全腔镜下Ivor-Lewis术与McKeown术治疗食管癌的临床疗效

目的探讨全腔镜下Ivor-Lewis术与McKeown术治疗食管癌的临床疗效。方法回顾性分析62例行食管癌根治术患者的临床资料,根据手术方式将其分为Ivor-Lewis组(33例)和McKeown组(29例)。比较2组患者围术期指标、术后并发症及肿瘤复发情况。结果2组患者围术期指标比较差异均无统计学意义(P>0.05)。与McKeown组相比,Ivor-Lewis组吻合口狭窄、吻合口瘘、喉返神经损伤发生率较低,差异有统计学意义(P<0.05);2组术后肺不张、肺部感染、胃排空延迟、乳糜胸等发生率比较差异无统计学意义(P>0.05)。术后6个月2组肿瘤复发率比较差异无统计学意义(P>0.05)。结论全腔镜下Ivor-Lewis术与McKeown术治疗食管癌均安全有效,但Ivor-Lewis术在吻合口狭窄、吻合口瘘及喉返神经损伤等并发症的控制上更有优势。     

腹腔镜联合手术的临床应用体会

目的探讨腹腔镜联合手术的临床应用价值和体会。方法回顾分析2005年1月～2008年12月间55例腹腔镜联合手术的临床资料。结果55例腹腔镜手术成功,无并发症发生,术后4～7 d痊愈出院。结论腹腔镜联合手术可以安全有效的处理多种腹部疾病,可在同一专科或多专科中联合应用,需严格掌握手术适应证。并且以各专科医师为主处理其专科疾病,不能擅自盲目独立跨科操作。     

胸腔镜食管癌切除术临床经验总结

目的:总结胸腔镜辅助(video-assisted thoracoscopic surgery,VATS)食管癌切除的临床经验,评价VATS食管癌切除术的近期效果。方法:回顾性分析河南安阳市肿瘤医院胸二科2010年7月至2012年2月行VATS食管癌切除的76例临床资料。男41例,女35例;年龄48～78(平均62)岁。肿瘤平均长度3.6 cm。鳞状细胞癌72例,癌肉瘤2例,小细胞内分泌癌1例,贲门腺癌合并食管胸上段黏膜重度不典型增生1例。胸上段癌10例,胸中段癌55例,胸下段癌10例,贲门癌合并食管胸上段黏膜重度不典型增生1例;其中8例行术前化学治疗(化疗)2周期,1例化疗3周期,1例行术前放射治疗(放疗),2例为放疗后复发。TNM分期:T1N0M0 15例;T1N1M0 2例,T1N2M0 2例,T2N0M0 9例,T2N1M0 8例,T2N2M0 1例,T3N0M0 19例,T3N1M0 10例,T3N2M0 5例,T3N3M0 2例,T4aN1M0 3例。手术操作分3步:1)经右胸VATS游离食管肿瘤,清扫胸腔淋巴结;2)经上腹部切口游离胃并制作管状胃:3)行食管胃颈部端侧器械吻合。结果:76例中70例成功经VATS切除食管病变,6例术中辅助MSI(muscle sparing incision)切口。平均手术时间4.4 h,平均出血量210 mL,平均清扫淋巴结14枚/例(其中胸部淋巴结平均8.97枚/例),平均住院时间23 d。术后发生肺部感染11例,治疗后痊愈。发生喉返神经损伤7例,无围手术期死亡,无吻合口瘘。结论:采用VATS对TNM分期中T3以内的食管癌切除可行,近期手术效果较好。     

胸、腹腔镜辅助下胸、腰椎结核手术治疗

目的探讨胸、腹腔镜辅助下胸、腰椎结核手术的临床效果。方法34例胸、腰椎结核病患者,其中男性23例,女性11例;年龄4-72岁,平均年龄39.2岁。对其应用胸、腹腔镜辅助下的胸、腰椎结核前路病灶清除,对不完全性截瘫病例同时进行脊髓减压术,对骨缺损较大者行植骨术,脊柱不稳定者增加钉棒或钉板内固定术。结果手术时间120-240min,平均手术时间145min;出血量150-1750ml,平均出血量564ml。全部病例随访1-5年,平均随访2.8年。影像学检查显示结核病灶清除彻底,脊髓减压充分,椎间植骨均融合,内固定无松动;并发不完全性截瘫患者均完全恢复。1例L4-L5结核并腰大肌脓肿及右大腿脓肿患者大腿脓肿复发再次行搔刮治愈。结论胸、腹腔镜辅助下胸、腰椎结核的手术治疗,可做到良好的病灶清除、脊髓减压、植骨及内固定,具有组织损伤小、康复快的优点。     

电视胸腔镜下食管癌切除术获成功

在胸部打一个6cm大小的切口，就可以完成食管肿瘤切除和消化道重建手术，手术中不需要其它形式的辅助，西南首例电视胸腔镜下食管癌切除术近日在第三军医大学西南医院成功进行。患者于日前康复出院，没有产生并发症。食管癌是一种常见的胸部恶性肿瘤，由于肿瘤与多个胸腔内重要脏器毗邻，在食管肿瘤切除的同时需要进行消化道重建，手术风险大、手术步骤复杂，因此国内外开展电视胸腔镜下食管癌切除术的单位极少，而且手术方式不统一，有些胸腔镜辅助下的手术创伤较常规开胸手术反而带来了其它的并发症。     

腹腔镜胆囊阑尾联合切除术42例临床分析

目的：探讨腹腔镜胆囊阑尾联合切除术临床价值。方法回顾性分析2006年6月~2011年10月我院42例腹腔镜胆囊阑尾联合切除术患者的临床资料,全麻下先行腹腔镜胆囊切除术,然后调换进镜孔和主操作孔位置,再行腹腔镜阑尾切除术。结果42例腹腔镜胆囊阑尾联合切除手术均获成功,无中转开腹,手术时间40~105min,平均(65.0±10.5)min,无1例并发症发生。结论腹腔镜胆囊切除联合阑尾切除术将需分两次进行的上、下腹手术简化为一次微创手术解决,具有创伤小,并发症少,恢复快的特点,值得临床推广应用。     

综合护理在腹腔镜胆囊切除术中的临床应用

目的 观察综合护理在腹腔镜胆囊切除术患者的应用效果.方法 120例腹腔镜胆囊切除术患者随机分为2组:每组60例.对照组给予传统护理,综合护理组给予围术期综合护理.比较术后排气时间、住院时间及并发症情况.结果 综合护理组术后排气时间、住院时间均短于对照组(P＜0.05);并发症发生率低于对照组(P＜0.05).结论 综合护理有利于腹腔镜胆囊切除术患者的预后.     

超声刀在腹腔镜下直肠癌根治术中的应用

自开展腹腔镜下右半结肠癌手术以来，超声刀及手术器械不断改进，腹腔镜技术逐渐成熟，使腹腔镜结直肠癌根治术更为安全。我院2006年5月至2007年8月应用超声刀在腹腔镜下行结直肠癌根治术14例，取得较好效果。现报告如下。     

全结肠系膜切除在腹腔镜结肠癌根治术中的应用

目的探讨全结肠系膜切除(CME)在腹腔镜结肠癌根治术中的应用。方法 102例腹腔镜手术患者按手术方法分为2组,68例行CME为CME组,34例行传统手术为传统手术组,对2组进行回顾性分析。结果 CME组与传统腹腔镜手术组相比,手术时间、肛门排气时间、住院时间稍增加,术后引流量减少,术中出血量减少,差异具有统计学意义;而且,CME组清扫淋巴结个数增多,与传统腹腔镜手术组比较差异具有统计学意义,P0.05;但术后并发症发生率2组比较无显著差异,P0.05。结论在腹腔镜下结肠癌根治术中应用CME技术具有减少肿瘤播散、淋巴结清扫更彻底的优势。     

简易腹腔镜阑尾手术悬吊法的临床应用研究

目的介绍一种腹腔镜阑尾切除术中因显露困难而采用的简易的悬吊法。方法 2009年9月至2010年12月对我院6例腹腔镜阑尾切除术中阑尾显露困难患者,术中采用一次性注射器针头带丝线入腹腔悬吊阑尾,术后随访3个月观察效果。结果 6例术中显露困难的腹腔镜阑尾切除术均顺利完成,术中应用一次性注射器针头带丝线入腹腔悬吊阑尾均避免了中转开腹及增加辅助操作戳孔,术后6例患者均获随访,注射器针头穿刺处均无任何瘢痕可见。结论一次性注射器针头带丝线入腹腔悬吊阑尾是一种简易的、安全可靠的悬吊方法,并且有美容效果。     

食管癌Ivor-Lewis和Sweet手术的解剖病理学评价

目的比较中段食管癌手术治疗术式的利弊,以提高食管癌的手术疗效。方法选择2010年1月至2012年6月位于食管中段的食管癌住院手术患者110例,依据术式不同,即经右胸Ivor-Lewis手术和左胸Sweet手术,将病例分为Ivor-Lewis组55例和Sweet组55例。对比分析2组术后切除标本的食管长度、肿瘤浸润和切除距离、切缘癌残留的发生率、胸腔和腹腔淋巴结清除的数量及癌浸润淋巴结的阳性率等,并以问卷调查的方式对医师参加Ivor-Lewis组和Sweet组术中处理胸部和腹部的解剖学问题进行评分比较。结果在食管切除长度、淋巴结清除个数方面Ivor-Lewis组明显大于Sweet组(P0.01);Ivor-Lewis组食管癌切缘癌残留阳性发生率为1.82%,显著低于Sweet组的21.82%(P0.01);问卷调查手术医师对2组术中解剖问题评分Ivor-Lewis组明显优于Sweet组。结论食管中上段癌外科手术建议采取Ivor-Lewis术式,贲门部及下段食管癌适宜Sweet手术。     

Prognosis after surgical resection of M1a/M1b esophageal squamous cell carcinoma

This study was undertaken to examine prognosis after resection for M1 disease in squamous cell esophageal carcinoma. Fifty-six patients with M1 esophageal cancer underwent esophageal resection with two or three-field nodal dissection from 1994 to 2001. Operative mortality occurred in 3 patients. Primary tumor sites were as follows; 10 upper, 23 middle, and 20 lower thoracic esophagus. They were found to have M1 disease by pathologic examination of dissected nodes, 24 M1a and 29 M1b. Forty-two patients (79%) were considered to have undergone curative resection. Chemotherapy and/or radiation therapy was given to 38 patients perioperatively. Recurrence was identified in 35 patients (66%) during a mean follow-up of 23 months. Overall median and 5-yr survivals were 19 months and 12.7%. Five-year survivals for M1a and M1b disease were 23.9% and 6.1%, respectively (p=0.0488). Curative resection tended to show better survival (p=0.3846). Chemotherapy and/or radiation therapy provided no advantage (p=0.5370). Multivariate analysis showed that M1b was significant risk factor over M1a disease. Our conclusion is that surgical resection can provide acceptable survival in thoracic squamous esophageal cancer with M1a disease. Survival differences between M1a and M1b disease support the current subclassification staging system.     

空肠造瘘术分别联合Ivor-Lewis术与McKeown术治疗中下段食管癌的短期效果

目的探讨空肠造瘘术分别联合Ivor-Lewis术与McKeown术治疗中下段食管癌的短期效果。方法回顾性分析127例中下段食管癌患者的临床资料,按照手术方式分为Ivor-Lewis组(IL组,72例)与McKeown组(MK组,55例)。IL组行空肠造瘘术联合Ivor-Lewis术,MK组行空肠造瘘术联合McKeown术。比较2组患者手术指标、术后炎症因子水平、术后并发症及复发情况。结果IL组患者手术时间、术后进食时间及术后住院时间均显著短于MK组,胸腔引流管留置时间长于MK组,住院费用高于MK组,差异均有统计学意义(P<0.05);2组患者术中失血量、淋巴结清扫数目比较,差异无统计学意义(P>0.05)。重复测量方差分析显示,时点效应可显著影响肿瘤坏死因子-α(TNFα)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)的水平;而手术方式、时点以及手术方式交互效应均不会影响TNF-α、IL-6、IL-8水平。2组患者术后并发症发生率及术后6个月内复发率比较,差异均无统计学意义(P>0.05)。结论空肠造瘘术联合Ivor-Lewis术与空肠造瘘术联合McKeown术治疗中下段食管癌短期效果相当,但空肠造瘘术联合Ivor-Lewis术手术时间、术后进食时间、术后住院时间较短,胸腔引流管留置时间较长,住院费用较高。     

The Role of One-Year Endoscopic Follow-Up for the Esophageal Remnant and Gastric Conduit after Esophagectomy with Gastric Reconstruction for Esophageal Squamous Cell Carcinoma

Purpose

After esophagectomy and gastric reconstruction for esophageal cancer, patients suffer from various symptoms that can detract from quality of life. Endoscopy is a useful diagnostic tool for evaluating patients after esophagectomy. This observational study was performed to investigate the correlation between symptoms and endoscopic findings one year after esophageal surgery and to assess the clinical usefulness of one-year endoscopic follow-up.

Materials and Methods

From 2001 to 2008, 162 patients who underwent esophagectomy with gastric reconstruction were endoscopically examined one year after operation.

Results

Patients suffered from the following symptoms: nocturnal cough (n=10), regurgitation (n=7), cervical heartburn (n=3), lump sensation (n=2), dysphagia (n=20) and odynophagia (n=22). Eighty-five (52.5%) patients had abnormal findings on endoscopic examination. Twelve (7.4%) patients had reflux esophagitis, and 37 (22.8%) patients had an anastomotic stricture. Only stricture-related symptoms were correlated with the finding of anastomotic strictures (p<0.001). Two patients had recurrences at the anastomotic sites, and four patients had regional lymph node recurrences with gastric conduit invasion visualized by endoscopy. Newly-developed malignancies in the esophageal remnant or hypopharynx that were not detected by clinical symptoms and imaging studies were reported in two patients.

Conclusion

One year after esophagectomy, endoscopic findings were not correlated with clinical symptoms, except those related to stricture. Routine endoscopic follow-up is a useful tool for identifying latent functional and oncological lesions.     

Risk factors for an intraoperative arrhythmia during esophagectomy

PURPOSE: Arrhythmias after an esophagectomy (most commonly atrial fibrillation) are a significant contributing factor to patient morbidity. However, the significance of an intraoperative arrhythmia is not completely understood. The aim of this retrospective study was to determine the occurrence and risk factors for developing intraoperative arrhythmias in patients undergoing an esophagectomy. MATERIALS AND METHODS: We reviewed the records of 427 patients who underwent a transthoracic esophagectomy between 2001 and 2005. Variables such as age, sex, hypertension, diabetes, cardiac disease, preoperative pulmonary function test (PFT) results, cancer level, combined radiochemotherapy, intrathoracic cavity adhesions and anastomosis site, hemoglobin, central venous pressure (CVP), fluid balance, serum potassium level, dose of vasopressors, temperature, and combined general and epidural anesthesia were analyzed as risk factors for the occurrence of an arrhythmia. We defined this arrhythmia as one not originating from the sinus node. RESULTS: The incidence of intraoperative arrhythmia in this subset of patients was 17.1%, with a 37.2% reoccurrence rate during the first three postoperative days. Univariate and multivariate analysis revealed the presence of heart disease, poor PFTs, cervical anastomosis, elevated CVP, and higher ephedrine doses to be independent predictors of the development of an intraoperative arrhythmia. CONCLUSION: The incidence of intraoperative arrhythmia during esophagectomy was 17.1% with a 37.2% of reoccurrence rate.     

Ras-MAPK通路在食管癌中的研究进展

Ras is best known for the ability of regulating cell growth, proliferation and differentiation. Mutations in Ras are associated with abnormal cell proliferation, resulting in the incidence of all human cancers. Mitogen-activated protein kinase (MAPK) signaling pathways are the most well described pathways in carcinogenesis, which has been identified as a key downstream effector in Ras signaling as well as playing important roles in prognosis of tumors. Recently, evidence has gradually accumulated to demonstrate that mutation in Ras or aberrant expression of MAPK has profound effects on the incidence of esophageal carcinoma, and applications of some chemotherapeutic drugs can not lead to the expectant function. Further understanding of the relevant molecular mechanisms of Ras-MAPK signaling pathways will be helpful for development of efficient targeting therapeutic approaches to the treatment of esophageal cancer. In this article, the advances of Ras-MAPK signaling pathways in esophageal carcinoma are reviewed.     

人乳头瘤病毒与食管癌病原学关系的Meta分析

目的 探讨人乳头瘤病毒(Human papiuomavirus,HPV)与我国食管癌发生的相关性.方法 汇总了国内有关HPV与食管癌相关的论文,选择采用PCR方法检测的论文对发表的数据进行Meta分析.结果 我们以检测方法为PCR、标本为石蜡包埋标本、论文中列出或提示了引物序列的15篇论文作为入选论文.15篇文献涉及蜡块标本共980份,按照只要检出一个HPV型别即为HPV阳性进行计算,检出阳性例数为460例,各地HPV检出率为8.3%～69.8%,HPV平均检出率为46.9%(95%CI:43.8%～50.0%).在以上980份样品中,检测范围包括了HPV16型的样品有556份,阳性份数为139份,各地检出率为4.4%～63.4%,平均检出率为25.0%(95%CI:21.4%～28.6%);检测范围包括HPV18型的样本有485份,阳性份数为33份,各地检出率为0%～19.0%,HPV18型的平均检出率为6.8%(95%CI:4.6%～9.0%).以上15篇论文中,使用同一引物的文献只有4篇,共检测406份石蜡包埋标本,HPV阳性率为20.3%～67.6%,平均检出率为40.2%(95%17 CI:36.0%～45.4%).结论 我国食管癌组织中有HPV存在,并且HPV感染可能食管癌发生的重要病因.     

食管癌中COX-2表达与其临床病理特征及预后的关系

目的：检测COX-2在食管癌中的表达，探讨其与食管癌临床病理特征及术后患者预后的关系。方法：应用SABC免疫组化染色法检测89例手术切除的食管癌组织和20例正常食管粘膜组织COX-2蛋白的表达，分析COX-2在食管癌组织的表达与患者性别、年龄、肿瘤部位、病变长度、浸润深度、区域淋巴结转移、远处转移、鳞癌分化程度的关系。并对其中81例有随访资料者，分析COX-2表达与预后的关系。结果：食管癌组COX-2呈阳性表达率为94.38%（84/89），且着色较深，正常食管组COX-2呈阳性表达率为60%（12/20），着色浅。食管癌中，随着肿瘤浸润深度的增加、鳞癌细胞分化程度的减低，COX-2的表达逐步增强（P＜0.05）。COX-2的表达与其它临床病理特征，包括性别、年龄、肿瘤生长部位、肿瘤大小、有无区域淋巴结转移、有无远处转移无相关（P＞0.05）。COX-2低表达组与高表达组的生存时间有显著差异，前者生存时间较后者为长（P＜0.01）。结论：COX-2在食管癌中的表达高于正常食管粘膜。肿瘤浸润越深、鳞癌分化程度越低，COX-2的表达越强；COX-2的表达与食管癌患者的年龄、性别、肿瘤生长部位、肿瘤长度、有无区域淋巴结转移、有无远处转移均无关。COX-2的表达与食管癌术后患者的预后相关，COX-2呈低表达者的生存时间比COX-2高表达者长。     

Identification of methylated-differentially expressed genes and pathways in esophageal squamous cell carcinoma

Methylation, as an epigenetic modification, can affect gene expression and play a role in the occurrence and development of cancer. This research is devoted to discover methylated-differentially expressed genes (MDEGs) in esophageal squamous cell carcinoma (ESCC) and explore special associated pathways. We downloaded GSE51287 methylation profiles and GSE26886 expression profiles from GEO DataSets, and performed a comprehensive bioinformatics analysis. Totally, 19 hypermethylated, lowly expressed genes (Hyper-LGs) were identified, and involved in regulation of cell proliferation, phosphorus metabolic process and protein kinase activity. Meanwhile, 17 hypomethylated, highly expressed genes (Hypo-HGs) were participated in collagen catabolic process, metallopeptidase and cytokine activity. Pathway analysis determined that Hyper-LGs were enriched in arachidonic acid metabolism pathway, while Hypo-HGs were primarily associated with the cytokine-cytokine receptor interaction pathway. IL 6, MMP3, MMP9, SPP1 were identified as hub genes based on the PPI network that combined 7 ranked methods included in cytoHubba, and verification was performed in human tissues. Our integrated analysis identified many novel genetic lesions in ESCC and provides a crucial molecular foundation to improve our understanding of ESCC. Hub genes, including IL 6, MMP3, MMP9 and SPP1, could be considered for use as aberrant methylation-based biomarkers to facilitate the accurate diagnosis and therapy of ESCC.