气管食管裂隙状发声孔发声机制研究

目的：探讨气管食管裂隙状发声孔的发声机制。方法：用大功率遥控X线机和动态频闪喉镜观察40例行全喉切除，Ⅰ期或Ⅱ期发声重建术患者发声时的贮气相、送气相、发声相。结果：患者吸气时肺部膨隆，食管黏膜闭拢；食管入口黏膜内翻呈环形缩小；随之，下咽腔增大呈一尖端向下的三角锥形；食管上端迅速膨大。发声开始时，食管上端扩张如球，食管人口黏膜以冠状位呈唇样外翻，气体从咽食管部冲出；黏膜、黏液发生振动，发出基音。后胸廓缩小，食管入口黏膜再次内翻，发声结束。结论：气管食管音发声的动力器官是肺，气管-食管造瘘口的通畅对发声至关重要。发声时，下咽黏膜、食管口黏膜与黏液均参与振动。     

镍太记忆合金支架治疗食管狭窄

目的：探讨镍钛记忆合金（ＮＴ－ＳＭＡ）支架在治疗食管狭窄中的应用价值。方法：在Ｘ线下了解食管狭窄的部位,经食管镜插入金属导丝,先行食管扩张术,再将装有支架的置入器沿导丝滑入食管狭窄处,放出ＮＴ－ＳＭＡ支架,并让其自行复形,术后Ｘ线吞钡复查了解支架位置和通畅情况。结果：１９例食管狭窄患者,安放支架均一次成功,恢复进食功能,近期有效率为１００％。结论：ＮＴ－ＳＭＡ支架可使狭窄的食管迅速扩张,明显地改善     

Cervical esophageal perforation and cricopharyngeal dysfunction

Spontaneous perforation of the esophagus is an uncommon event; when it does occur, it usually affects the thoracic esophagus. We present a rare and fatal case of spontaneous perforation of the cervical esophagus in a 68-year-old woman. We believe this rupture was related to a proximal outlet obstruction secondary to cricopharyngeal muscle dysfunction.     

Involvement of carbon monoxide in the innervation of the canine cervical esophagus and trachea

We investigated the involvement of carbon monoxide (CO) in the innervation of the canine cervical esophagus and trachea by means of immunohistochemistry using an antiserum against heme oxygenase-2 (HO-2). We detected HO-2-immunoreactive nerve fibers around the blood vessels and submucosal glands of the esophagus and trachea. We found HO-2-immunoreactive neurons in ganglia in the trachea and in the myenteric plexus of the esophagus. These results suggest that CO is involved as a neurotransmitter in the innervation of the canine esophagus and trachea.     

Ectopic gastric mucosa in the cervical esophagus

This study describes the clinical presentation and management of ectopic gastric mucosa (EGM) in the cervical esophagus. This is a case report of a 53-year-old male who presented with left-sided odynophagia of 3 months' duration. Office examination, including flexible fiberoptic laryngoscopy, was unremarkable. Direct larynogoscopy and rigid esophagoscopy revealed a 2 x 1-cm fleshy, red, and raised lesion in the cervical esophagus. The remainder of the esophagus was normal. Histologic examination of a biopsy specimen from the lesion showed a normal gastric epithelium consistent with the diagnosis of ectopic gastric mucosa. He was treated with 3 months of proton pump inhibitors, which resulted in complete symptom resolution. Patient was then switched to H2-blockers and has been symptom-free for one year. The medical literature regarding EGM in the cervical esophagus is reviewed with respect to its incidence, pathogenesis, clinical course, and management. In conclusion, EGM can occur in the cervical esophagus, and odynophagia is the typical presenting symptom. Adenocarcinoma developing within random, nonsyndromic EGM of the cervical esophagus is exceedingly rare. The primary mode of treatment is medical therapy.     

儿童纽扣式电池食管异物分析

目的　总结儿童纽扣式电池食管异物临床表现,探讨其安全、有效的治疗方法。方法　回顾性分析我院2014年4月～2016年12月收治的误咽纽扣式电池患儿12例,其中1例异物位于食管第二狭窄,其余11例均位于食管第一狭窄。结果　8例经食道镜取出,1例电子胃镜取出,1例经电子胃镜取出困难,改行食道镜取出,1例采用Foley管取出,1例Foley管取出困难进一步行食道镜取出。9例并发食管周围炎,食管腐蚀伤,2例并发食管穿孔,1例并发食管气管瘘。结论　食管异物为小儿常见急诊,其中纽扣式电池对人体的危害极大,纽扣式电池含有重金属及化学化合物,对食管壁具有腐蚀性,造成食管壁的损伤,伴发食管穿孔、狭窄等,损伤程度与异物嵌顿时间成正比,及时采取合理的手术是治愈的关键。     

Transnasal esophagoscopy: revisited (over 700 consecutive cases)

BACKGROUND: High-resolution transnasal esophagoscopy (TNE) allows comprehensive, in-office examination of the esophagus without sedation. OBJECTIVE: To compare the authors' present experience using TNE with our initial, previously reported experience. METHODOLOGY: Retrospective review of 611 consecutive patients undergoing TNE was compared with 100 consecutive patients previously reported. RESULTS: The most frequent indications for TNE were screening examination of the esophagus in reflux, globus, or dysphagia patients (n = 490), biopsy of a lesion in the laryngopharynx, trachea, or esophagus (n = 42), screening examination of the esophagus in head and neck cancer patients (n = 45), and evaluation for an esophageal foreign body (n = 12). Seventeen procedures were aborted secondary to a tight nasal vault. Significant findings were found in 50% (294/592). The most frequent findings were esophagitis (n = 98), hiatal hernia (n = 47), and Barrett's esophagus (n = 27). These results are similar to those previously reported. CONCLUSIONS: TNE is safe, well tolerated by patients, and is easy to learn with a short learning curve. TNE may replace radiographic imaging of the esophagus in otolaryngology patients with reflux, globus, and dysphagia.     

Esophageal contractility synchronous with expiration.

On the basis of our previous finding that the cervical esophagus was closed during tracheoesophageal phonation, we postulated that the muscle of the cervical esophagus actually contracted during expiration and speculated on its possible regulation by the recurrent laryngeal nerve. Electromyography of the esophageal musculature and fluoroscopy of the esophagus were performed in laryngectomees to demonstrate whether the esophagus contracted during expiration or not. Electromyography, performed in 2 subjects, revealed a burst of discharges synchronous with expiration. Fluoroscopy during tracheoesophageal phonation was performed in 13 subjects to investigate the influence of resection of the esophageal branch of the recurrent nerve on esophageal motor activity. Among 13 subjects, 4 subjects who underwent paratracheal dissection (PTD) at the time of laryngectomy showed a lower superior limit of esophageal closure than did the 9 subjects without PTD, indicating that the cervical esophagus in PTD loses its contractility with the sacrifice of the esophageal branch of the recurrent nerve. We concluded that the cervical esophagus is closed by muscle contraction synchronous with expiration, preventing air entry into the stomach during deep expiration or phonation, and that the esophageal branch of the recurrent nerve is involved.     

无痛食管镜检查及异物取出术

目的：观察静脉麻醉行无痛食管镜检查及异物取出术的效果。方法：静脉麻醉下对42例临床疑似食管异物患者作食管镜检查,术中见异物者同时行异物取出术。结果：32例食管异物均顺利取出,其余10例为食管黏膜擦伤,未见明显异物。结论：采用异丙酚静脉麻醉下作食管镜检查加异物取出术操作安全、无痛、损伤少,术中、术后并发症少,患者术后恢复快,符合舒适医疗理念,值得临床推广应用。     

颈段食管吻合口狭窄的手术治疗

目的探索颈段食管吻合口狭窄的手术方法及疗效。方法回顾9例颈段食管吻合口狭窄患者的治疗经过,其中,因腐蚀伤行结肠食管吻合者5例,因食管癌行胃食管吻合者3例,1例为颈部恶性淋巴瘤放射治疗后颈部食管狭窄,局部成形术后再狭窄。手术方法包括吻合口局部成形术6例,胸锁乳突肌骨膜瓣修复1例,结肠和空肠食管重建各1例。结果患者均一期愈合,吞咽功能完全恢复者7例,二次术后吞咽功能基本恢复者2例。随访1～3年吞咽功能恢复稳定。无新发喉返神经麻痹或胸腹腔并发症。结论颈段食管吻合口狭窄扩张治疗失败者宜行手术治疗。     

The relationship between esophagoscopic findings and total acid reflux time below pH 4 and pH 5 in the upper esophagus in patients with laryngopharyngeal reflux disease (LPRD)

OBJECTIVE:: To investigate the relationship between esophagoscopic findings and total acid reflux time in the upper esophagus in the patients of laryngopharyngeal reflux disease (LPRD), and to evaluate whether pH<5 holding time is appropriate for diagnosing LPRD. METHOD:: Esophagoscopy and 24-h pH monitoring in the upper esophagus were performed in 29 patients suspected of LPRD and 19 healthy volunteers participated as controls. The total acid reflux times below pH 4 and 5 in the upper esophagus were compared between the LPRD group and the controls. The LPRD group was divided into LPRD with reflux esophagitis (RE) and LPRD without RE, and the total acid reflux times below pH 4 and 5 of these two groups were compared. RESULTS:: Eight of the 29 (27.6%) LPRD patients had reflux esophagitis. The LPRD group showed a significantly longer acid reflux time than the control group at pH below 5 (P=0.009) but not at pH below 4 (P=0.48). The LPRD with RE had significantly longer acid reflux times below both pH 4 and 5 in the upper esophagus compared to those of the LPRD without RE. The P values using a cut-off value of pH 5 were smaller than that of pH 4 in all statistical results. CONCLUSION:: The LPRD patients showed significantly longer acid reflux time in the upper esophagus than the control group. In the LPRD group, the LPRD with RE patients had more frequent acid exposure in the upper esophagus than the LPRD without RE. A pH level of 5 could be appropriate as a cutoff level for the diagnosis of LPRD in upper esophagus pH monitoring.     

Synovial sarcoma of the esophagus

The occurrence of synovial sarcoma in sites other than the extremities is rare. Twelve cases in the hypopharynx but none in the esophagus have been described. A case of polypoid synovial sarcoma arising in the upper third of the esophagus in a 25-year-old man is reported. To the authors' knowledge, this is the first report of synovial sarcoma arising in the esophagus. The pathologic findings, ultrastructural studies, and results of surgical management and radiotherapy are discussed.     

Extracting coins from the upper end of the esophagus using a Magill forceps technique

OBJECTIVES: To assess the efficiency of a Magill forceps technique (MFT) in removing coins from the upper end of the esophagus. METHOD: The study population was 75 patients, all of them were children under the age of 12 years. This study was carried out in ENT department at Princess Basma Teaching Hospital during the period October 1996-September 1999. MFT is based on the insertion of a Mc-Intosch laryngoscope into the pharynx to elevate the larynx and to expose the esophageal entrance, then Magill forceps were advanced into the esophagus and opened in order to see and extract the coin from the esophagus. RESULTS: Seventy-one coins were successfully removed without any complications from 75 children admitted with coins in the upper end of the esophagus. In the remaining four cases, the coins had slipped down into the stomach. The average time taken to remove the coin was 30 s. CONCLUSION: MFT is a quick, easy and safe technique for removing coins from the upper end of the esophagus.     

纤维喉镜用于食管检查209例

目的 探索纤维喉镜用于食管检查的可行性及临床效果。方法 选择需要辨别食管病变的患者209例,应用带显示系统纤维喉镜进行食管检查。结果 209例中共查出有明显食管疾病患者117例,其中反流性食管炎76例,食管裂孔疝7例,霉菌性食管炎5例,食管憩室3例,食管静脉曲张3例,Barrett食管1例,食管黄色素瘤1例,食管息肉2例,食管癌7例,贲门癌1例,异物11例。以上病变均得到胃镜和/或病理支持。结论 纤维喉镜可用于食管检查,且痛苦小,方便患者,有益于耳鼻咽喉科医生对食管反流性咽喉疾病的诊断获取第一手资料。     

食管异物摘取术的麻醉选择

为探讨食管异物摘取术的麻醉方法，提高手术效果，对７２例食管异物患者采用强化表面麻醉法和气管内插管麻醉法进行了手术和对比观察。７２例异物均取出顺利，无严重并发症发生。资料显示：两种麻醉各具优越性，前者适用于年龄较大的儿童和成人，后者适用于食管异物并呼吸困难的小儿。     

Ectopic gastric mucosa in the cervical esophagus

Ectopic gastric mucosa is a known entity of the mid and lower esophagus which was initially described by Schmidt in 1805. The presence of ectopic gastric mucosa in the cervical esophagus, however, was not described. A review of the literature reveals that ectopic gastric mucosa of the cervical esophagus is not uncommon, but symptoms rarely have been attributed to its presence. This paper reports five patients with isolated inflamed ectopic gastric mucosa in the cervical esophagus who presented with odynophagia and/or dysphagia. Physical examination was unremarkable in each case, and an acid barium esophagram was negative in four of five patients. Factors that distinguish these patients from other cases of odynophagia and dysphagia, as well as detailed clinical findings and treatment, are described. Debate exists as to whether the origin of ectopic gastric mucosa is congenital or acquired. The embryology, gross and microscopic anatomy, and pathologic features are outlined. Patients with persistent dysphagia should have flexible fiberoptic esophagoscopy with an index of suspicion to the existence of ectopic gastric mucosa. Inflamed or ulcerated ectopic gastric mucosa in the cervical esophagus should be treated to relieve symptoms and because of the potential for complications.     

颈段食管癌组织中FOXP3蛋白表达、肿瘤间质浸润FOXP3+淋巴细胞数量的临床意义

目的 观察研究FOXP3蛋白在颈段食管癌细胞中的表达及肿瘤间质浸润的FOXP3+淋巴细胞数量,探讨其临床意义。方法 通过免疫组织化学方法、免疫组化双染技术,对42例颈段食管癌的肿瘤组织和30例的癌旁组织的石蜡切片进行分析,观察FOXP3蛋白的表达FOXP3+淋巴细胞的浸润。结果 FOXP3蛋白在颈段食管癌实质细胞和癌旁实质细胞表达的阳性率分别为42.9% （18/42）和6.67%（2/30）,两者差异有统计学意义(χ2=10.324,P<0.01)。颈段食管癌和癌旁组织间质浸润的FOXP3+淋巴细胞阳性率分别为38.1%（16/42）和13.33%（4/30）,两者差异有统计学意义(χ2=15.376,P<0.01)。颈段食管癌实质细胞中,周围淋巴结转移组FOXP3蛋白表达显著性高于无淋巴结转移组(P<0.05);同时临床分期Ⅲ、Ⅳ期标本中FOXP3蛋白表达显著性高于Ⅰ、Ⅱ期标本(P<0.05)。在淋巴结转移组中,肿瘤间质中浸润FOXP3+淋巴细胞数量明显多于无淋巴结转移组,表达有显著性差异(P<0.05)。结论 颈段食管癌实质细胞FOXP3表达异常和FOXP3+淋巴细胞浸润可能与颈段食管癌的转移关系密切,能够促进肿瘤免疫逃逸的发生;FOXP3可作为评估颈段食管癌术后转移的一种潜在标记物。     

The negative effect of hyperbaric oxygen therapy at the acute phase of electrochemical esophageal burn induced by button battery ingestion

OBJECTIVE: Ingestion of button battery, if lodges in esophagus, causes mucosal destruction in esophagus and may damage surrounding tissues due to electrochemical reactions which may lead to esophagus perforation, tracheosefageal fistula and other serious problems. We designed an experimental study to test the effect of hyperbaric oxygen therapy on battery induced electrochemical tissue damage in the esophagus of a rabbit model and possible change with duration of contact time. METHODS: Button batteries were inserted in esophagus of 40 rabbits which were divided into four groups. Groups 1 and 2 had 15 min of duration of contact time of battery in esophagus, while Groups 3 and 4 had 30 min. Groups 1 and 3 had hyperbaric oxygen therapy for 3 days; Groups 2 and 4 did not. At the end of 3rd day all animals were sacrified and samples were taken from the esophagus for determination of malondialdehyde levels and for histopathological examination to compare: mucosal destruction, muscular layer involvement, perforation and tracheal involvement between groups. RESULTS: Malondialdehyde levels, mucosal destruction, muscular layer involvement, perforation and tracheal involvement were significantly higher in groups which had 30 min of contact time compared to groups which had 15 min. The same assessments were significantly higher in Group 1 (15 min of contact time with hyperbaric oxygen therapy) compared to Group 2 (15 min of contact time without hyperbaric oxygen therapy). However, the difference between Group 3 (30 min of contact time with hyperbaric oxygen therapy) and Group 4 (30 min of contact time, no hyperbaric oxygen therapy) was not significant. CONCLUSION: Our study demonstrated that if contact time is 15 min HBO had an additive adverse effect to electrochemically burned esophagus by increasing free radicals and eventually tissue damage. However, if the contact time is 30 min its adverse effect is shielded by huge electrochemical destruction due to long contact time.     

The challenge of esophagoscopy in infants with open safety pin in the esophagus: report of two cases

Among all foreign bodies impacted at the esophagus, the safety pin still seems to be a challenge for the specialist. This is a report of 2 cases presenting infants with open safety pin impacted in the esophagus. The strategy and intraoperative management of this rare finding is discussed in detail.     

A case of long-term presence of a foreign body in the esophagus

The following long-term presence of foreign body in esophagus in psychotic patient. Diagnostic and treatment principles of foreign body in esophagus was discussed.