T1bSM2期食管鳞状细胞癌内镜治疗的安全性和有效性分析

目的回顾性分析内镜切除术治疗T1bSM2期(黏膜下层≥200 μm)早期食管鳞状细胞癌的安全性、有效性。 方法选取2009年1月至2017年7月于解放军总医院第一医学中心接受内镜切除术治疗且术后病理提示病变累及M3层(黏膜肌层)、SM1层(黏膜下层<200 μm)和SM2层(黏膜下层≥200 μm)的79例患者为研究对象,根据浸润深度分为相对适应证组和拓展适应证组,分析比较两组患者的基本资料及术后并发症的差异,Kaplan-Meier生存分析总体生存率及无进展生存率。 结果两组患者的基本资料、术后并发症、预后、总体生存率及无进展生存率比较,差异无统计学意义。 结论对于T1bSM2期食管鳞状细胞癌,内镜切除术也是一种可以选择的治疗方式。     

内镜下黏膜剥离术:欧洲胃肠内镜学会指南

<正>本指南是欧洲胃肠内镜学会(ESGE)的官方声明,是根据GRADE系统评估的强度和证据的质量推荐。主要建议如下:①对于Barrett食管内可见的病变行根治性内镜切除(强烈推荐,中等质量证据)。对于黏膜内癌,内镜下黏膜剥离术并未显示出较内镜下黏膜切除术的优势,因此可优先考虑内镜下黏膜切除术。内镜下黏膜剥离术可用于部分病例,如病变大于15 mm以及具有黏膜下层侵犯风险者(强烈推荐,中等质量证据)。②对于浅表性食管鳞状细胞癌应行内镜下整块切除,有明显黏膜     

Src家族酪氨酸激酶Fyn在人食管鳞状细胞癌中的表达

目的 探讨食管鳞状细胞癌组织中Fyn的表达水平及其意义.方法 收集13例食管鳞状细胞癌组织(ESCC)和10例食管正常黏膜上皮组织(UNR),采用免疫组织化学法和免疫印迹法分析食管鳞状细胞癌组织及食管正常黏膜组织Fyn蛋白表达水平的变化.结果 免疫组织化学染色显示食管鳞状细胞癌组织中Fyn蛋白表达水平(9.68±2.31)高于食管正常黏膜组织中染色指数(3.21±1.25),差异有统计学意义(P<0.01).免疫印迹结果亦显示食管鳞癌组织中Fyn蛋白表达强于食管正常黏膜组织.结论 Fyn蛋白在食管鳞状细胞癌组织中高表达,提示Fyn基因在食管鳞状细胞癌的发生发展过程中可能起重要作用.     

43例食管鳞状细胞癌新辅助化疗疗效观察

食管鳞状细胞癌占食管癌的90％，50％的食管患者在就诊时已为中晚期，单纯手术治疗效果不理想，术后5年生存率一直排徊于10％-35％，平均20％。为了提高食管癌的术后生存期，近年来提出新辅助化疗（neoadjuvant chemotherapv）概念。本文对我院以往食管鳞状细胞癌患者进行回顾性分析，以观察其对食管鳞状细胞癌的临床疗效。     

早期食管癌内镜及病理特点分析

目的 总结早期食管癌内镜及病理特点,探讨其对临床诊断的价值.方法 回顾性分析2003年1月至2007年12月西南医院收治的62例早期食管癌患者的临床资料,总结其内镜和病理特点.结果 食管上段癌8例,中段癌42例,下段癌12例.内镜分型依次为表面扩散生长型30例,双向生长型11例,腔内生长型9例,壁内生长型7例,混合生长型5例.多数肿瘤直径为1.0～2.9 cm.行外科手术治疗38例、内镜黏膜切除术治疗23例、内镜黏膜下层剥离术治疗1例.术后病理检查:原位癌13例,黏膜内癌22例,黏膜下癌27例,黏膜内癌和黏膜下癌的淋巴结转移率分别为5%(1/22)和15%(4/27).病理分型:鳞癌57例,腺癌2例,小细胞癌、肉瘤化癌、梭形细胞癌各1例.结论 早期食管癌好发于食管中段,以表面扩散生长型多见,以鳞癌为主,普通内镜联合卢戈液和美蓝检查是发现早期食管癌的重要方法.     

内镜下治疗伴发静脉曲张的上消化道早癌患者的出血风险

目的研究内镜下治疗伴发食管胃静脉曲张的上消化道早癌患者的出血风险。方法回顾性分析2005年4月至2011年8月行内镜下治疗伴发食管胃底静脉曲张的7例上消化道早癌患者的临床资料。静脉曲张采用LDRf分型进行分型。对于早癌或癌前病变采用内镜下黏膜剥离术（ESD）或内镜下黏膜切除术（EMR）治疗。结果本组7例患者行ESD或EMR,7例患者中4例早期胃癌,3例早期食管癌;6例食管静脉曲张,1例胃底静脉曲张。均完整切除病变,内镜下早癌治疗术中及术后均未发生静脉曲张出血。结论内镜下治疗伴发食管胃静脉曲张的上消化道早癌不增加静脉曲张的出血风险。     

人工智能在浅表食管鳞状细胞癌及癌前病变内镜诊断中的应用进展

食管癌严重威胁国民身体健康,破解这一难题的关键是早诊早治,内镜筛查为早期诊断最重要的手段。人工智能（artificial intelligence,AI）技术的快速发展使得其在消化内镜领域的应用及研究日益增加,并有望成为内镜医师早期诊断食管癌的得力助手。目前,整合多种内镜模式、具备多种诊断功能的多模态、多功能AI系统在浅表食管鳞状细胞癌及癌前病变中的应用取得不错的成果,本文将对其研究进展进行综述,并对其未来发展方向进行展望。     

利用经口隧道技术切除食管大面积病变的体会

食管癌是我国的常见病、多发病,随着消化内镜检查的普及,越来越多的癌前病变与早癌被发现。虽然内镜下黏膜剥离术（endoscopic submucosal dissection,ESD）已经成为用于切除食管癌前病变与早癌的一种标准技术,但大面积的食管早癌的治疗仍然使人感到困惑，经典的标记一注射一环形切开病变边缘一注射一剥离的方法速度慢。     

舌、食管、胃重复癌1例报告

男性病人,58岁。5年前因患舌鳞状细胞癌在我院行舌癌根治术。现因进行性吞咽困难1个月余入院。上消化道X线钡餐见食管中段狭窄,胃镜发现除食管中段有长径约5cm肿块外,在贲门部胃小弯侧还有2.5cm×2.0cm大小的黏膜糜烂区,病理检查结果为食管鳞状细胞癌、贲门腺癌。行食管癌、贲门癌根治术,残胃与食管吻合,术后恢复良好,术后病理检查结果同术前。讨论:上消化道3处以上的重复癌极为罕见。重复癌的诊断目前多采用Warren和Gates提出的诊断标准:(1)每个肿瘤必须是恶性,(2)每个肿瘤有独特的病理形态,(3)必须排除转移性癌。所有肿块在6个月以内获…     

黏膜下隧道技术

黏膜下隧道技术是在利用内镜下黏膜剥离术在黏膜层与肌层之间建立隧道,利用该隧道空间进行内镜下治疗的技术。黏膜下隧道技术的应用包括:(1)黏膜层疾病的治疗,如食管大面积甚至环周早癌的剥离等。(2)肌层相关病变的治疗,如黏膜下隧道内镜肿瘤切除术(STER)、内镜下食管下段环形肌切开术(POEM)等。(3)诊断与治疗胃肠道管腔外疾病,如淋巴结切除、肿瘤切除、经自然腔道内镜手术(NOTES)等。由于隧道使黏膜层切开部位和操作部位分开,术后入口易关闭,故有"黏膜安全瓣"之称。     

Transthoracic Esophagectomy After Endoscopic Mucosal Resection in Patients with Early Esophageal Carcinoma

Introduction  For patients with esophageal carcinoma limited to the mucosa endoscopic mucosal resection (EMR) is the therapy of choice whereas surgical resection is advocated for submucosal tumors. Methods  This study analyzes the histopathologic results of patients with early esophageal carcinoma who underwent EMR prior to transthoracic esophagectomy. Sixteen patients with early esophageal carcinoma and EMR as first line treatment were included in this retrospective study. Ten patients underwent transthoracic esophagectomy because of submucosal infiltration combined incomplete tumor resection at the lateral/basal resection margin. In one patient each, surgical therapy was indicated due to submucosal infiltration or incomplete resection only. Three patients underwent surgical resection due to residual neoplasia within an esophageal stenosis following EMR. Surgical specimens were examined for pT and pN stage according to the UICC. Results  Three patients had a squamous cell carcinoma (SCC) and 13 patients an adenocarcinoma (AC), nine patients with a long segment Barrett’s esophagus. The distribution of the pT stages was as follows: 6× pT0 (no histopathologic evidence of residual tumor), 1× pT1m1, 1× pT1m2, 3× pT1m3, 1× pT1sm1, 1× pT1sm2, 1× pT2, and 2× pT3. Three of 16 patients (18.8%) with a pT1sm1, pT2, and pT3 stage had nodal metastases. In all three patients metastatic nodes were located in the mediastinum. In two patients, a second carcinoma was detected during histopathologic work-up (1× AC in the cardia and 1× SCC in the cervical esophagus). Conclusion  The data of this highly selected patients indicate that the boundary between the therapy of mucosal and submucosal tumors is not as clear as stated. Therefore, treatment of early esophageal carcinoma demands a close interdisciplinary cooperation.     

Prediction of lymph node status in patients with superficial esophageal carcinoma: analysis of 160 surgically resected cancers

BACKGROUND: The ability to predict lymph node metastasis in cases of superficial esophageal carcinoma before surgery would allow the identification of specific patients who do not require additional surgical resection after endoscopic local resection. METHODS: From 1980 to 2002 a total of 160 patients with superficial esophageal carcinoma, Tis or T1 tumors, underwent subtotal esophagectomy with lymph node dissection. On the basis of clinicopathologic data the risk factors for lymph node metastases are discussed. RESULTS: Patients with tumors that showed submucosal invasion, a nonflat shape, and lymphatic invasion had a higher risk for lymph node metastasis than the other patients. Multivariate analysis showed that the tumor depth and the macroscopic shape of the tumor were independent risk factors for lymph node metastases. CONCLUSIONS: Esophagectomy with lymph node dissection is recommended for patients with submucosal cancer. Local tumor resection can be recommended for patients with mucosal cancer without lymphatic invasion.     

Esophageal cancer from the german point of view

Although there are no differences worth mentioning between esophageal cancer in Japan and in Europe regarding epidemiology, tumor stages at the beginning of therapy and surgical selection. In Japan, early esophageal squamous cell carcinoma is more often diagnosed than in Europe where esophageal adenocarcinoma, especially that of the endobrachyesophagus, is becoming more and more relevant. For a long time, the limiting factor for the prognosis of esophageal cancer was the postoperative lethality. However, by carefully analysing the factors influencing this operative lethality over the last few years, the lethality following esophagectomy has been decreased to approximately 15 per cent. In fact, in some specialized centers, the lethality is now less than 10 per cent and in selected patient groups even 3 per cent has been reached. It is only through this achievement that the prognosis for esophageal cancer has been able to be markedly improved. The results of this analysis can be detailed as follows: 1) The preoperative definition of tumor stage by CT or MRI is not reliable, the validity being between 45 per cent and 73 per cent. Therefore, no therapeutical decisions can be made on the basis of these diagnostic procedures. Hopefully the intraluminal ultrasound will improve this situation in the future. 2) The analysis of preoperative nutritional status did not allow a definition of risk groups. 3) Decisive improvements were able to be achieved by the standardising of surgical procedures and indications. Enbloc resection is indicated for all intrathoracic squamous cell carcinomas and accounts for a high percentage of RO-resections. The blunt dissection is especially appropriate for distal adenocarcinomas. 4) Endobronchial onesided ventilation during the operation and prophylatic assisted ventilation have both decreased the pulmonary risk considerably. A further improvement in the prognosis of esophageal carcinoma can possibly be achieved by the preoperative identification of advanced tumors (T₃/T₄) and preoperatively treating these tumor types accordingly. From our own experience, we believe combined radio-chemotherapy could be successful.     

胸段食管鳞癌患者的喉返神经旁淋巴结转移特点

目的探究胸段食管鳞癌患者的喉返神经旁淋巴结转移特点。 方法回顾性分析福建协和医院胸外科2012年1月至2015年12月间收治的行胸腹腔镜联合食管癌切除术的294例胸段食管鳞癌患者的喉返神经旁淋巴结清扫及转移情况,并分析喉返神经旁淋巴结转移特点。 结果294例行喉返神经旁淋巴结清扫的患者中,有88例患者有喉返神经旁淋巴结转移,转移率为29.93%;共清扫喉返神经旁淋巴结1 899枚,转移淋巴结145枚,转移度为7.64%。胸段食管鳞癌患者左、右喉返神经旁淋巴结转移与肿瘤浸润深度、分化程度、脉管瘤栓均有显著相关性(P<0.05),但与性别、年龄、肿瘤部位无显著相关性(P>0.05)。 结论胸段食管鳞癌患者易发生喉返神经旁淋巴结转移。对于肿瘤浸润程度大、分化程度差、有脉管瘤栓的胸段食管鳞癌患者,应重视左、右两侧喉返神经旁淋巴结清扫。     

Detection of telomerase activity in esophageal squamous cell carcinoma and normal esophageal epithelium

Background/aims: Relatively little has been reported about the telomerase activity of esophageal squamous cell carcinoma or normal esophageal epithelium. In this study, we have evaluated whether telomerase activity is a useful marker for detecting malignancies in the esophagus. Patients/methods: Esophageal carcinomas and normal esophageal tissues adjacent to carcinomas were obtained from 52 surgically treated, unselected patients, and normal esophageal epithelium from 11 non-cancerous patients were obtained by means of biopsy. The telomeric repeat amplification protocol (TRAP) assay was used for detection of telomerase activity in these samples. The incidence of detection of telomerase activity in esophageal carcinoma was compared with that of telomerase activity in normal esophageal epithelium. Moreover, the clinicopathological characteristics of telomerase-positive tumors were compared with those of telomerase-negative tumors. Results: Of the 52 carcinomas, 40 (77%) had detectable telomerase activity. However, telomerase activity was detected in 45 of 52 (87%) normal tissue samples adjacent to carcinomas and in 8 of 11 (73%) normal esophageal epithelium from non-cancerous patients. In esophageal cancer, no significant difference was detected in the clinicopathological findings between the telomerase-positive and -negative cases. Conclusion: These results indicate that not only esophageal squamous cell carcinomas but also normal esophageal epithelium show strong telomerase activity. Thus, telomerase activity may not be a good marker for the detection of carcinoma in the esophagus. Received: 16 March 1999 Accepted: 8 July 1999     

Resection of carcinoma in the cervical esophagus following prior removal of a thoracic esophageal carcinoma — A case report—

We report herein, a rare case of a patient who, having undergone resection of a thoracic esophageal cancer, underwent removal of a cervical esophageal cancer, for which a free jejunal graft with microvascular anastomoses was utilized. The tumor in the cervical esophagus had originated from a second primary squamous cell cancer, which had occurred synchronously but had unfortunately escaped detection before the first operation. Due to the high incidence of other multicentric neoplasma or metastatic skip lesions accompanying esophageal carcinoma, careful evaluation during preoperative examinations in order to avoid overlooking another lesion, especially in the cervical portion of the esophagus is imperative.     

内镜下黏膜多环套扎切除术治疗食管癌前病变和食管早癌的近期疗效和安全性分析

目的探讨内镜下黏膜多环套扎切除术（EMBL）治疗食管癌前病变和早癌的近期疗效和安全性。方法回顾性分析2012年1-11月在复旦大学附属中山医院内镜中心接受EMBL治疗的21例食管癌前病变和早期食管癌患者的临床资料,总结治疗效果及术后并发症发生情况。结果21例患者均顺利完成EMBL术。手术时间（21．0±8．3）min。术后无皮下气肿、纵隔气肿、气胸及迟发性出血病例。2例患者术后1个月出现食管创面狭窄,经气囊扩张术后症状缓解。术后病理示：中度不典型增生1例,中-重度不典型增生2例,重度不典型增生10例,原位癌2例,早期鳞癌6例。除1例早期鳞癌患者因癌灶距离切缘仅1mm,遂追加开胸食管癌根治术外,其余患者切缘均阴性。随访期间未见复发病例。结论EMBL术可有效治愈食管癌前病变和早期食管癌,具有微创、安全、操作简单的优点。     

Two cases of resected esophageal mucoepidermoid carcinoma

Two cases of resected esophageal mucoepidermoid carcinoma are described herein. Case 1, a 56-year-old man, had an ulcerous lesion of 6.5 cm in length, in the lower esophagus and a small skin tumor of 0.5 cm in diameter, in the forehead. Pathologic studies of both tumors revealed mucoepidermoid carcinoma. This case was therefore considered to be a primary tumor of the esophagus with skin metastasis. The patient was alive and well when last seen, 15 months after his operation. Case 2, a 66-year-old man, had a long ulcerous lesion of 9.0 cm in length, in the mid-thoracic and lower esophagus. The tumor had invaded the aorta and the membranous portion of the left main bronchus, and therefore complete resection was impossible. The patient died of mediastinal recurrence only 3 months after his operation in spite of postoperative irradiation. A review of the literature showed that this tumor has a much greater incidence of rapid recurrence and distant metastasis, regardless of treatment, than usual squamous cell carcinoma of the esophagus. In order to establish and accurate diagnosis of mucoepidermoid carcinoma, alcian blue and/or mucicarmin staining of the endoscopic biopsy specimen should be performed if the tumor contains both glandular and squamous cell carcinoma.     

食管鳞癌环周切缘的临床意义分析

目的:分析食管鳞癌环周切缘情况与患者术后生存预后的关系,并探讨其与临床病理特征的相关性。方法:收集河北医科大学第四医院2017年10月至2019年3月行食管癌根治性切除术后的患者资料,所有患者临床资料完整,术后病理均为进展期鳞癌。采集并分析患者性别、年龄、T分期、N分期、肿瘤位置、病变长度、大体病理类型、脉管瘤栓、神经...