覆膜食管支架治疗食管癌放疗后并发食管狭窄及食管瘘的临床效果

 目的 评价覆膜食管支架治疗食管癌放疗后并发食管狭窄或食管瘘的临床效果。方法 回顾性分析58例食管癌放疗后并发食管狭窄及食管瘘的患者,所有患者均在X线监视下放置Z形全覆膜食管支架,分析支架置入的疗效及安全性。结果 58例食管支架均放置成功,术后患者进食恢复通畅、瘘口封闭,各种临床症状得到有效迅速缓解,放置成功率及治疗有效率均为100.0%。术后出现胸痛52例(89.7%),恶心呕吐31例(53.4%),轻度消化道出血21例(36.2%),前两项经对症处理后可有效控制,后者自行好转。结论 采用覆膜食管支架治疗食管癌放疗后并发的食管狭窄及食管瘘简便、安全、疗效确切,值得推广。     

带蒂息肉状食管癌11例报告

报告带蒂息肉状食管癌１１例。此类食管癌临床症状出现较晚，瘤体呈息肉状突入食管腔内，有小蒂与食管壁相连。Ｘ线表现：局部管腔高度扩张，管壁光整、柔软，腔内有圆形或卵圆形充盈缺损，不同于常见型中晚期食管癌。     

覆膜食管支架置入术60例临床应用分析

目的：分析晚期食管癌狭窄、纵隔淋巴结增大侵犯食管狭窄、贲门失弛缓症和食管术后吻合口狭窄、腐蚀性食管狭窄及食管破裂、食管-纵隔瘘、食管-气管瘘等病变的食管支架置入术的治疗方法及效果。方法60例中,晚期食管癌患者22例;食管癌并食管-气管瘘1例;纵隔内淋巴结增大侵犯食管导致食管狭窄10例;贲门失弛缓症18例;食管癌术后狭窄5例及腐蚀局限性食管狭窄2例;食管胸腔瘘1例、食管-纵隔瘘1例;60例均采用数字多功能X线机透视引导,其中部分病例同时采用胃镜下置入导丝放置支架治疗。结果60例患者中恶性狭窄永久性植入支架33例;良性狭窄暂时性置入支架27例,暂时性置入支架均在3-28 d安全取出;支架留置以后98％（59/60）患者的摄食能力有了很大提高,生活质量明显改善。结论食管支架置入术,简捷、安全、有效,对提高食管狭窄及食管瘘患者的生活质量、延长生命是一个好的治疗方法。     

CT在食管癌诊疗中的应用

目的评价CT检查在食管癌诊疗中的价值。方法回顾性分析65例经手术病理或内镜活检证实的食管癌CT及临床资料。结果65例食管癌CT表现均呈阳性，表现为食管管壁增厚，管腔狭窄，腔内肿块。部分病例侵及周围器官，或伴发肝脏纵隔及腹腔淋巴结转移。结论CT检查可为食管癌的诊断、手术评估及放化治疗跟踪提供可靠的依据。     

OPN基因与食管癌浸润及青蒿琥酯抑制食管癌细胞生长的关系研究

目的 探讨骨桥蛋白(OPN)基因与食管癌发生及浸润转移的关系,以及青蒿琥酯(Art)抑制食管癌细胞生长的作用与OPN蛋白表达的关系.方法 应用原位杂交及免疫组织化学方法检测45例食管鳞癌组织、21例不典型增生组织、24例正常的食管黏膜上皮组织中OPN基因及蛋白的表达,并分析其与食管癌临床病理特征的关系.以不同浓度(0、30、60、120μmol/L)青蒿琥酯干预食管鳞癌Eca109细胞24h,采用流式细胞术检测细胞周期及细胞中OPN蛋白的表达水平.结果 OPN基因及蛋白在食管鳞癌组织中的表达水平显著高于不典型增生及正常组织(P<0.01),且不典型增生组织中的表达水平显著高于正常组织(P<0.05).OPN基因及蛋白在食管鳞癌组织中的表达与淋巴结转移及浸润深度呈正相关(P<0.05),与患者性别、年龄及肿瘤的分化程度无明显相关(P>0.05).青蒿琥酯作用24h后,Eca109细胞增殖指数及OPN蛋白表达水平均显著降低(P<0.01),且具有浓度依赖性.结论 OPN基因在食管鳞癌组织中异常高表达,可能参与了食管癌的发生及浸润转移.青蒿琥酯抑制食管癌细胞生长的作用可能与其下调细胞中OPN蛋白的表达有关.     

食管癌肉瘤和肉瘤样癌X线、病理分析

目的 探讨食管癌肉瘤和肉瘤样癌的X线表现及病理特点,以提高对其认识.资料与方法 分析10例食管癌肉瘤和肉瘤样癌患者的X线、病理资料并复习文献.结果 食管钡餐检查表现为食管腔内充盈缺损.病理表现为癌与肉瘤两种成分同时存在.结论 食管癌肉瘤是同一肿瘤中既有癌又有肉瘤成分的复合肿瘤,食管肉瘤样癌本质是一种特殊类型的癌.当食管吞钡见腔内充盈缺损,且病变段有梭形扩张时,应考虑本病可能.两者手术切除预后较好,区分两者实用意义不大.     

Esophageal scintigraphy: applications and limitations in the study of esophageal disorders

This study examines the scintigraphic transit pattern in a variety of esophageal disorders. Scintigraphy was performed with a semi solid bolus and the patient in an upright position. Condensed esophageal images were obtained from which we derived the esophageal transit time. The pattern of bolus transit was graded by the duration of transit and by the presence of hold up or retrograde motion. Scintigrams were performed in 11 volunteers and 88 patients whose esophageal function had been confirmed by conventional gastroesophageal techniques. Esophageal disorders examined included achalasia (20), scleroderma (9), esophageal carcinoma (8), Barrett esophagus (5), and reflux esophagitis (27). We also examined the effects of gastroesophageal surgery on esophageal function. Transit times distinguished grossly abnormal esophageal function from normal but did not distinguish between different esophageal disorders. Graded transit patterns were a more sensitive indicator of esophageal function and permitted some differentiation between esophageal disorders and allowed evaluation of the effects of gastroesophageal surgery.     

Esophageal scintigraphy: Applications and limitations in the study of esophageal disorders

This study examines the scintigraphic transit patern in a variety of esophageal disorders. Scintigraphy was performed with a semi solid bolus and the patient in an upright position. condensed esophageal images were obtained from which we derived the esophageal transit time. The pattern of bolus transit was graded by the duration of transit and by the presence of hold up or retrograde motion. Scintigrams were performed in 11 volunteers and 88 patients whose esophageal function had been confirmed by conventional gastroesophageal techniques. Esophageal disorders examined included achalasia (20), scleroderma (9), esophageal carcinoma (8), Barrett esophagus (5), and reflux esophagitis (27). We also examined the effects of gastroesophageal surgery on esophageal function. Transit times distinguished grossly abnormal esophageal function from normal but did not distinguish between different esophageal disorders. Graded transit patterns were a more sensitive indicator of esophageal function and permitted some differentiation between esophageal disorders and allowed evaluation of the effects of gastroesophageal surgery.     

三种自行设计和改进的食管支架的临床应用

目的：探讨三种自行研制的食管支架对１０６例各种原因引起的食管狭窄及合并食管瘘的治疗效果。材料与方法：三种支架为镍钛合金螺旋丝双喇叭口支架、镍钛合金网格状编织型支架、带膜不锈钢支架。在Ｘ线电视监视下使用自制的插送器械放置支架治疗食管狭窄１０６例，１４例合并食管瘘。结果：明显缓解了患者进食困难的症状，尤其是带膜食管支架对治疗各种食管瘘有特效。随访３～２６个月，患者无不良反应。结论：采用食管支架治疗各种食管狭窄及食管瘘是安全、有效的方法。     

Esophageal transit scintigraphy--a cautionary note

Esophageal transit scintigraphy and esophageal manometry were compared in forty-two patients with symptoms of esophageal disease. Fifteen healthy volunteers were studied as a control group for the scintigraphic investigation. Agreement between the tests was present in 79% of patients. In all the five patients in whom the esophageal manometry was abnormal and the esophageal transit study was normal, the manometric finding was "giant esophageal contractions." In four of the control group an abnormal transit pattern was observed on one of two esophageal studies. Esophageal transit scintigraphy has some limitations as a screening test for esophageal motor dysfunction.     

食管支架成形术治疗食管狭窄现状及研究进展

支架置入术是治疗食管良恶性狭窄最常用的方法.目前广泛应用于治疗进展期食管癌性狭窄、顽固性食管良性狭窄、各种食管瘘等.本文就食管支架的临床应用现状及研究进展作一综述.     

食管支架选择应用的临床探讨

目的：探讨合理选用食管金属内支架置入治疗晚期食管癌性狭窄引起的吞咽困难。方法：对72例晚期食管癌置入食管金属内支架。结果：吞咽困难完全清除或明显缓解,食管－气管瘘或纵隔瘘完全封闭。结论：合理选择食管内支架可减少并发症的发生,是解决晚期食管癌患者进食的有效方法。     

食管癌选择性动脉造影和肿瘤供血的研究

目的：通过食管动脉造影对胸段食管癌动脉血供进行研究, 为食管癌动脉灌注化疗提供依据。方法：７０ 例经病理证实的胸段食管癌病例,胸上段１７ 例,胸中段２９ 例,胸下段２４ 例,对肿瘤的供血动脉行选择性 Ｄ Ｓ Ａ 造影并进行了分析。结果： 胸上段肿瘤主要由支气管动脉发出食管支供血,胸中下段主要接受由支气管动脉食管支和食管固有动脉供血。肿瘤由２ 支或多支动脉供血者占９０ ％ ,单支供血者占１０ ％ 。各供血动脉间８５ ．．７ ％ 的病例存在广泛的交通吻合。结论： 胸段食管癌多支动脉供血居多,灌注化疗时靶血管选择的条数应由造影所显示肿瘤血管及染色范围确定。     

Esophageal balloon dilatation: A follow-up study in 74 patients

Balloon esophageal dilatation was performed in 74 patients, 60 of whom had malignant neoplasia of the esophagus, 11 had benign esophageal stenoses, and 3 had esophageal stenoses caused by nonesophageal cancer. Sixteen patients underwent preoperative balloon dilatations and 15 were able to swallow until surgery. In 49 patients receiving palliative treatment for esophageal cancer, balloon dilatation allowed 40 (82%) to swallow until near death. We experienced one esophageal rupture.     

食管癌病人血清及癌组织游离氨基酸谱的临床研究

应用氨基酸自动分析仪，对２２ 例食管癌病人血清，正常食管组织和食管癌组织游离氨基酸含量分析。结果表明：食管癌病人血清有６ 种氨基酸降低，２ 种升高；食管癌组织游离氨基酸较正常食管组织显著增多，血清下降显著的几种氨基酸，在癌组织中增加比例明显。提示食管癌病人血和组织游离氨基酸代谢紊乱。     

P53、PCNA及P-gp在食管癌中表达的研究

目的：观察P53（P53蛋白）、PCNA（增殖细胞核杭原）和P-gp（P-糖蛋白）在人食管癌组织中的表达,探讨其与食管癌临床病理学的关系。方法：采用S-P免疫组化法检浏57例食管癌组织标本及12例正常食管组织标本中P53、PCNA和P-gp的表达。采用χ2检验对结果进行统计学分析。结果：1.P53和PCNA在正常食管组织与食管癌组织中的表达存在非常显著差异（P〈0.01）。2.P53和PCNA在不同分化程度的食管癌组织中的表达存在显著差异（P〈0.05）。3.P53在有无淋巴结转移的食管癌组织中的表达存在显著差异（P〈0.05）;而PCNA的表达存在不显著差异（P〉0.05）。4.P53和PCNA在不同PTNM分期的食管癌组织中的表达存在不显著差异（P〉0.05）。5.P-gp的表达与食管癌的发生及临床病理学特征无关（P〉0.05）。结论：P53、PCNA的表达与食管癌的发生及临床病理学特征有关,可作为一个新的评价食管癌的指标;而P-gp的表达与食管癌的发生及临床病理学特征无关。     

食管鳞状细胞癌高分辨率显微内镜图像定量分析的诊断价值

 

目的 探究食管鳞状细胞癌高分辨率显微内镜图像定量分析的诊断价值。方法 选择35例食管鳞状细胞癌和正常食管黏膜的大体标本,在前期制定的食管鳞状细胞癌高分辨率显微内镜(high resolution microendoscopy,HRME)诊断标准的基础上,回顾性分析其HRME图像特征。根据标本病理结果,由一名经验丰富的HRME医师挑选出1张HRME图片,纳入训练集,用计算机软件对图像特征进行定量分析,制定图像分析诊断标准。在此基础上,将100例内镜下疑诊食管鳞状细胞癌的活检标本的HRME图像纳入测试集,进行HRME图像定量分析,将计算机分析得出的预诊断结果与病理结果进行比较,评估定量分析HRME图像对食管鳞状细胞癌的诊断价值。结果 通过定量分析HRME图像中细胞的核面积(nuclear area,NA)对食管鳞状细胞癌和正常食管黏膜进行区分,经统计学分析,在训练集中的敏感性和特异性分别为90%和97%,测试集中的敏感性和特异性分别为97%和90%。结论 定量分析HRME图像可以区分食管鳞状细胞癌组织和正常食管黏膜,并能够增加诊断的客观性,有利于HRME技术的推广应用。

     

布-加综合征与食管静脉关系的X线研究

通过６０例布－加综合征患者食管静脉的观察，食管静脉正常的２４人（４０％），轻度曲张的２５人（４１．７％），中度曲张的８人（１３．３％），重度曲张的３人（５％）。提示食管静脉的改变主要受下腔静脉病变性质、范围和病史长短的影响，与狭窄的程度关系不大。笔者还结合文献资料对上述结果和形成原因进行了分析。     

创新是介入放射学可持续发展的动力——论食管内照射支架技术治疗食管癌

食管癌的治疗仍然是目前临床所面临的难题之一.虽然,金属食管支架技术为缓解食管癌所致食管梗阻的重要技术,能快速、安全缓解食管癌所致的食管梗阻,但是对原发肿瘤无治疗作用.将支架作为放射性粒子载体,同时对肿瘤行近距离放射治疗,无疑将开创食管癌治疗的新模式,延伸了支架治疗的意义,是食管癌治疗乃至支架技术的重要突破.介入放射学的...     

Complications of esophageal surgery: role of imaging in diagnosis and treatments

Esophageal surgery is a common and integral component in the management of hiatal hernias, esophageal carcinoma, and esophageal perforation. Understanding the expected postsurgical imaging features of these common esophageal surgeries and postoperative complications is essential. Image-guided intervention can be used to aid the surgeon in the management of many post esophageal surgical complications. We discuss the imaging features of the postoperative esophagus and the use of imaging, including fluoroscopy and computed tomography, in the diagnosis of post esophageal surgical complications and treatment.