双源性食管胃癌1例

双源性食管胃癌１例王建设山西省翼城县人民医院外科０４３５００主题词食管肿瘤胃肿瘤癌，鳞状细胞腺癌中国图书资料分类号Ｒ７３５１Ｒ７３５２１病例报告男，６２岁。因进行性吞咽困难１月伴上腹部胀痛，经院外先后两家医院行食管造影、内镜检查诊断为食管癌，故...     

食管鳞癌并胃窦粘液腺癌1例

食管鳞癌并胃窦粘液腺癌１例陈萍１张玉华１潘玲２吉林省吉林市中心医院１病理科２口腔科１３２０１１主题词食管肿瘤／并发症癌，鳞状细胞／并发症胃肿瘤／并发症腺癌，粘液中国图书资料分类号Ｒ７３５病例报告男，８５岁，农民．上腹痛，消瘦２个月，吞咽困难，呕吐...     

食管腺癌和贲门癌鉴别诊断的研究进展

食管腺癌和贲门癌是临床上常见的上消化道恶性肿瘤,两者概念不同,又有重叠之处,特别是食管下段腺癌和贲门癌,临床上常需对两者进行鉴别诊断,以指导临床治疗和判断预后,比较两者的异同点有一定意义.鉴定于目前国际上对贲门癌的定义尚无统一的定论,胃食管交界处肿瘤的分类方法较多,根据Siewert的分类方法,食管腺癌和贲门癌的临床特征、淋巴结播散类型、发病机制和某些生物学标记物表达水平均有些不同,最新的检测技术如细胞角质蛋白染色法、Das-1单克隆抗体反应、硫粘蛋白克隆型表达技术等对两者的鉴别价值尚在确定中.     

食管贲门癌切除术后胃排空测定

食管贲门癌切除术后胃排空测定张旭东朱海杭陈锡志李登銮扬州大学医学院附属苏北人民医院消化内科江苏省扬州市２２５００１Ｓｕｂｊｅｃｔｈｅａｄｉｎｇｓｅｓｏｐｈａｇｅａｌｎｅｏｐｌａｓｍｓ／ｓｕｒｇｅｒｙ；ｓｔｏｍａｃｈｎｅｏｐｌａｓｍｓ／ｓｕｒｇｅ...     

腔内冷冻综合治疗食管,贲门癌术后吻合口狭窄

应用纤维内镜引导下食管腔内软管冷冻法和食管，贲门扩张器综合治疗食管，贲门癌术后吻合口狭窄６０例。冷冻后局部狭窄的平均直径由０．３２ｃｍ增至１．０９ｃｍ，狭窄近侧端扩张的平均直径由３．４３ｃｍ缩至２．７６ｃｍ；扩张术后，狭窄处平均直径由０．２７ｃｍ增至１．０２ｃｍ，狭窄近侧端扩张的平均直径由３．８ｃｍ降至３．３２ｃｍ。     

食管鳞状细胞癌与胃腺癌共同致病机制的网络分析

目的 探讨食管鳞状细胞癌与胃腺癌共同致病机制。方法 我们使用基因表达综合数据库(Gene Expression Omnibus, GEO)鉴定出食管鳞状细胞癌和胃腺癌的共同差异表达基因,并通过功能富集分析,蛋白互作网络(PPI网络)及转录因子调控网络的构建进一步揭示共同致病基因的生物学特征。结果 89个共同上调差异基因和27个共同下调差异基因构成一个PPI网络,然后筛选前15个核心基因。在删除验证组中无统计学意义的基因后得到12个核心基因,分别是：UBE2C,CXCL8,SPARC,COL1A1,COL1A2,KIF20A,COL3A1,TPX2,THBS1,COL5A1,COL4A1,SERPINH1。本研究继续对基因的转录因子进行富集分析并验证,然后构建转录因子靶基因调控网络。3个转录因子(HDAC2,NFKB1,RELA)调控3个核心基因(CXCL8,COL1A2,COL1A1)的网络分析进一步阐明了食管鳞状细胞癌与胃腺癌的共同致病途径。结论 本研究发现3个转录因子调控3个核心基因的共同致病基因网络。这与食管鳞状细胞癌和胃腺癌共同致病机制高度有关。其中HDAC2转录因子通过调控C...     

内镜下三联疗法治疗进展期食管,食管贲门胃底癌33例随访 …

目的：评价内镜下三联疗法治疗进展期食管贲门胃底癌疗效，方法；采用内镜下三联疗法（包括激光光动力学疗法，微波和局部注射化疗药物）根据癌肿的类型，病变范围的不同区别地采用内镜下三联疗法进行治疗。结果：采用内镜下三联疗法共治疗５３例病人，并对其中３３例进行了随访，近期疗效的：ＣＲ２５例，ＰＲ８例，无无效者，通过１５个月随访，３个月生存率为８４．８４％，６个月生存率为６０．６１％（其中包括６例仍存活，随访     

贲门癌侵及食管下段患者术后胃食管反流的治疗研究

目的探讨贲门癌侵及食管下段患者术后胃食管反流的治疗方法。 方法回顾性分析2013年1月至2015年12月,新疆维吾尔自治区人民医院胸外科行手术治疗的216例贲门癌侵及食管下段的患者临床资料,随访2～18个月(中位数8个月),并观察恢复状况。 结果216例贲门癌侵及食管下段患者中,95例患者术后出现胃食管反流,其中26例患者反流症状较明显,经口服药物及行为干预治疗后患者胃食管反流症状均能得到缓解。 结论术中将胸胃缩小缝合形如食管,重建食管裂孔,能有效起到抗反流作用,结合术后药物及行为干预治疗,可以显著缓解贲门癌侵及食管下段患者术后胃食管反流的临床症状。     

胃食管贲门癌发病分布调查1436例

目的通过一大宗胃、食管贲门癌门诊、住院患者发病分布资料调查，以了解本地区胃、食管贲门癌发病分布与职业、年龄、性别的关系．方法调查1990－01／1997．10经内镜、病理或手术后病理确诊的胃、食管贲门癌门诊、住院患者的统计资料进行分析，未确诊或可疑病例给予剔除．结果发现胃、食管贲门癌检出率占同期检查患者的10．2％（1436／14057），其中梅州籍占88．2％（1267／1436）．早期癌5例，进展期癌占99．7％（1431／1436），男与女比为1．9：1．发病除少数来自城市居民外，大部分为农民及中老年患者，分别占87．4％（1255／1436）和93．3％（1341／1436）；其中又以兴宁、梅县、五华发病居多，合计占71．5％．结论在一定程度上反映了广东梅州地区胃、食管贲门癌的发病分布状况，梅州地处粤东北部，为客家地区，人口460多万，现究其发病流行情况如何？发病的真正诱因是什么？目前还不十分清楚，有待投入大量人力、物力深入探讨．     

老年食管癌贲门癌合并糖尿病的外科治疗

目的探讨老年食管、贲门癌合并糖尿病患者的手术治疗。方法回顾性总结72例食管贲门癌合并糖尿病患者的手术治疗经验。结果72例中食管癌61例,贲门癌11例;术前伴慢性阻塞性肺部疾病者10例,伴心血管疾病者13例,伴慢性肾功能不全2例。空腹血糖6．2—14．6mmol／L;手术切除率100％;术后切口感染4例,肺部感染5例,低血糖休克1例,吻合口瘘2例;全组无手术死亡,均顺利渡过手术期。术前、术中、术后均用胰岛素控制糖尿病,补糖以5％等渗液体为主,按1U普通胰岛素4～5g糖的比例补液,血糖保持在略高于正常水平。结论食管贲门癌合并糖尿病是一较严重的临床疾病,术后并发症发生率高,应予以重视,胰岛素的合理应用是治疗成功的关键。     

单克隆抗体SC3A在胃癌及癌前病变的表达意义

目的研究单克隆抗体ＳＣ３Ａ在胃癌及癌前病变的表达意义．方法应用免疫组化ＡＢＣ法及粘液组化染色检测１０１例胃良恶性病变组织中ＳＣ３Ａ的表达．结果胃癌７１例中ＳＣ３Ａ阳性５７例（８０３％），但与癌组织类型、分化程度、转移及术后生存率无明显关系．ＳＣ３Ａ阳性率在酸性粘液（＋）组胃癌明显高于酸性粘液（－）组（９０２％对２００％，Ｐ＜００１），硫酸粘液（＋）组胃癌明显高于硫酸粘液（－）组（９１３％对６００％，Ｐ＜００１）．而且癌旁肠化硫酸粘液阳性率明显较良性病变伴肠化高（８８９％对３５３％，Ｐ＜００１）；硫酸粘液（＋）组肠化ＳＣ３Ａ阳性率明显高于硫酸粘液（－）组（６０９％对３１３％，Ｐ＜００５）．结论单克隆抗体ＳＣ３Ａ的表达对胃癌诊断及组织发生探讨有一定意义．     

70岁以上食管癌和贲门癌患者的开胸手术分析

目的 探讨高龄食管癌和贲门癌患者的外科手术选择及围手术期处理方法 . 方法 回顾性分析1088例食管癌和贲门癌患者的临床资料,分为70岁以下(41～69岁)、70～74岁、75～79岁、80岁以上(80～90岁)4组.统计4组患者术后并发症、住院时间及预后,并对手术选择和围手术期治疗措施进行分析. 结果 70岁以上食管癌和贲门癌患者术后肺部感染、心律失常、精神症状和切口不愈的发生率明显上升,术后住院时间明显延长;80岁以上的高龄患者术后肺部感染发生率和术后住院时间较其他年龄段明显上升.全组痊愈1084例,死亡4例. 结论 在高龄食管癌和贲门癌患者中,了解开胸术后并发症发生状况,加强对肺部感染的预防和治疗是决定手术成败的关键.     

胰腺腺鳞癌的临床诊治分析

目的 总结胰腺腺鳞癌临床诊治经验,以提高对该病的认识和诊治水平.方法 对2002年7月至2008年6月我院收治的5例胰腺腺鳞癌患者的临床资料进行回顾性分析,并结合文献讨论.结果 本组5例胰腺腺鳞癌患者,其中男3例,女2例,平均年龄(64±18)岁.肿瘤位于胰头部者2例,位于胰体尾部者3例;行胰头十二指肠切除术1例,行胰体尾、脾脏切除术3例,行胆肠+胃肠双旁路内引流术并~(125)Ⅰ粒子植入1例.肿瘤平均长径4.5 em,1例侵犯胃后壁、十二指肠降部、门静脉,2例侵犯脾门处包膜,2例合并有神经、血管侵犯,1例伴有淋巴结转移.组织学特征为腺癌和鳞癌成分混杂在一起,呈浸润性生长.5例均获随访,3例死于肿瘤复发和肝转移,术后生存8.5～13.5个月,平均11.2个月,2例已生存6个月和56个月.结论 胰腺腺鳞癌好发年龄60岁左右,临床确诊较困难,恶性程度高,预后差,手术切除结合放、化疗的综合治疗可提高疗效.     

食管鳞癌中微小核糖核酸-21的作用及对靶蛋白的影响

目的 探讨微小RNA(miRNA)-21对食管鳞癌细胞Eca109和哈萨克族食管癌的促增殖作用及对程序性细胞死亡基因4(PDCD4)表达的影响。方法将食管鳞癌细胞系Eca109分为miRNA-21 Mimics组（转染序列5′-UCAACAUCAGUCUGAUAAGCUA-3′）、miRNA-21抑制剂组（转染序列5′-UAGCUUAUCAGACUGAUGUUGA-3′）、阴性对照组（转染随机序列）和正常对照组（不予转染等任何处理）。细胞按4.5×105个/孔接种于6孔板,基于RNA干扰(RNAi)技术、使用脂质体2000试剂进行细胞转染。采用细胞计数法检测转染后各组细胞的增殖情况。使用实时荧光定量聚合酶链反应(qRT-PCR)检测各组细胞的miRNA-21转录水平。采用Western印迹技术检测转染后各组PDCD4蛋白表达情况。检测18对哈萨克族食管癌及其对应的癌旁正常食管组织中miRNA-21转录和PDCD4蛋白表达情况。结果 转染48 h后,与正常对照组比较,miRNA-21Mimics组Eca109细胞数增加36％(P=0.002),miRNA-21抑制剂组细胞数减少28％(P=0.002),阴性对照组细胞数变化不明显(P=0.515)。转染48 h后,miRNA-21抑制剂组、miRNA-21 Mimics 组、阴性对照组、正常对照组miRNA-21的相对表达量分别为0.37±0.10、9.17±1.08、0.74±0.23和1.04±0.34,PDCD4蛋白相对表达量分别为1.47±0.11、0.61±0.09、0.89±0.12、0.79±0.02。与正常对照组比较,miRNA-21抑制剂组miRNA-21相对表达量下降(P=0.031)、PDCD4蛋白相对表达量上调（P=0.001）,miRNA-21 Mimics组miRNA-21相对表达量上升(P=0.001)、PDCD4相对表达量下调(P=0.030),阴性对照组则差异无统计学意义（P值分别=0.272和0.541）。18对哈萨克族食管癌组织中16对的miRNA-21相对表达量(0.11±0.09)高于其对应的癌旁正常食管组织(0.03±0.03,P=0.001),PDCD4蛋白相对表达量（0.92±0.39）低于其对应的癌旁正常食管组织（1.57±0.80,P=0.004）,且癌组织中miRNA-21相对表达水平越高,PDCD4蛋白相对表达水平越低（r=-0.538,P=0.046）。结论miRNA-21可能通过抑制PDCD4蛋白表达而促进食管鳞癌细胞Eca109增殖,并且参与哈萨克族食管癌的发生。     

食管鳞癌中微小核糖核酸let-7的表达及病理生物学意义

目的 探讨微小RNA(miRNA)1et-7对食管鳞癌细胞增殖的影响及食管鳞癌组织中let-7表达水平与临床病理特征间的关系.方法 利用RNA干扰(RNAi)和细胞转染技术将食管鳞癌细胞Eca109分别转染入let-7、let-7抑制剂及随机序列.以正常培养的Eca109细胞为阴性对照组.噻唑蓝(MTT)比色法检测各组Eca109细胞的增殖情况.实时荧光定量聚合酶链反应(qRTPCR)检测各组细胞、45例食管鳞癌组织及其癌旁组织中let-7的表达水平,并分析其与食管鳞癌临床病理特征间的关系.结果 转染后72 h,转染let-7组吸光度(A)值较阴性对照组明显降低(P=0.005),转染let-7抑制剂组A值较阴性对照组明显升高(P=0.029).与阴性对照组let-7表达量比较,转染let-7组表达增加33%(1.33比1.00,P=0.039),转染let-7抑制剂组表达降低50%(0.50比1.00,P=0.014).食管鳞癌组织和癌旁组织中let-7相对表达量的比值为0.66±0.47,差异有统计学意义(P=0.001).汉族患者食管鳞癌组织中let-7相对表达量(0.48±0.43)低于哈萨克族(0.88±0.51,P=0.019).低分化食管鳞癌组织中let-7相对表达量(0.42±0.30)低于高分化食管鳞癌组织(0.84±0.38,P=0.015).有淋巴结转移者食管鳞癌组织中let-7相对表达量(0.50±0.35)低于无淋巴结转移者(0.80±0.52,P=0.032).结论 let-7对食管鳞癌的发生、发展起抑制作用,其表达水平与组织分化程度、淋巴结转移及民族相关.

Abstract：

Objective To estimate the effect of microRNA (miRNA) let-7 expression on human esophageal squamous cell carcinoma(ESCC) and the relationship between let-7 level and clinicopathological parameters. Methods ESCC cell line (Eca109) was transfected with let-7 or its inhibitor by RNAi and cell transfection techniques. Normal cultured Eca109 cell was served as negative control. The proliferation of Eca109 cell was detected by MTT. The expression of let-7 in Eca109 cells and 45 paired ESCC tissues and corresponding para-cancerous tissues were measured using real-time quantitative polymerase chain reaction (qRT-PCR). The relationship between let-7 level and clinicopathological parameters in patients with ESCC was analyzed. Results The A value of let-7 in Eca109 cells transfected with let-7 was lower than negative control (P=0.005), while it was higher in Eca109 cells transfected inhibitor than that in negative control 72 hours after transfection. In comparison with negative control, the expression of let-7 in Eca109 cells transfected with let-7 was increased 33% (1.33 vs 1.00,P=0. 039) and it was decreased 50% in Eca109 cells transfected with inhibitor (0.50 vs 1.00,P=0. 014). The ratio of let-7 expression in ESCC tissue and para-cancerous tissue was 0.66 ± 0.47 with significant differece (P= 0.001). Moreover, The level of let-7 expression in Han patients with ESCC was lower than Kazakh patients with ESCC (0.48±0.43 vs 0. 88±0.51,P=0. 019). The level of let-7 expression in poorly differentiated ESCC tissue was lower than well differentiated ESCC tissue (0.42±0.30 vs 0.84±0.38,P=0. 015). The level of let-7 expression in patients with lymph node metastasis was lower than those without lymph node metastasis (0.50±0.35vs 0. 80±0.52,P=0. 032) . Conclusion It is demonstrated that let-7 can inhibit the carcinogenesis and development of ESCC. The level of let-7 expression is associated with cell differentiation,lymph node metastasis and nationalities.     

胃癌细胞DNA含量肿瘤相关抗原及其异质性

目的探讨胃癌异质性标志物之间的关系．方法应用显微分光光度计和抗ＳＳＥＡ１，抗胃癌单抗ＭＧ７的免疫组织化学染色对３５例胃癌和１０例正常胃粘膜进行了ＤＮＡ含量和ＳＳＥＡ１，ＭＧ７抗原表达的研究．结果正常胃粘膜细胞和管状腺癌，低分化腺癌，粘液腺癌，印戒细胞癌及未分化癌的ＤＮＡ相对含量分别为１１６０±０２０７，２１７６±０７０３，２２１４±０６６３，２２０６±０６０２，１１９６±０２７９和１６６５±０４９１，其中正常胃粘膜９５８％细胞为２Ｃ细胞，而胃癌常见＞８Ｃ，＞１２Ｃ细胞，在直方图上分布弥散；同一类型的不同病例间，同一病例切片的不同部位呈明显的异质性，但印戒细胞癌的ＤＮＡ含量接近正常．大部分胃癌标本中可检出ＳＳＥＡ１和ＭＧ７Ａｇ，但分布及染色程度呈明显的不均质性．ＳＳＥＡ１，ＭＧ７Ａｇ的表达与ＤＮＡ含量无明显关系．结论ＤＮＡ含量和ＳＳＥＡ１，ＭＧ７的表达是互相独立的，均与肿瘤的行为有关．     

Predictive factors of survival in patients treated with definitive chemoradiotherapy for squamous cell esophageal carcinoma

AIM: The aim of the study was to evaluate the predictive factors of survival in patients with locally advanced squamous cell esophageal carcinoma (LASCOC) treated with definitive chemoradiotherapy (CRT) regimen based on the 5FU/CDDP combination. METHODS: All patients with LASCOC treated with a definitive CRT using the 5FU/CDDP combination between 1994 and 2000 were retrospectively included. Clinical complete response (CCR) to CRT was assessed by esophageal endoscopy and CT-scan 2 mo after CRT completion. Prognostic factors of survival were assessed using univariate and multivariate analysis by the Cox regression model. RESULTS: A total of 116 patients were included in the study. A CCR to CRT was observed in 86/116 (74.1%). The median survival was 20 mo (range 2-114) and the 5-year survival was 9.4%. Median survival of responder patients to CRT was 25 mo (range 3-114) as compared to 9 mo (range 2-81) in non-responder patients (P < 0.001). In univariate analysis, survival was associated with CCR (P < 0.001), WHO performance status < 2 (P = 0.01), tumour length < 6 cm (P = 0.045) and weight loss < 10% was in limit of significance (P = 0.053). In multivariate analysis, survival was dependant to CCR (P < 0.0001), weight loss < 10% (P = 0.034) and WHO performance <2(P = 0.046). CONCLUSION: Our results suggest that survival in patients with LASCOC treated with definitive CRT was correlated to CCR, weight loss and WHO performance status.     

Elevated serum levels of human relaxin-2 in patients with esophageal squamous cell carcinoma

AIM: To assess the prognostic value of serum human relaxin 2 (H2 RLN) level in patients with esophageal squamous cell carcinoma (ESCC). METHODS: From October 1998 to September 2009, 146 patients with histopathologically confirmed ESCC were enrolled in this study. One hundred patients underwent en bloc esophagectomy, and 46 patients with unresectable tumors underwent palliative surgery. Five of the 146 patients died of surgical complications. Serum levels of H2 RLN were measured by enzyme linked immunosorbent assay. The relationship between serum H2 RLN level and each of the clinicopathological parameters was analyzed using the χ2 test. Patients were classified into two groups according to their H2 RLN level (< 0.462 ng/mL vs ≥ 0.462 ng/mL). When any analysis cell had fewer than five cases, the Fisher’s exact test was used. The statistical difference between groups A and B in each clinicopathological category was determined by the Student’s t test (two-tailed) or analysis of variance. Survival curves were plotted using the Kaplan-Meier method. The statistical difference in survival between the different groups was compared using the log-rank test. Survival correlation with the prognostic factors was further investigated by multivariate analysis using the Cox proportional hazards model with backward stepwise likelihood ratio. RESULTS: ESCC patients tended to have significantly higher serum H2 RLN concentrations (0.48 ± 0.17 ng/ mL, n=141) compared with the healthy control group (0.342 ± 0.12 ng/mL, n=112). There was a significant difference between patients with lymph node involvement (0.74 ± 0.15 ng/mL, n=90), distant metastasis (0.90 ± 0.19 ng/mL, n=32) and those without lymph node involvement (0.45 ± 0.12 ng/mL, n=51), and distant metastasis (0.43 ± 0.14 ng/mL, n=109), respectively (P < 0.01). Patients with high H2 RLN levels (≥ 0.462 ng/mL) had a poorer prognosis than patients with low serum H2 RLN levels (< 0.462 ng/mL; P=0.0056). The H2 RLN level was also correlated with survival and