病理诊断均为平滑肌瘤。19例随访5-35个月,平均24.5月,无复发。结论电视胸腔镜肌瘤切除术可作为食管平滑肌瘤的首选治疗方法,对于较大食管平滑肌瘤应考虑开胸手术。     

电视胸腔镜辅助食管平滑肌瘤摘除术

目的探讨电视胸腔镜辅助手术在食管平滑肌瘤患者治疗中的应用价值。方法回顾性分析2002年6月至2009年1月第二军医大学附属长海医院87例食管平滑肌瘤患者在电视胸腔镜辅助下行食管平滑肌瘤摘除术的临床资料,其中男61例,女26例;年龄20～65岁,平均年龄38．2岁。食管中段平滑肌瘤66例,下段9例,上段12例。肿瘤最小直径约0．5cm,最大体积约10．5cm×5．2cm×4．0cm,均为食管壁内型和纵隔型。87例患者中在全电视胸腔镜辅助下行食管平滑肌瘤摘除术80例;另7例术中采用辅助小切口完成手术。结果术后所有患者均恢复顺利,无死亡及其他严重并发症发生。术后第1d进流质食物,术后第3d进普通食物。术后病理检查：均为食管平滑肌瘤。随访81例,随访时间6个月～6．5年,平均3．8年,食管平滑肌瘤无复发。结论电视胸腔镜辅助下行食管平滑肌瘤摘除术是食管平滑肌瘤首选的治疗方法,对食管平滑肌瘤直径〉1．0cm者,应积极在电视胸腔镜下手术摘除。     

胸腔镜下食管平滑肌瘤摘除术83例临床分析

目的 探讨胸腔镜下摘除食管平滑肌瘤的可行性.方法 回顾性分析2002年12月至2012年8月间在复旦大学附属中山医院胸外科接受胸腔镜下食管平滑肌瘤摘除术的83例患者的临床资料.全组患者肿瘤直径为 0.8～12.0（平均3.3）cm,其中肿瘤直径大于5 cm者22例.结果 3例患者术中发现食管黏膜破裂,其中2例于胸腔镜下行食管黏膜修补,另1例中转开胸修补.全组手术时间40～300（平均83.0）min,术中出血 20～150（平均52.4）ml,术后住院时间3～50（平均5.8）d.术后1例患者出现食管瘘,经胸腔引流保守治疗治愈.80例（96.4％）患者获2～117月的术后随访,随访期间所有患者吞咽困难症状均消失,未见肿瘤复发、食管憩室及食管狭窄等发生.结论 胸腔镜下摘除食管平滑肌瘤是安全、有效的手术方式,并具有创伤小、康复快等优势.对于大于5 cm的食管平滑肌瘤,胸腔镜下摘除也是可供选择的手术方式,但应在具有一定胸腔镜手术经验的中心开展.     

胸腔镜下食管平滑肌瘤摘除术39例

目的探讨胸腔镜下食管平滑肌瘤摘除术的可行性和有效性。方法回顾分析2002年12月至2008年11月共计39例食管平滑肌瘤胸腔镜手术患者的临床资料。结果36例患者经右侧进胸．3例经左侧进胸：胸腔镜下完成手术者38例,1例术中发生食管黏膜破裂,予以开胸行食管黏膜修补术。手术时间1～5（1．2±0．6）h;术中出血30～100（50±8．3）ml。肿瘤最大横径0．8～6．0（3．0±0．7）cm。术后胸管拔出时间为1～4（1．5±0．7）d：胸腔引流量为100～500（200±101）ml。除1例术中食管黏膜破裂行食管黏膜修补术．余患者无手术并发症和死亡发生。术后住院时间3-10（3．6±1．2）d。术后随访1个月至6年。所有患者未见肿瘤复发,无不适症状。结论胸腔镜下食管平滑肌瘤切除术安全可行．是治疗食管平滑肌瘤的主要手术方式之一。     

单孔胸腔镜联合胃镜治疗食管平滑肌瘤2例报告

食管平滑肌瘤是食管良性肿瘤,约占食管良性肿瘤的70％[1];发病率为0.006％～0.1％,好发于20～50岁.传统治疗方式以开胸食管平滑肌瘤剥除术为主,是小手术、大切口、大创伤[2] ,对呼吸、循环功能影响大.随着胸腔镜技术的迅速发展,胸腔镜可完成胸部95％以上的手术.胸腔镜食管平滑肌瘤剥除术具有创伤小、疼痛轻、并发...     

3 cm单孔胸腔镜食管平滑肌瘤摘除术

目的探讨单孔胸腔镜食管平滑肌瘤摘除术的可行性和安全性。方法 2014年10月~2016年7月实施3cm单孔胸腔镜食管平滑肌瘤摘除术11例,肿瘤直径1.2~4 cm,平均2.42 cm,位于食管中段6例,下段3例,上段2例。结果 1例因胸膜广泛粘连中转开胸手术,其他10例均在单孔胸腔镜下完成手术。术后病理证实均为食管平滑肌瘤。随访1~22个月,平均11.9月,无复发。结论单孔胸腔镜食管平滑肌瘤摘除术符合肿瘤手术原则,手术创伤小,是安全有效的手术方式。     

电视胸腔镜和胸腔镜辅助下小切口手术治疗食管平滑肌瘤的临床分析

目的 对比研究电视胸腔镜辅助下小切口和电视胸腔镜手术治疗食管平滑肌瘤的临床疗效,为临床治疗方案作出指导.方法 选取接受食管平滑肌瘤治疗的128例患者为研究对象.根据手术方式将患者分为两组,试验组为电视胸腔镜辅助下小切口（VAMTS）治疗组,对照组为电视胸腔镜（VATS）手术治疗组.对两组患者手术情况进行比较.结果 两组患者在术中出血量、术后引流量比较,差异无统计学意义（P＞0.05）,在手术时间、术后住院时间、术后禁食时间和总费用方面,差异有统计学意义（P＜0.05）.结论 电视胸腔镜辅助下小切口和电视胸腔镜手术治疗食管平滑肌瘤的临床疗效都具有创口小、并发症少的特点,但是胸腔镜辅助下小切口组的手术时间明显长于胸腔镜组.两种方法 临床疗效均好,临床应根据患者自身情况进行选择.     

完全胸腔镜下食管平滑肌瘤切除术17例临床分析

食管平滑肌瘤是食管最常见的良性肿瘤,约占食管良性肿瘤的70％,以食管中段较常见,其次为食管下段,食管上段最少见,手术切除是唯一有效的治疗方式。随着微创外科的发展,现多在电视胸腔镜辅助下完成食管平滑肌瘤摘除术,自2006年3月至2011年12月,我们在电视胸腔镜辅助下完成食管平滑肌瘤摘除术17例,效果良好,报道如下。     

电视胸腔镜手术治疗食管良性疾病76例

目的总结电视胸腔镜手术治疗食管良性疾病的经验，推广其治疗方法。方法回顾性分析1995年3月～2004年12月我院76例食管良性疾病患者被施行胸腔镜手术的临床资料，其中贲门失弛缓症42例，食管平滑肌瘤28例，食管囊肿2例，食管憩室3例，食管肉芽肿1例；75例经胸腔镜完成手术，1例巨大食管平滑肌瘤转开胸手术。结果术中发生食管黏膜破裂5例，1例食管憩室术后胸膜腔感染；本组无手术死亡患者。手术时间40～135min，平均72.4min；带胸腔引流管时间0～14d，平均3.4d；术后住院时间6～15d，平均9.4d。2003年12月以前贲门失弛缓症手术38例，随访36例，随访时间4～92个月，平均35.4个月；2例失访。36例中33例进食无哽噎，3例轻度间歇吞咽困难，2例伴有不同程度反酸或烧心。结论采用胸腔镜手术治疗食管良性疾病技术操作是可行的，达到了与传统开胸手术相似的结果，可作为某些食管良性疾病手术的首选方法。     

Endosonography in the preoperative evaluation of cancers of the esophagus

OBJECTIVE: To assess the diagnostic accuracy of endoscopic ultrasonography (EUS) for the local and regional staging of esophageal cancer, and its possible alteration resulting from the performance of preoperative chemoradiation. METHODS: Prospective study of 85 consecutive patients with esophageal cancer evaluated by EUS and operated on between January 1992 and December 1995. 28 of these patients had received previous induction therapy. In all cases, EUS examination was performed by the same physician not informed about the results of previous morphological explorations. Histopathological analysis of all operative specimens was performed by the same pathologist, not informed about the results of EUS. Data were collected by another independent observer. RESULTS: EUS examination resulted in incomplete staging in 8 patients (9.5%) with severe stenosis precluding endoscope passage. The accuracy, specificity and sensitivity of EUS in detecting the depth of esophageal involvement (T0-2 vs. T3-4) were 82.3%, 78%, and 86% respectively, and 72%, 70%, and 73% respectively for lymph node metastasis. The overall accuracy of EUS in identifying the preoperative stage was 67%, with a clear-cut alteration when patients had received induction therapy (61% vs 72%). On the other hand, 7 (64%) of the 11 patients thought to have a complete response at endosonography had no residual tumor. CONCLUSION: EUS provides precise information for the preoperative identification of locally advanced esophageal tumor, even after induction therapy. The latter alters the diagnostic accuracy of EUS, although complete responders could be identified in two-thirds of cases.     

残胃癌49例临床分析

目的分析和总结残胃癌的临床诊治特点。方法回顾性分析我院1994年1月~2004年3月收治的49例残胃癌病人的临床资料。按胃镜、病理检查结果和手术方式分组,采用Kap-lan-M e ier法绘制生存曲线,进行累积生存率比较。结果49例残胃癌病人中,早期残胃癌9例(18.4%),进展期残胃癌40例(81.6%),两者的5年累积生存率分别为88.9%,47.5%,早期残胃癌的5年累积生存率明显高于进展期(P<0.01)。根治性切除36例,姑息性切除11例,根治手术组,姑息性手术组的中位生存时间分别为69月和12月,两者之间差异有显著性(P<0.01)。结论定期胃镜复查和合理的根治性手术是提高残胃癌病人生存率的关键。     

Impact of miniprobe ultrasonography on planning of minimally invasive surgery for gastric and colonic tumors

Background The use of minimally invasive procedures for the management of gastrointestinal cancer is increasing. The aim of this study was to investigate the role of high-frequency miniprobe endoscopic ultrasound (EUS) for therapeutic decisions making in patients with gastric or colonic tumors.Methods A total of 137 patients underwent EUS with a 12.5-MHz miniprobe for preoperative staging of tumors of the stomach (n = 49) or colon (n = 88). After resection, the surgical path was reviewed to analyze the role of preoperative staging with miniprobes.Results Miniprobe EUS enabled accurate assessment of the infiltration depth of gastric and colonic tumors. The overall accuracy rates were 88% and 87%, respectively. The lymph node status was predicted correctly in 82% of the patients (sensivity, 61%, specificity, 94%). Based on the results of miniprobe EUS, patients with gastric cancer were accurately selected to undergo endoscopic mucosal resection, laparoscopic resection, or open surgery in 100%, 91%, and 86% of the cases, respectively. In patients with colonic tumors, the treatment decision analysis showed that the stratification was correct in 90% of the patients.Conclusions Miniprobe EUS is a reliable method for validating treatment decisions for patients undergoing minimally invasive procedures for gastric and colonic tumors. This method is particularly valuable in the management of colon cancer, because endoscopic and laparoscopic resections can be offered to selected patients as an alternative to open surgery.     

269例手术后残胃的内镜观察

目的 :探讨内镜对手术后残胃随访的临床价值。方法 :对胃手术后 12d～ 32年的 2 6 9例患者行胃镜检查 ,观察记录并进行治疗。结果 :本组患者吻合口炎、残胃炎发生率分别为 5 5 76 %和 36 0 6 % ;因癌肿而行手术切除占全部病例的 78 0 7% ;胃及贲门癌术后复发 32例 ,占切除术后的 14 2 8% ;再生癌 5例 ;均同时对患者的胃石、残余缝线等进行相应治疗。结论 :因癌肿而手术的患者应坚持定期内镜复查 ,内镜不仅可诊断残胃的病变 ,且可同时治疗     

Lessons learned from laparoscopic treatment of gastric and gastroesophageal junction stromal cell tumors

Background Stromal cell tumors of the gastric and gastroesophageal junction are rare neoplasms that traditionally have been resected for negative margins using an open approach. This study aimed to evaluate the efficacy laparoscopic resection of gastric and gastroesophageal stromal cell tumors and the lessons learned from experience with this method. Methods This retrospective review evaluated all patients who underwent laparoscopic resection of gastric or esophageal stromal cell tumors at a tertiary referral center between December 2002 and March 2005. Medical records were reviewed with regard to patient demographics, preoperative evaluation, operative approach, tumor location and pathology, length of operation, complications, and length of hospital stay. Results A total of 12 consecutive patients with a mean age of 55 ± 5.9 years were treated. Preoperative endoscopic ultrasound (EUS) was performed for 11 of 12 patients with a diagnostic accuracy of 100%, whereas EUS-guided fine-needle aspiration was performed for 10 of 12 patients with a diagnostic accuracy of 50%. Four patients with symptomatic gastroesophageal junction leiomyomas were treated with enucleation and Nissen fundoplication. Eight patients were treated with laparoscopic wedge resection of gastric lesions. Complete R0 resection was achieved for all the patients undergoing laparoscopic resection. Intraoperative endoscopy was performed for four patients and resulted in shorter operative times. The average operative time for this entire series was 169 ± 17 min: 199 ± 24 min for the first six cases and 138 ± 19 min for the last six cases. The median hospital length of stay was 2 days. One patient with esophageal leiomyoma had persistent dysphagia at the 12-month follow-up assessment. There were no other complications and no deaths in this series of patients. Conclusions Laparoscopic resection of gastric and gastroesophageal junction stromal cell tumors may be performed safely with low patient morbidity. This approach can achieve adequate surgical margins and lead to short hospital stays. Improvements in the technique have led to shorter operative times. Presented at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) meeting, Ft. Lauderdale, Florida, 15 April 2005     

Endoscopic ultrasonography in the preoperative staging of gastric cancer

BACKGROUND: Endoscopic ultrasonography (EUS) is a standard procedure in the preoperative staging of patients with gastric carcinomas. Herein we present our experience with EUS and discuss the results and their implications for surgical therapy. METHODS: A total of 116 patients with histologically confirmed gastric adenocarcinoma were referred to EUS and classified prospectively by the TNM system. The results of the preoperative endosonographic staging were compared with the definitive histopathological results after the operation. RESULTS: The overall accuracy of EUS for determination of the T stage was 78%. The accuracy for the T1 and T2 stages was 80% and 63%, respectively. With 20% and 30%, there was a relatively high rate of overstaging in these cases. The accuracy for T3 and T4 tumors was 95% and 83%, respectively. The accuracy of EUS for determination of the N stage was 77%, with a sensitivity of 91% and a specificity of 84%. Resectability was predicted correctly with a sensitivity of 94% and a specificity of 83%. CONCLUSIONS: Generally accepted standards for the therapy of advanced gastric carcinomas do not exist. In cases where the therapeutic strategy is surgical exploration, no preoperative staging is necessary. In cases with differentiated treatment strategies, the accuracy of EUS is not sufficient for the selection of patients for endoscopic resection. Its accuracy for submucosal cancer invasion and for the detection of lymph node metastases needs to be further enhanced. If only multimodal therapy is considered, EUS staging seems to be absolutely mandatory. Patients classified preoperatively as T1 to T3 can be operated on primarily with sufficient security. In patients where radical resection of the tumor seems doubtful, we recommend that a diagnostic laparoscopy be performed to confirm the diagnosis.     

Endoscopic ultrasound in routine clinical practice for staging adenocarcinomas of the stomach and distal esophagus]

PROBLEM: Endoscopic ultrasound (EUS) is an important diagnostic tool for determining the best therapeutic strategy (primary resection, neoadjuvant therapy or palliation only) to offer esophageal or gastric cancer patients. PATIENTS AND METHODS: In the present study (1992-2001),we evaluated the accuracy of EUS in adenocarcinomas of the distal esophagus and stomach and compared our results with pathologists findings as the gold standard. RESULTS: Of the 222 patients studied, the precise examination of 11% EUS was not completely possible due to severe tumor stenosis. The accuracy of EUS with respect to T, N+/- and TN+/- amounted to 51%, 65% and 34% in 131 patients with adenocarcinomas of the esophageal gastric junction and to 50%, 66% and 37% in 91 patients with adenocarcinomas located in the fundus, corpus or antrum of the stomach respectively. With respect to T-stage, the overstaging of tumors was more common than understaging, especially in pT2b-carcinomas. The subgroup analysis of the 131 EGJ adenocarcinoma patients showed that the results obtained by EUS were slightly better in type I (distal esophageal cancer) than in type II and III cardia carcinomas (proximal gastric cancer).When comparing two observation periods (1992-1996 and 1997-2001), the accuracy of endoscopic ultrasound staging was very similar in both periods for T-category (51% vs 49%) and N-category (63% vs 64%) as well as for combined TN-staging (36% vs 35%) respectively. CONCLUSIONS: In clinical routine examinations of adenocarcinomas of the stomach and the distal esophagus, the accuracy of EUS is not as good as the excellent results in the past--mostly obtained under study conditions--may suggest.     

Fiberoptic endoscopic resection of symptomatic leiomyoma of the upper esophagus. Case report

A symptomatic leiomyoma of the upper esophagus was successfully removed through a fiberoptic endoscope in an 84-year-old man. Endoscopic resection via flexible endoscope may be considered as an option in treating selected cases of esophageal leiomyoma and for high surgical risk patients.     

不同手术式治疗甲状腺癌的临床疗效分析

目的对比分析不同手术方案治疗甲状腺癌的临床疗效和安全性。方法回顾性分析2013年1月至2015年1月间130例甲状腺癌患者的临床资料和随访资料,其中65例经胸乳路径的腔镜手术切除治疗作为腔镜组,传统开放性手术治疗的65例患者作为传统组。将收集的数据纳入SPSS 20.0进行统计学分析,计量资料以(x珋±s)表示,手术治疗相关指标、疼痛视觉模拟评分法(VAS)及美容效果评分(NSS)比较采用t检验;计数资料以率(%)表示,不良反应及并发症发生情况比较采用χ2检验,以P0.05为差异有统计学意义。结果腔镜组手术时间(t=4.906,P=0.000)和术后引流量(t=5.211,P=0.000)明显高于传统组;术中出血量(t=10.155,P=0.000)和切口长度(t=14.688,P=0.000)明显低于传统组。腔镜组不良反应及并发症总发生率(10.77%)显著低于传统组(27.69%)(χ2=5.992,P=0.014)。腔镜组患者经手术治疗后其VAS疼痛评分(4.08±1.12)显著低于传统组(5.89±1.48)(t=7.862,P=0.000);NSS美容效果评分(8.11±1.52)显著高于传统组(4.96±1.26)(t=12.863,P=0.000)。结论与传统开放性手术治疗相比,经胸乳路径腔镜治疗方法具有术中出血量少、切口较短、不良反应及并发症发生率较低、患者术后疼痛症状较轻等优点,而且具有术后颈部无瘢痕的美容效果,值得进一步临床推广。     

Endoscopic ultrasound does not accurately assess pathologic stage of esophageal cancer after neoadjuvant chemoradiotherapy

The accuracy of endoscopic ultrasound (EUS) for initial staging of esophageal cancer is widely accepted. There is, however, considerable variability in the reported accuracy of EUS for restaging of esophageal neoplasms after neoadjuvant therapy. From June 1995 through December 1999, we prospectively studied a series of 26 patients who underwent neoadjuvant treatment for esophageal cancer and were subsequently restaged by EUS before resection. Twenty-four patients had adenocarcinoma (92%), and two patients had squamous cell carcinoma (8%). EUS correctly predicted tumor stage in seven of 26 patients for an overall accuracy of 27 per cent. EUS overestimated the depth of tumor penetration in 18 patients (69%) and underestimated depth of penetration in one patient (4%). Lymph nodes were correctly staged in 15 of 26 patients for an overall accuracy of 58 per cent. Levels of sensitivity for detecting N0 and N1 disease were 44 per cent and 80 per cent respectively. Patients with a complete pathologic response were staged as T4N1 (one patient), T3N1 (three patients), T3N0 (one patient), and T2N1 (two patients). EUS cannot distinguish tumor involvement of the esophageal wall and lymph nodes from the postinflammatory changes that characterize effective neoadjuvant treatment. EUS is of limited utility in guiding clinical decision making after neoadjuvant therapy.