内镜黏膜下剥离术(ESD)治疗消化道病变

目的探讨内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)治疗消化道病变的疗效、安全性及并发症防治。方法回顾性分析ESD方法治疗29例(共31块)消化道病变的内镜下手术情况、并发症及治疗、预后情况。结果术中出血2例,1例创面小动脉出血,内镜下钛夹止血,另1例胃黏膜下持续出血,形成血肿,中转开腹行胃窦切除术;1例直肠管状腺瘤ESD术后7天大出血,经肛门缝扎止血;术中发现肠壁穿孔1例,中转开腹行肠壁修补术。29例患者均痊愈出院,无1例留下后遗症,平均住院时间5 d。随访2～27个月未见复发。结论 ESD治疗消化道病变是安全的,可以一次性完整切除较大病变,提供完整的病理学资料,且术后不易复发。缺点是操作时间长,技术难度较大,并发症较EMR多。     

内镜下黏膜剥离术对消化道早癌及癌前病变疗效分析

[目的]评估内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)治疗消化道早癌及癌前病变的疗效及安全性。[方法]回顾性分析行ESD治疗的125例消化道早癌及癌前病变的患者的手术成功率、安全性、并发症及预后等。[结果]125例中食管病变67例,胃病变41例,十二指肠病变1例,结肠病变6例,直肠病变10例;病灶共143个,平均直径2.66cm。所有病灶均在内镜下完整切除,平均手术时间44.6min。术中少量出血占7.2%,延迟出血占4%,穿孔发生率4.8%,术后发热率12%,4例ESD后病理基底有癌细胞浸润追加外科手术治疗。住院时间4~50(平均11.87)d。随访3~31个月,其中1例残留,2例复发,6例出现食管狭窄,1例发生支气管胃食管瘘。[结论]ESD治疗消化道早癌及癌前病变是安全有效的,具有广阔的应用前景。虽然有出血、穿孔等并发症的发生,但随着内镜操作医师技术水平的提高,内镜器械的改进,可减少并发症的发生率。     

透明质酸钠、甘油果糖混合液黏膜下注射行内镜黏膜下剥离术:26例临床分析

背景:内镜黏膜下剥离术(ESD)逐渐成为消化道早期癌症和癌前病变的首选治疗手段,但目前对术中选择何种黏膜下注射液尚未达成共识。目的:评估ESD术中黏膜下注射透明质酸钠、甘油果糖混合液的临床价值。方法:纳入2007年12月～2009年8月扬州市第一人民医院收治的26例经染色内镜和内镜超声检查诊断为消化道黏膜及黏膜下病变的患者,黏膜下注射透明质酸钠、甘油果糖混合液行ESD治疗,分析操作一般情况、剥离成功率以及穿孔发生率。结果:本组患者切除标本最大长径1.3～4.3cm,平均2.6cm;ESD操作时间28～162min,平均62.6min;平均黏膜下注射量为26.6ml。剥离成功率92.3%。1例食管平滑肌瘤术后出现纵隔气肿,经保守治疗后痊愈,穿孔发生率3.8%。ESD术后患者平均住院时间为4.2d,平均随访4.5个月,复查内镜示创面基本愈合,无复发。结论:黏膜下注射透明质酸钠、甘油果糖混合液行ESD的疗效良好,安全性高。     

内镜黏膜下剥离术治疗有症状的结肠巨大脂肪瘤

探讨内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）治疗有临床症状的结肠巨大脂肪瘤（≥5 cm）的疗效和安全性。2018年12月—2021年12月，上海市东方医院消化内镜科收治巨大结肠脂肪瘤患者8例，患者均成功行ESD完整切除，完整切除率100%，切除病变长径5.5~9.0 cm，平均6.0 cm。ESD操作耗时25~80 min，平均41 min。术中极少量出血均通过热活检钳电凝止血成功，2例术中发生小穿孔，均成功缝合。患者术后无腹痛、发热，亦无迟发性出血或迟发性穿孔；住院时间3~5 d，平均3 d；随访8~36个月，无一例病灶残留或复发。可见，ESD治疗结肠巨大脂肪瘤安全有效，可避免行外科手术切除。     

内镜黏膜下剥离术治疗消化道病灶56例疗效分析

目的探讨内镜黏膜下剥离术（ESD）治疗消化道病灶的疗效和安全性。方法内镜检查发现的消化道病灶病例患者为入选对象,术前行染色内镜和超声内镜检查,确定病变范围和深度,常规行术前评估,观察手术时间、手术成功率及并发症发生率,并进行术后随访。结果 2008年12月~2009年6月我院共实施ESD手术56例进入观察,切除标本平均直径（2.56±0.69）cm,平均手术操作时间（70.24±28.35）min;手术完整剥离成功率94.6%,术中穿孔发生率5.4%,迟发性穿孔率3.6%。1例发生迟发型出血,行手术治疗。术后随访率92.9%,随访患者中6个月内切面愈合率91.3%,12个月内切面愈合率达100%。结论 ESD治疗消化道病灶病变局部的复发率低,并发症少。     

内镜黏膜下剥离术在治疗胃肠道黏膜切除术后残留和复发病灶中的应用

目的 探讨内镜黏膜下剥离术(ESD)治疗胃肠道黏膜切除术(EMR)后残留、复发病变的疗效和安全性.方法 自2006年6月至2007年11月对EMR术后内镜随访发现的15例残留和复发病变进行ESD治疗,先于黏膜下注射生理盐水以抬高病变,接着预切开病变周围黏膜,再沿病变下方黏膜下层进行剥离,对瘢痕形成部位直接应用Hook刀沿瘢痕基底切线方向进行切开.结果 15例EMR术后残留和复发病变,位于胃6例、结肠3例、直肠6例,病变直径0.8～3.5 cm,平均2.3 cm.所有病变抬举征(一).14例病变成功完成ESD治疗,成功率93.3%(14/15),13例术后病理切缘和基底无肿瘤累及,完整切除率86.7%(13/15).ESD手术时间60～155 min,平均87 min.治疗中创面均有少量出血,全组未出现术后出血.2例治疗中局部剥离较深、腹腔出现游离气体,成功保守治疗,未转外科手术,ESD穿孔发生率13.3%(2/15).术后平均随访13个月,无复发.结论 ESD治疗EMR术后残留和复发病变相对安全、有效,不仅能完整切除残留和复发病变,还能提供完整的病理诊断资料.     

内镜黏膜下剥离术治疗消化道黏膜下肿瘤的疗效分析

目的探讨内镜黏膜下剥离术(ESD)治疗消化道黏膜下肿瘤(submucosal tumor,SMT)的疗效及安全性。方法选取我院2008年3月-2011年6月经胃肠镜检查发现消化道黏膜下肿瘤48例,回顾性分析48例患者资料,包括患者的基本情况、病变部位、大小、治疗经过以及病理结果等,统计并发症发生情况及术后随访结果。结果病灶直径为0.8～5.8 cm,平均(3.3±0.75)cm,ESD手术时间为27～167 min,平均(71.0±22.6)min,ESD完整切除病灶45例(45/48,93.75%),穿孔3例(3/48,6.25%),其中1例大出血,1例食管患者ESD术后出现食管狭窄,经内镜下球囊扩张食管狭窄消失。所有病人均完成了术后6个月的内镜随访,1例患者见肿瘤复发。结论 ESD技术对较大病变可以整块切除,并提供完整的病理诊断资料;消化道SMT行ESD术是安全、有效的。     

内镜黏膜剥离术治疗消化道黏膜及黏膜下病变

目的探讨内镜下黏膜剥离术(endoscopic gubmucosal disseetion,ESD)治疗消化道黏膜及黏膜下病变的疗效、安全性及并发症防治。方法回顾性分析ESD方法治疗37例消化道黏膜及黏膜下病变的内镜下手术情况、并发症及治疗、预后情况。结果术中出血3例,术后出血2例,均内镜下成功止血;术中穿孔2例,均予内镜下金属夹夹闭后内科保守治疗成功,未有中转外科手术;l例直肠类癌及1例食管重度异型增生术后切缘病变组织残留,2~6月后复查未见明显复发迹象。结论 ESD治疗消化道黏膜及黏膜下病变安全、有效,可以一次性完整切除较大病变,提供完整的病理学资料,且术后不易复发。     

内镜黏膜下剥离术治疗食管早期癌及癌前病变

目的 探讨内镜黏膜下剥离术(ESD)治疗食管早期癌及癌前病变的应用价值.方法 对胃镜发现的食管早癌和上皮内瘤变、深度未超越黏膜卜层者15例进行ESD治疗:(1)黏膜下注射生理盐水抬高病变;(2)预切开病变周围黏膜;(3)沿病变下方黏膜下层完整剥离病变.结果 15例食管早癌和上皮内瘤变病变,最大卣径2.5～4.5 cm(平均3.2 cm).14例病变成功完成ESD治疗,ESD成功率93.3%(14/15).所有剥离病变全部得到病理确诊,基底和切缘未见病变累及.ESD手术时间(白黏膜下注射至完整剥离病变)45～150 min,(平均75 min).术中出血量平均30 ml,均经电凝、氙离子凝固术和止血夹成功止血,未出现需再次内镜下治疗的出血;ESD穿孔发生率0(0/15).术后随访14例,随访期6～18个月(平均11.5个月),创而完全愈合,无一例病变残留和复发.结论 ESD是治疗食管早癌和癌前病变的新方法,不仅能完整切除较大的病变,还能提供完整的病理学诊断资料.     

内镜黏膜下剥离术治疗早期食管癌及癌前病变

目的分析探讨胃镜下黏膜剥离术(endoscopic submucosal dissection,ESD)在诊治早期食管癌和癌前病变中的临床应用价值。方法回顾分析胃镜下行ESD治疗的18例患者的临床资料。结果 17例一次性完全切除,ESD剥离病变成功率94.44%(17/18);所有剥离病变全部得到病理确诊,基底和切缘未见病变累及;ESD手术时间(自黏膜下注射至完整剥离病变)35～150min,平均65 min;术后未发生出血、穿孔等并发症;术后随访3～24个月(平均14个月),创面完全愈合,无1例病变残留和复发;术前病理与术后病理对照相符者13例,占72.22%。结论 ESD操作安全,创伤少,恢复快,在早期食管癌和癌前病变的诊疗中值得推广。     

Gastric cancer patients at high-risk of having synchronous cancer

AIM: To identify patients with a high-risk of having a synchronous cancer among gastric cancer patients. METHODS: We retrospectively analyzed the prospective gastric cancer database at the National Cancer Center, Korea from December 2000 to December 2004. The clinicopathological characteristics of patients with synchronous cancers and those of patients without synchronous cancers were compared. Multivariate analysis was performed to identify the risk factors for the presence of a synchronous cancer in gastric cancer patients. RESULTS: 111 of 3291 gastric cancer patients (3.4%) registered in the database had a synchronous cancer. Among these 111 patients, 109 had a single synchronous cancer and 2 patients had two synchronous cancers. The most common form of synchronous cancer was colorectal cancer (42 patients, 37.2%) followed by lung cancer (21 patients, 18.6%). Multivariate analyses revealed that elderly patients with differentiated early gastric cancer have a higher probability of a synchronous cancer. CONCLUSION: Synchronous cancers in gastric cancer patients are not infrequent. The physicians should try to find synchronous cancers in gastric cancer patients, especially in the elderly with a differentiated early gastric cancer.     

食管癌为第一原发癌的双原发癌患者预后分析

目的 探索以食管癌为第一原发癌的双原发癌患者的预后因素.方法 用美国国立癌症研究所SEER数据库,确定并收集2004至2013年组织病理诊断明确的以食管癌为第一原发癌的双原发癌患者临床资料.通过Kaplan-Meier生存分析及对数秩检验绘制生存曲线.通过COX比例风险模型分析患者的独立预后因素.结果 共收集了540名...     

Epidemiological aspects of cancer screening in Germany

Purpose Since 1971, a statutory early detection programme has operated in Germany which comprises health-insurance-paid annual examinations of the breast, cervix, prostate, rectum, and the skin. Since the programme is conceptualised as opportunistic screening, the attendance rates have been low and only reached about 50% among females and 13% among males by the end of the 1990s. Based on these figures and present knowledge on the efficacy of screening modalities, we assessed past benefits and the future potential of cancer screening in Germany.Methods We used published data on the efficacy of screening procedures and German attendance rates, and internationally available data on incidence and mortality in Germany and, for cervical cancer, in other countries. Incidence and mortality rates have been standardised to the world standard, and screening benefit has been given as the population preventable fraction given in percentage.Results The past benefits of the statutory early detection programme ranged around 2.0–6.5%. Since the upper limit was due to generous assumptions regarding efficacy or inclusion of treatment effects, the true value might be closer to the estimates of the effect of cervical cancer screening (2.0–4.7%). The achievable future benefit of exploiting the theoretical potential of more exhaustive screening could provide a further mortality reduction of about 3.4% (50% compliance) or 4.7% (70% compliance).Conclusions Screening partially requires an expensive medical infrastructure and is not without risks for the participants. The overall benefit is critically dependent upon the quality of the programme and its in-time control. Any benefit may be annulled by poor quality while costs are overflowing. Well-organised high-quality screening may be a sound basis for cancer control. To preserve or increase the impact of screening and control its expenses: (a) further research efforts are needed towards new or better targeted screening tools or modalities; (b) the efficacy of new modalities has to be evaluated carefully in advance; (c) the programme has to be reconceptualised as organised screening; (d) in-time quality control based on the collection of the basic performance data must be an intrinsic part of the programme.     

Metachronous bile duct cancer nine years after resection of gallbladder cancer

We report a rare case of a 74-year-old man with metachronous gallbladder cancer and bile duct cancer who underwent curative resection twice, with the operations nine years apart. At the age of 65 years, the patient underwent a cholecystectomy and resection of the liver bed for gallbladder cancer. This was a welldifferentiated adenocarcinoma, with negative resection margins （T2NOM0, stage Ⅰ B）. Nine years later, during a follow-up examination, abdominal computed tomography and MRCP showed an enhanced 1.7 cm mass in the hilum that extended to the second branch of the right intrahepatic bile duct. We diagnosed this lesion as a perihilar bile duct cancer, Bismuth type Ⅲ a, and performed bile duct excision, right hepatic Iobectomy and Roux-en-Y hepaticojejunostomy. The histological diagnosis was a well-differentiated adenocarcinoma with one regional lymph node metastasis （TINIM0, stage Ⅱ B）. Twelve months after the second operation, the patient is well, with no signs of recurrence. This case is compared with 11 other cases of metachronous biliary tract cancer published in the world medical literature.     

喉癌与喉咽癌患者的SE—SLT含量检测及其意义

采用定量ELISA法对19例正常人、35例喉癌及喉咽癌患者(其中15例为术后患者)进行血浆可溶性E-选择素(SE-SLT)含量检测.结果发现,正常对照组及喉癌、喉咽癌组的SE-SLT含量分别为29.82±4.88μg/L、49.66±8.16μg/L,喉癌、喉咽癌组的血浆SE-SLT含量明显高于正常对照组(P＜0.01);喉癌、喉咽癌I、Ⅱ期组及Ⅲ、Ⅳ期组的SE-SLT含量分别为42.50±6.10μg/L、54.11±6.20μg/L,I、Ⅱ期组明显低于Ⅲ、Ⅳ期组(P＜0.01);15例手术前后测血浆SE-SLT含量分别为45.12±7.09μg/L、38.85±6.40μg/L,术后SE-SLT值明显低于术前(P＜0.01).认为喉癌、喉咽癌患者血浆SE-SLT含量与病情严重程度有关,可作为疗效观察、肿瘤转移情况的参考指标.     

A study of metachronous cancer after endoscopic resection of early gastric cancer

Abstract

Objective. Endoscopic resection is commonly used for early gastric cancer (EGC) in Korea and Japan. There are only a few reports of metachronous cancer after endoscopic resection. The aim of this study was to identify clinical factors associated with metachronous gastric cancer after endoscopic resection. Methods. A total of 176 patients with EGC who had underwent endoscopic submucosal dissection (ESD) were periodically followed-up with endoscopic examinations from January 2004 to December 2007. The incidence and variable factors of metachronous gastric cancer were investigated in a retrospective study. Results. The median interval between the diagnosis of primary cancer and the diagnosis of the first metachronous cancer was 30 months (range 18–42 months). Metachronous gastric cancer had developed in nine patients (5.1%) during follow-up period and seven patients (4.0%) had synchronous gastric cancer lesions within 1 year of the initial endoscopic treatment. Annual incidence rate of metachronous cancer was approximately 3.3%. Antrum atrophy and old age were significantly associated with the incidence of metachronous cancer. The status of Helicobacter pylori, size, location and gross finding of lesion had no significant relationship with metachronous occurrence. Conclusions. We should examine more carefully older patients who have atrophic gastritis because secondary cancer including metachronous cancer might occur in remnant stomach after initial successful endoscopic resection. And prospective study will be needed for the optimal endoscopic surveillance interval.     

Hereditary factors in pancreatic cancer

The incidence and the mortality rates for pancreatic cancer are the same, indicating its dismal outlook. Its natural history remains elusive. Cigarette smoking appears to be the most significant environmental culprit. Hereditary factors may account for approximately 5% of the total pancreatic cancer burden. However, when its extant heterogeneity and the reduced penetrance of causal germline mutations are considered, the hereditary incidence may significantly exceed this estimate. Even when endoscopic ultrasound (EUS), the gold standard for pancreatic cancer screening, is utilized, early detection with surgical cure has rarely been accomplished. Needed to ameliorate this problem is research into genetic and environmental risk factors and their interaction. The identification of tumor biomarkers which signal early pathogenetic events, thereby enabling pancreatic cancer to be diagnosed at its earliest possible stage before it has spread to regional lymph nodes or to more distant sites, will improve the outlook. We discuss our research approaches to this problem. Members of families with thep16 germline mutation will undergo EUS coupled with the collection of pancreatic juice for the study of a possible gradient for telomerase activity, K‐ras mutations, and cytology. If changes in these putative biomarkers are observed, endoscopic retrograde cholangiopancreatography (ERCP) would be the next diagnostic step. We conclude with a discussion of ethical concerns about this research.     

BCRP基因在乳腺癌组织中的表达及意义

目的　研究乳腺癌耐药蛋白 (BCRP)基因在乳腺癌组织中的表达水平 ,探讨其与肿瘤病理分期、淋巴结转移的关系。方法　采用实时荧光定量 RT- PCR检测 5 1例乳腺癌患者癌组织和癌旁组织中 BCRP基因表达。结果　 BCRP基因在乳腺癌组织中的阳性表达率、表达水平均显著高于癌旁组织 (P<0 .0 1、<0 .0 5 ) ;BCRP基因在 、 、 期乳腺癌组织中的表达水平无显著性差异 (P>0 .0 5 ) ;有淋巴结转移者的 BCRP基因表达水平显著高于无淋巴结转移者 (P<0 .0 5 )。结论　 BCRP基因表达水平与肿瘤病理分期无关 ,与淋巴结转移有关 ,BCRP基因过表达可能在乳腺癌的多药耐药中起较重要的作用。