食管、贲门、膈

^18F-脱氧葡萄糖正电子发射体层显像在食管癌患者中的应用,贲门癌根治术后患者预后的多因素分析,胃底贲门癌的术式选择（专家论坛）,保留胸肌的微创剖胸切口在早期食管胸中上段癌手术中的应用,胸腔镜辅助治疗早期食管破裂，[编者按]     

经腹经后纵隔贲门癌根治术

目的 探讨经腹经后纵隔进行贲门癌根治的可行性和安全性.方法 对26例贲门癌侵及食管下段的患者进行经腹经后纵隔贲门癌根治术,其中根治性近端胃食管切除9例,根治性全胃食管切除17例.结果 本组26例均成功完成经腹经后纵隔贲门癌根治术.平均手术时间:全胃切除(189±39)min,近端胃切除(153±35)min;平均手术出血量:全胃切除(200±80)ml,近端胃切除(168±76)ml;平均清扫淋巴结数:腹腔淋巴结(23.3±7.3)枚/例,食管旁淋巴结(4.1±2.0)枚/例.术后无吻合口出血、吻合口瘘、吻合口狭窄发生,4例患者出现肺部感染,经治疗好转,所有患者恢复良好.术后随访5～51个月,4例出现肝转移,2例发生肺转移,其中1例死亡,其余患者情况良好,无吻合口癌复发.结论 经腹经后纵隔贲门癌根治术安全、可行,适用于膈肌没有受侵犯、食管受侵小于5 cm的胃上都癌.     

经腹与经胸部入路胃底贲门癌根治术80例分析

目的比较经腹与经胸入路行胃底贲门癌根治术的效果。方法根据不同手术入路将80例接受胃底贲门癌根治术的患者为2组,各40例。经腹组行开腹手术,经胸组实施开胸手术,比较2组平均淋巴结清扫数、食管切缘癌残留率、并发症发生率、术后平均恢复时间及2 a生存率。结果经腹组平均淋巴结清扫数及食管切缘癌残留率高于经胸组;术后平均恢复时间及肺部感染率明显低于经胸组,2组差异有统计学意义(P0.05)。其余指标组差异无统计学意义(P0.05)。结论经腹和经胸手术入路实施胃底贲门癌根治术各有优缺点,应根据患者对手术的耐受力和病变的局部情况以及术者自身的技术特点,个体化进行选择。     

肺隔离症误诊为食管肿瘤一例

患者 女,34岁.因吞咽困难伴胸闷3个月入院,食管X线钡餐造影示食管下段占位性病变(图1);胃镜示距门齿38 cm处食管右侧壁可见直径1.0 cm黏膜隆起,边界清楚,考虑食管平滑肌瘤;术前诊断为食管平滑肌瘤.于1999年6月手术治疗,术中发现左肺上下叶发育正常,左肺下叶包膜可见丰富的毛细血管网;异常动脉经食管裂孔来源于腹腔,走行迂曲,管径约1.8 cm,平行于降主动脉上行,由左肺下叶背段进入肺内,肺门部未探及左肺下叶动脉;左肺下叶静脉和支气管属正常解剖形态,左肺下叶通气功能良好;胸段食管未探及占位性病变.手术游离显露异常血管,予以缝扎后常规行左肺下叶切除术,术后诊断为左下肺隔离症.病理检查示:肺内部分细支气管呈囊状扩张,部分区域肺泡未发育完全.术后6个月复查无异常.     

肺癌术中癌块脱落导致肺不张一例

肺癌术中癌块脱落导致肺不张一例孙洪英１应诗达１苏云芝患者女，５６岁，因肺癌行左下肺叶切除术。静脉快速诱导，插Ｆ３４单腔气管导管，行静吸复合麻醉及全程机械通气。剖胸后见左肺下叶完全萎陷，上叶膨胀良好。于切下左肺下叶缝毕左下支气管残端后，发现原膨胀良好的...     

食管多源癌的诊断与治疗

目的探讨食管多源癌的诊断及治疗方法。方法回顾性分析2008年3月至2009年11月在四川大学华西医院行手术治疗的15例食管多源癌患者的临床资料,其中男14例,女1例,中位年龄62.5(48~75)岁。15例行手术治疗食管多源癌的患者中,行Sweet术式8例,左胸-左颈两切口4例,胸腹腔镜联合Mc Keown术式2例,开胸探查而未能切除肿瘤1例。结果术前确诊11例,术前确诊率为73.3%(11/15)。术后1例发生肺部并发症,3例发生吻合口瘘,围术期无死亡。除肿瘤未能切除的患者外,随访13例,随访5年,1年生存率61.5%(8/13)、3年生存率30.8%(4/13)、5年生存率15.4%(2/13)。第一病灶位置与预后关系密切,第一病灶位于胸上段的食管多源癌患者,其中5例顺利完成手术,吻合部位均在颈部,2例食管残端存在癌残留(R1),1年内死亡3例,无1例获得3年生存。第一病灶位于胸中、下段的9例食管多源癌患者均完成根治性切除,食管及胃残端均无癌残留(R0),1年生存率75.0%,3年生存率50.0%,2例获得5年长期生存。结论对于食管多源癌,如第一病灶位于胸中、下段,首选手术治疗。如第一病灶位于胸上段,不宜首选手术治疗,这类患者采用新辅助放化疗后再手术或直接采用其他治疗模式,这需要以后进一步研究比较。     

食管、贲门、膈

游离空肠修复下咽及颈段食管肿瘤切除后组织缺损的临床分析；食管癌贲门癌切除机械吻合术后胃食管反流的诊断和治疗；原发性食管小细胞癌的外科治疗；改良人工食管结构预防新生食管狭窄；机械吻合器在食管癌和贲门癌手术中的应用；食管癌术中胸导管预防结扎连续1031例无乳糜胸手术经验；预防性胸导管结扎术在食管癌根治术中应用的评价     

青年医师连续52例食管癌、贲门癌手术无并发症治疗体会

目的总结青年医师连续食管癌、贲门癌手术无并发症的治疗体会。方法回顾性分析52例食管癌、贲门癌手术的临床资料,其中食管癌36例,贲门癌16例。肿瘤根治性切除后行食管胃胸膜顶吻合2例,主动脉弓上(含弓后)吻合13例,食管胃主动脉弓下吻合37例。手术均采用机械吻合。结果本组病例手术时间为160～280 min,围术期无麻醉意外,术中无大出血,无近期的吻合口狭窄,连续无吻合口瘘、脓胸、乳糜胸、心脑血管意外及肺部感染等并发症,均治愈出院。结论青年医师连续食管癌、贲门癌手术无并发症的关键在于"慎于术前,精于术中,勤于术后",多学习,并按照从贲门癌→食管下段癌→食管中段癌→食管上段癌这一由易到难的顺序进行。     

食管癌术后乳糜胸的治疗

目的探讨食管癌术后乳糜胸的治疗方法和效果。方法回顾分析湖北医药学院附属襄阳一医院684例食管癌术后并发乳糜胸18例患者的临床资料,其中男12例,女6例;年龄57.5(38～66)岁。食管上段癌2例,食管中段癌15例,食管下段癌1例。所有患者均行左胸径路食管癌根治术,术中均未见明确的胸导管损伤,未行预防性胸导管结扎。结果 18例均先行保守治疗,10例痊愈;再手术治疗8例,手术时间60～90 min,术后无感染等并发症发生,住院时间8～10 d;7例治愈,1例死于术后吻合口瘘。17例治愈患者3个月后复查无乳糜胸再发。结论食管癌术后乳糜胸患者有必要早期行10 d严格、正规的保守治疗,经保守治疗后乳糜液量仍>800 ml/d者应及时再手术治疗,手术方式以右胸径路、膈上低位胸导管结扎术为宜。     

食管和肺双原癌术后并发重症肝炎1例

病人　男 ,6 6岁。左上胸背部疼痛伴吞咽梗噎感 4个月。曾患左上肺结核 ,血吸虫病。Ｘ线胸片示左上肺后段团块状密度增高影。胃镜咬检证实为食管下段鳞癌。术前诊断左上肺癌合并食管下段癌。1999年 8月行左侧剖胸探查。术中见左肺上叶后段质硬肿块 ,约 5ｃｍ× 4ｃｍ× 2ｃｍ ;食管下段质硬肿块 ,约 4ｃｍ×4ｃｍ× 2ｃｍ。行左肺上叶病灶楔形切除 ,食管下段肿物切除、食管胃弓下机械吻合术。病理报告示左上肺中分化乳头状腺癌 (图 1)、食管溃疡型低分化鳞癌 (图 2 ) ,浸润到外膜层伴胃左动脉旁淋巴结转移。术后 7ｄ病人出现皮肤、巩膜黄染 …     

Minimally invasive resection of synchronous triple primary tumors of the esophagus,lung, and thymus: A case report

IntroductionReports of synchronous multiple primary tumors are very rare. We report a case of synchronous esophagus and lung cancer combined with thymoma treated with a minimally invasive approach.Presentation of caseIn a 63-year-old patient, cT2 esophageal squamous cell carcinoma was found. Chest computed tomography revealed a lesion in the right upper lobe combined with an antero-superior mediastinal mass. She was treated with one-stage bilateral video-assisted thoracoscopic + laparoscopic esophagectomy with lymph node dissection and lobectomy with complete lymphadenectomy followed by thymomectomy and demonstrated a favorable response at early follow-up, without severe adverse surgical complications and evidence of local recurrence or distant metastasis. But the long-term follow-up is still needed for the evaluation of therapeutic effects of surgery.DiscussionIn the diagnostic procedure we excluded the probability of esophageal carcinoma metastasizing to the lung. Considering the patient's physical condition permit, we performed a minimally invasive surgery for three tumors. Besides, suitable operative incisions are important for the success of surgery.ConclusionTo our knowledge, this is the first case report in which simultaneous minimally invasive resection of esophagus and lung cancer combined with thymoma.     

Unusual case of cavitary lung metastasis of esophageal cancer: A case report

Introduction and importanceCavitary lung metastases are rare. We experienced lung metastasis of esophageal cancer with a cavity, which is extremely rare.Case presentationA 69-year-old female diagnosed with thoracic esophageal cancer underwent radical esophagectomy. Pathological diagnosis was T3N0M0-pStageII. Cavitary lesion appeared in the lower lobe of the right lung 12 months after surgery. We suspected an inflammatory change and followed up strictly. On Computed tomography (CT) image 18 months after surgery, the cavitary lesion slightly increased in size, showing wall thickening and fluid inside. Fluid collection disappeared after antibiotic treatment. The patient was followed for 4 weeks without antibiotics and fluid collection reappeared. Cavitary lesion resection for the purpose of diagnosis was planned because malignancy could not be excluded, although the readministration of antibiotics was also considered. Thoracoscopic partial resection of the right lower lobe of the lung was performed. Histopathological examination showed squamous cell carcinoma which was similar in morphology to esophageal cancer. The final diagnosis was lung metastasis of esophageal cancer.Clinical discussionMetastatic lung cancer with a cavity is rare, accounting for approximately 4% of all cases. Moreover, Lung metastasis of esophageal cancer with a cavity is extremely rare.ConclusionsThe specimen collection, including total biopsy, should be aggressively performed when diagnosing cavitary lung disease in patients with a history of neoplastic disease.     

Clinical analysis of esophageal cancer associated with other primary cancers

This study aims to investigate the therapeutic and prognostic implications of esophageal cancer in patients with other primary cancer. Between April 1992 and December 2008, in 83 patients underwent surgery for esophageal cancer at our department. Among them, 24 patients (28.9%) had medical history of additional primary cancer. There were 16 metachronous cancers and 8 synchronous cancers. Six patients had antecedent other primary cancers, and subsequent primary cancers developed in 10 patients. The other primary cancers included head and neck cancer in 8 patients, gastric cancer in 8, lung cancer in 6, colorectal cancer in 3, and other cancer in 3. The patients with other primary cancers were both heavy smokers and heavy drinkers in comparison to those without other primary cancers. The post-operative 5-year survival rate in patients with subsequent cancers, antecedent cancers, and synchronous cancers were 100%, 70.0%, and 46.9%. The 5-year survival rate was 33.4% in patients without other primary cancers. A high incidence of multiple primary cancers was observed in patients with esophageal carcinoma but the prognosis of these patients with metachronous cancers are better than that of patient with synchronous cancers and patients without other primary cancers. Post-operative follow up is considered to be necessary for early detection of multiple occurrences of carcinoma, especially in the upper aerodigestive tract.     

Salvage photodynamic therapy accompanied by extended lymphadenectomy for advanced esophageal carcinoma: A case report

IntroductionSalvage surgery for locoregional failures after definitive chemoradiotherapy (dCRT) for esophageal cancer is widely practiced, but treatment options complementing it are also needed due to the high morbidity and mortality and low rate of curative resection.Presentation of caseA 58-year-old man with a surgical history of right upper lobectomy for lung cancer was diagnosed as having esophageal squamous cell carcinoma. Computed tomography revealed swelling of the lesser curvature lymph node, and it had invaded the stomach, the body and tail of the pancreas and the left gastric artery, splenic artery and celiac artery. The patient underwent definitive-dose radiation with chemotherapy. Complete response was attained for the primary tumor, but the metastatic lymph node infiltrating the stomach, pancreas and major vessels remained. Therefore, the Appleby operation was proposed to the patient and subsequently performed aiming at curability. However, the primary tumor recurred 38 months after surgery, so the novel modality of photodynamic therapy using talaporfin sodium and a diode laser was performed, and a complete response was attained for this lesion. The patient is alive at 50 months after the salvage Appleby operation.Discussion and conclusionSalvage lymphadenectomy for esophageal cancer may be insufficient as a curative treatment because of regrowth of the primary lesion. However, photodynamic therapy may be applicable as a curative treatment option for recurrence of the primary lesion after salvage lymphadenectomy.     

Multiple primary cancers in surgically resected lung cancer patients

Among 337 cases of surgically resected lung cancer from April 1977 to March 1984, there were 24 cases (7.12%) of multiple primary cancers including 22 cases of double cancer and one case each of triple and quadruple cancer. They consisted of 17 males and 7 females and the patient age at the time of the lung resection ranged from 32 to 81 years old (average: 67.4). In double cancer cases, the most common site of the other primary cancer was the lung (9 cases), followed by the stomach (5 cases), the colon (4 cases), the pancreas (2 cases), and there was one case each of the salivary gland and the skin. The cases of triple and quadruple cancer involved multiple primary lung cancer associated with mammary and esophageal cancer, respectively. There were 14 synchronous and 8 metachronous cases. The histology of lung cancer in 13 cases of double cancer was adenocarcinoma in 6, squamous cell carcinoma in 2, large cell carcinoma in 3, small cell carcinoma in 1, and adenosquamous cell carcinoma in 1. The histology of 11 cases of double or triple primary lung cancers was squamous cell carcinoma in 17, adenocarcinoma in 5, and large cell carcinoma in 1. In 24 cases 19 lobectomies, 4 pneumonectomies and one partial resection of the lung was performed for the first primary lung cancer. All cancer lesions of other organs apart from the lung were also surgically resected.(ABSTRACT TRUNCATED AT 250 WORDS)     

Multiple Primary Cancers Associated with Esophageal Carcinoma

This study was conducted to examine the characteristics of esophageal cancers with primary synchronous or metachronous cancer in another organ. We retrospectively evaluated 744 patients who underwent esophagectomy for esophageal cancers between 1985 and 1998. The patients were divided into two groups according to whether they had multiple primary cancer (MPC) or nonmultiple primary cancer (NPC). Stage I cancer was significantly more frequent among patients with MPC than among those with NPC (P < 0.0001). Among patients with MPC, another primary cancer was found in the head and neck region in 70 (42.4%), in the stomach in 51 (30.9%), and in the colon, lung, breast, and other locations in the remaining patients. Of the 70 patients with another primary cancer in the head and neck region, 32 (45.7%) had pharyngeal cancer. Furthermore, the incidence of intraesophageal multiple cancer in the patients with primary cancer in the head and neck region was significantly higher than that in those whose other primary cancers were gastric cancer or in those with NPC (P = 0.0135, P < 0.0001). The 5-year survival rate of the patients with MPC was 51.28%, which was significantly higher than that of those with NPC (P = 0.019). In conclusion, a better knowledge of the relationships between esophageal carcinoma and cancers in other organs may lead to earlier detection of other primary cancers and improved therapeutic results. Received: August 23, 2000 / Accepted: May 15, 2001     

Cytophotometric DNA analysis of early esophageal carcinoma

In four patients with early esophageal carcinoma who underwent radical surgery, one died of cancer recurrence 13 months after surgery, two had an uneventful postoperative course after over five years and one succumbed to an incidental pneumonia 18 months postoperatively. Cytophotometric DNA analysis of the cancer cells reflected well the outcome of these patients. One recurrent patient had malignant pattern similar to that seen in usual advanced carcinoma of the esophagus, whereas the remaining three patient without recurrence throughout the postoperative course showed less malignant patterns. These result ssuggested the potential usefulness of cytophotometric DNA analysis in assessing the prognosis of early esophageal carcinoma.     

An attempt to analyze the relation between hospital surgical volume and clinical outcome

Objectives The aim of this study was to investigate the relation between hospital volume and clinical surgical outcome for 10 cardiac, lung, and esophageal surgical procedures. Methods The Committee for Scientific Affairs of the Japanese Association for Thoracic Surgery collected the pooled data on cardiac, lung, and esophageal surgical procedures between 2000 and 2004 from the annual reports. The relation between operative mortality (30-day or in-hospital mortality) and hospital volume was analyzed using a logistic regression model. The surgical procedures studied were surgery for acquired cardiac diseases [coronary artery bypass grafting (CABG), valve procedures, acute type A dissection surgery], total CABG (elective + emergency), elective CABG, emergency CABG, single-valve surgery, acute type A dissection surgery, open heart surgery for the newborn, open heart surgery for the infants, lung cancer surgery, and esophageal cancer surgery. The data used in this study were not risk-adjusted. Results The data on the relation between hospital volume and operative mortality generally tended to show an inverse correlation for all 10 cardiac, lung, and esophageal surgical procedures; that is, the higher was the volume the lower was the mortality. However, wide variations in operative mortality were noted among the very-low-volume hospital groups. Conclusion An inverse correlation was noted between hospital volume and operative mortality in the present study, although wide variations in clinical outcome were noted among the very low-volume hospitals. Further analysis is warranted using risk-adjusted data. This report was prepared by the Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery     

Development of synchronous bilateral lung cancers after esophagectomy for esophageal cancer: Report of a case

It is well known that squamous cell carcinoma of the esophagus can be associated with carcinoma of other organs. We report herein the rare case of a 60-year-old man who developed sychronous bilateral lung cancers after undergoing esophagectomy for esophageal cancer. Staged bilateral lobectomy was successfully performed to minimize respiratory complications 3 years after his esophagectomy. This case report serves to demonstrate that aggressive and careful surgical approach with adquate followup offers the chance of long-term survival for patients with multiple primary cancers.