食管癌术后辅助治疗的临床价值

食管癌目前主要的治疗手段仍为手术切除,但术后患者的生存率较低,主要失败模式为局部复发和区域淋巴结转移.术后是否应该行辅助治疗及如何选择方案仍无明确的指南.研究显示Ⅲ期、N1的患者行术后辅助放疗可以提高无瘤生存率及总生存率,靶区范围应根据肿瘤所在的位置来确定.术后辅助化疗方案以顺铂联合5-氟尿嘧啶为首选,该方案主要不良反应为胃肠反应和骨髓抑制;术后辅助放化疗的临床价值仍需更多临床研究来支持.     

新疆地区164例胃癌根治术后患者预后因素分析

目的:研究新疆地区胃癌根治术后患者的临床因素以及术后治疗对预后产生的影响.方法:对2003-01-2009-12新疆医科大学第一附属医院收治的胃癌根治术后患者164例进行回顾性分析,采用Kaplan-Meier法计算患者的生存率,用Log-rank检验进行单因素分析,应用Cox模型进行预后的多因素分析.结果:共82例患者死亡,中位随访时间28.0个月,1年累积生存率为78.7％(129/164),3年为42.1％(69/164),5年为6.7％(11/164),中位生存时间40.1个月.单因素分析显示,性别、民族、临床分期、浸润深度、淋巴结转移、网膜转移、组织学分化、肿瘤部位、切缘残留、肿瘤大小、脉管侵犯和术后治疗情况与预后相关,P＜0.05;多因素分析证实,网膜转移(RR=8.564,P＜0.01)、淋巴结转移(RR=4.092,P＜0.01)、切缘残留(RR=3.282,P=0.002)、民族(RR=2.152,P=0.013)、浸润深度(RR=2.071,P=0.022)和肿瘤部位(RR=0.680,P=0.010)是影响胃癌预后独立的危险因子.结论:胃癌根治术后影响预后的独立因素按RR从高到低依次为网膜转移、淋巴结转移、切缘残留、民族、浸润深度和肿瘤部位.     

Longterm outcomes after endoscopic mucosal resection for early gastric cancer

Background Despite the widespread use of endoscopic mucosal resection (EMR) in patients with early gastric cancer (EGC), its longterm outcomes have not been fully evaluated. Our aim was to evaluate longterm survival after complete EMR for EGC. Methods From patients who underwent EMR between 1978 and 1996 at our center, we enrolled 131 patients with differentiated mucosal EGCs less than 2 cm (without ulcerative change) that had been completely removed by EMR. The vital status of the patients at the end of December 1998 was confirmed by the hospital cancer registry, which is linked to the Osaka Cancer Registry. Results A total of 124 patients (95%) were completely followed-up. Two patients (1.5%) died of gastric cancer and 26 died of other causes during the mean observation period of 58 months. The overall 5- and 10-year survival rates were 84% and 64%, respectively. The disease-specific 5- and 10-year survival rates were 99% and 99%. Conclusion En bloc EMR ensured an excellent prognosis, and should be the first choice of treatment in patients with small differentiated mucosal EGC. Careful histological examination and longterm endoscopic surveillance are important.     

胃癌根治术后早期复发的临床病理特点及预后分析

目的:探讨胃癌根治术后早期复发的相关因素及预后分析。方法:回顾性分析235例胃癌根治术后复发患者的临床病理资料,对相关参数进行单因素和多因素分析。Kaplan-Meier法进行预后的生存分析。结果:235例患者平均复发时间为术后24.3个月,其中早期复发145例（≤2年）,晚期复发90例（＞2年）。单因素分析显示手术方式、肿瘤大小、脉管侵犯、浸润深度、淋巴结转移、TNM分期、术后化疗与早期复发相关（P<0.05）。多因素分析显示肿瘤大小（P=0.001）、淋巴结转移（P=0.007）、术后化疗（P=0.011）是早期复发的独立影响因素。生存分析显示肿瘤大小（P=0.013）、TNM分期（P<0.01）是预后的独立影响因素。结论:肿瘤大小、淋巴结转移、术后化疗是胃癌早期复发的独立影响因素,且预后与肿瘤大小、TNM分期密切相关。     

腹腔镜辅助胃癌D2根治术淋巴结清扫的早期体会

目的 分析腹腔镜辅助胃癌D2根治术清扫血管根部各组淋巴结所需时间,探讨各组淋巴结清扫的难点和手术技巧.方法 采用观看手术录像方法,计算2010年10月至2011年7月于中山大学肿瘤防治中心施行的25例腹腔镜辅助胃癌D2根治术,分别计算清扫胃网膜左、胃网膜右、胃右及胃左血管根部淋巴结群所需时间,并比较各组淋巴结清扫所需时...     

腹腔镜与开腹胃癌根治术后患者生存质量分析

目的 调查胃癌根治术后患者生存质量变化情况,研究原发胃癌根治术后患者生存质量的影响因素.方法 采用消化病生存质量指数( GLQI)测定45例原发胃癌根治术后患者的生存质量,分析其影响因素并比较腔镜手术与开腹手术生存质量的不同.结果 患者术后GLQI评分与患者年龄无相关性.随病理分期增高,患者GLQI总分、心理情绪状态、生理功能状态及主观症状评分显著降低(P＜0.05),而社会活动状态评分无显著变化(P＞0.05).男性患者在GLQI总分及生理功能状态上均优于女性患者(P＜0.05),而在心理情绪状态、社会活动状态及主观症状评分无明显差异(P＞0.05).手术后2周腹腔镜组在GLQI总分、生理功能状态及主观症状方面优于开腹组(P＜0.05),而在心理情绪状态及社会活动状态评分无明显差异(P＞0.05).手术3个月以后,腹腔镜组在GLQI总分及主观症状优于开腹组(P＜0.05),而在心理情绪状态、生理功能状态及社会活动状态评分无显著性差异(P＞0.05).结论 胃癌根治术后患者的肿瘤病理分期、性别及手术方式是患者术后生存质量的影响因素,其中病理分期早优于分期晚的患者,男性优于女性,腹腔镜手术优于开腹手术.     

中晚期食管癌胸腔镜根治术的疗效观察

目的探讨中晚期食管癌行胸腔镜食管癌根治术治疗的临床疗效。方法选取2012年1月至2014年12月间南京医科大学附属淮安一院收治的178例中晚期食管癌患者,按其手术方式分为胸腔镜食管癌根治组(100例),三切口食管癌根治开放组(78例)。记录患者术中情况、术后拔管时间、住院费用、并发症发生情况及复发率和死亡率。结果两组患者均顺利完成手术,胸腔镜组无中转开胸病例,围术期两组均无死亡病例。胸腔镜组平均术中出血量(158.5±26.5)ml、引流时间(4.5±1.5)d、引流量(470.0±250.0)ml、平均住院时间(12.5±2.5)d和并发症发生率为20.0%,均优于开放组的(176.5±28.5)ml、(7.5±2.5)d、(900.0±360.0)ml、(16.5±3.5)d和29.5%,两组比较差异均有统计学意义(均P<0.05)。胸腔镜组淋巴结清扫数量(22.8±6.8)枚、阳性淋巴结率(9.5±1.5)%、手术时间(158.5±26.5)min和住院费用(5.5±0.3)万元,与开放组的(23.7±7.0)枚、(9.6±1.5)%、(176.5±28.5)min和(5.3±0.2)万元比较,差异均无统计学意义(均P>0.05)。胸腔镜组患者复发或转移9例(9.0%),开放组为10例(12.8%),组间比较差异无统计学意义(P>0.05)。胸腔镜组患者死亡3例(3.0%),开放组患者死亡4例(5.1%),组间比较差异无统计学意义(P>0.05)。胸腔镜组总生存率为97.0%,开放组为94.9%,组间比较差异无统计学意义(P>0.05)。结论胸腔镜下治疗中晚期食管癌临床疗效理想,术后恢复快,术后并发症发生率低,适于临床上使用。     

食管癌根治术后放射治疗的疗效分析

目的:评价食管癌根治术后放射治疗的价值.方法: 181例食管癌根治术后患者,其中96例行术后放射治疗,术后3-4周开始放射治疗,放射源为4MV-X射线.上、中段食管癌放射治疗野为双侧锁骨上区野联合纵隔野.下段食管癌放射治疗野为纵隔野,包括胃左动脉淋巴结引流区域.放射剂量:锁骨上区野50Gy/5周,纵隔野50-60Gy/5-6周.结果:总的术后放疗组患者5年生存率相对单纯手术组有显著性差异(P<0.05).淋巴结阳性者3年生存率两组有显著性差异(P<0.05);阴性者5年生存率两组有显著性差异(P<0.05);Ⅱa期患者5年生存率两组有显著性差异(P<0.01);Ⅱb期患者3年生存率两组有显著性差异(P<0.05);Ⅲ期患者两组生存率无显著性差异.术后放疗组患者吻合口复发率、胸内淋巴结转移率、锁骨上淋巴结转移率均明显下降.两组病例远处转移无显著性差异.放射治疗期间无严重不良反应.结论:食管癌术后放射治疗对淋巴结阴性和阳性者均有好处,可以提高Ⅱ期食管癌患者的长期生存率,有效降低局部复发率及放射野内淋巴结转移率.对晚期食管癌(Ⅲ期)术后局部放射治疗未见明显益处,但可以改善其生活质量.     

进展期胃癌标准根治术(D2)

胃癌是我国的高发肿瘤之一,临床收治的病例仍以进展期为主,虽然在胃癌的淋巴结清扫范围方面东西方仍存在较大争议,但是在东亚地区已经达成共识,标准的淋巴结清扫范围应该达到D2,即以胃窦癌为例,应该清扫No.1、No.3、No.4、No.5、No.6、No.7、No.8、No.9、No.11、No.12、No.14、淋巴结.     

Endoscopic resection of early gastric cancer

The purpose of this review is to examine recent advances in the techniques and technologies of endoscopic resection of early gastric cancer (EGC). Endoscopic mucosal resection (EMR) of EGC, with negligible risk of lymph node metastasis, is a standard technique in Japan and is increasingly becoming accepted and regularly used in Western countries. EMR is a minimally invasive technique which is safe, convenient, and efficacious; however, it is insufficient when treating larger lesions. The evidence suggests that difficulties with the correct assessment of depth of tumor invasion lead to an increase in local recurrence with standard EMR when lesions are larger than 15 mm. A major factor contributing to this increase in local recurrence relates to lesions being excised piecemeal due to the technical limitations of standard EMR. A new development in endoscopic techniques is to dissect directly along the submucosal layer — a procedure called endoscopic submucosal dissection (ESD). This allows the en-bloc resection of larger lesions. ESD is not necessarily limited by lesion size and it is predicted to replace conventional surgery in dealing with certain stages of ECG. However, it still has a higher complication rate when compared to standard EMR, and it requires high levels of endoscopic skill and experience. Endoscopic techniques, indications, pathological assessment, and methods of endoscopic resection of EGC need to be established for carrying out appropriate treatment and for the collation of long-term outcome data.     

S-1 chemotherapy for cancer of the gastric tube used for esophageal reconstruction following surgery for esophageal cancer

We used S-1 chemotherapy to treat 5 patients with cancer of the gastric tube used for esophageal reconstruction through the posterior mediastinal route following surgery for esophageal cancer. The response rate was 40%, the median survival 15 months, and 3 patients still survive. In those 3 patients, the gastric tube cancer was at a resectable stage, but the patients elected to have chemotherapy instead. One patient has survived 21 months after responding completely to 2 cycles of combined chemotherapy with S-1 and cisplatin. Another has survived 15 months after partially respondingto S-1 chemotherapy. And the third has survived 46 months after endoscopic treatment, radiation therapy and S-1 chemotherapy. S-1 chemotherapy thus appears to be an effective treatment for cancer of the gastric tube after surgery for esophageal cancer.     

食管癌根治术后复发患者122例预后因素分析

目的 探讨食管癌根治术后局部复发的疗效和预后影响因素.方法 回顾性分析2008-01-31-2014-12-31河南省肿瘤医院收治的122例食管癌根治术后复发转移接受局部放疗患者资料,采用Kaplan-Meier法进行生存分析,组间比较采用Log-rank法,以Cox比例风险模型进行多因素分析.结果 全组中位生存时间1...     

374例根治术后肠型胃癌患者预后的影响因素分析

目的:肠型胃癌约占中国胃癌总数的40％～45％,本研究旨在探讨根治术后肠型胃癌预后的影响因素.方法:回顾性收集2010年7月至2015年7月于山东第一医科大学附属省立医院行根治性切除且术后病理证实为肠型胃癌患者的临床病理和预后资料.Log-rank检验比较各临床病理特征对无病生存期(disease-free survi...     

Endoscopic mucosal resection for early gastric cancer.

Progress in the detection of early gastric cancer has made endoscopic mucosal resection (EMR) possible for the treatment of gastric cancer instead of only conventional surgical resection. The most commonly employed modalities include strip biopsy, double snare polypectomy, and resection with combined use of highly concentrated saline and epinephrine, and resection using a cap. The indications should be strictly limited to the differentiated IIa type (the slightly elevated type) that is smaller than 2 cm, or the differentiated IIc type (slightly depressed type) without ulcer formation and smaller than 1 cm. Both of these entities are thought to have a negligible risk of lymph node metastasis. Prognosis after this treatment is comparable that of surgical resection for early gastric cancer in completely resected cases. EMR also permits local resection in elderly patients with various complications who would be at risk for conventional surgical operations. EMR should be encouraged for treatment of gastric cancer if the indications are strictly chosen.     

早期肠内营养在腹腔镜结直肠癌根治术后应用的疗效观察

目的观察结直肠癌腹腔镜手术后患者早期肠内营养支持的近期疗效.方法将68例腹腔镜结直肠癌术后患者随机分为肠内营养组(EN)与肠外营养组(PN),于术后24小时内开始分别给予肠内与肠外营养,每天热卡为30kcal/kg.EN组患者术后第1天口服安素500ml,术后第二天1,000ml,术后第三天直至第7天口服1,500ml.比较两组患者术后营养状况和临床恢复情况.结果两组患者年龄、性别、体重指数、临床分期、手术方式比较,差异无统计学意义(P＞0.05).EN组术后消化道功能恢复时间优于PN组(P＜0.05),EN组感染性并发症发生率为6.7％,PN组为7.9％,差异无统计学意义(P＞0.05).两组患者术后7天营养指标血清白蛋白、前白蛋白、总蛋白较术前下降,但两组间比较无显著性差异.EN组患者术后营养支持费用显著低于PN组.结论术后早期肠内营养安全有效,可以改善腹腔镜结直肠癌患者术后胃肠道功能的恢复,且可降低术后营养支持费用.     

食管癌根治术后吻合口复发的放射治疗

探讨食管癌根治术后吻合口复发放射治疗的价值。方法　病理确诊为食管癌且术后病理切缘阴性的 6 1例患者根治术后吻合口复发 ,复发时间在术后 3～ 16 1个月 ,中位时间 16个月。单纯吻合口复发 2 7例 ,吻合口复发伴纵隔淋巴结转移 34例。 46例在吻合口复发后接受放射治疗 (放射治疗组 ) ,10例化疗及 5例未治为非放射治疗组。结果　手术后 1、3、5年总生存率分别为88.5 %、31.2 %、19.7% ;复发后 1、3、5年生存率分别为 2 6 .3 %、3 .2 8%、1.6 4%。 >1年复发后的手术后 5年总生存率分别为 0 .0 %、31.4% (P <0 .0 1) ;5年复发后生存率分别为 0 .0 %、8.9% (P =0 .0 4)。单纯吻合口复发手术后 5年总生存率为 33 .3 % ,吻合口复发 纵隔淋巴结转移手术后 5年总生存率为 5 .9% (P =0 .0 7)。放射治疗组的手术后 5年总生存率为 2 1.7% ,而非放射治疗组则为6 .7% (P =0 .0 2 ) ,且放射治疗组的复发后 1年生存率为 2 8.3% ,而非放射治疗组则为 0 .0 % (P <0 .0 1)。结论　手术后吻合口复发时间及是否接受放射治疗是影响预后的主要因素 ,单纯吻合口复发者的预后优于吻合口复发合并纵隔淋巴结转移者。     

Long-term results of early gastric cancer accomplished in a European institution by Japanese-type radical resection

Background. Long-term survival following Japanese-type radical surgery for 130 consecutively performed early gastric cancers (EGC) in a single Austrian institution between January 1, 1984 and May 31, 1998 was analyzed in terms of long-term survival, postoperative morbidity, and mortality. Methods. Extended D2 lymphadenectomy as defined by the JRSGC was performed in 129 patients with EGC. The surgical process was consistent as nearly all patients were operated on by only two surgeons. Overall survival and factors influencing survival were analyzed with particular regard to the depth of tumor infiltration, histological type, tumor grading, Lauren classification, tumor diameter, macroscopic appearance, localization, and lymph node involvement. Results. Of 678 gastric cancer patients surgically treated in the mentioned period, 130 patients (19.2%) were qualified as EGC. In 70 patients the tumor was limited to the mucosa and in 60 patients the tumor had not yet invaded the submucosa. The percentage of patients with positive lymph nodes increased from 2.9% with mucosal invasion to 21.7% with submucosal tumor involvement. The overall 5- and 10-year observed survival rate, postoperative mortality not excluded, was 74.6% and 62.1%, respectively, and 91.1% and 91.1%, respectively, when calculated as tumor specific. The 5- and 10-year observed survival rate of tumors limited to the mucosa was 77.2% and 72.1%, respectively, and 98.1% and 98.1%, respectively, when calculated as tumor specific. The respective values for submucosal invasion were 71.6% and 51.7%, and 82.7% and 82.7%. Postoperative complications occurred in 17 patients (13.1%) and postoperative hospital mortality totaled 1.5% (2/130). In multivariate analysis, only lymph node metastases were found to have independent prognostic influence on survival (P < 0.001; hazard ratio, 8.25). Conclusion. Japanese-type radical lymph node dissection for EGC in a European surgical institution yielded long-term survival nearly identical to that reported repeatedly by Japanese authors. Postoperative morbidity and mortality was not sacrificed by our comparatively radical surgical approach. Received for publication on March 8, 1999; accepted on June 7, 1999     

External validation of nomogram for the prediction of recurrence after curative resection in early gastric cancer

BackgroundNomograms are statistics-based tools that provide the overall probability of a specific outcome. In our previous study, we developed a nomogram that predicts recurrence of early gastric cancer (EGC) after curative resection. We carried out this study to externally validate our EGC nomogram.Patients and methodsThe EGC nomogram was established from a retrospective EGC database that included 2923 consecutive patients. This nomogram was independently externally validated for a cohort of 1058 consecutive patients. For the EGC nomogram validation, we assessed both discrimination and calibration.ResultsWithin the follow-up period (median 37 months), a total of 11 patients (1.1%) experienced recurrence. The concordance index (c-index) was 0.7 (P = 0.02) and the result of the overall C index was 0.82 [P = 0.006, 95% confidence interval (CI) 0.59–1.00]. The goodness of fit test showed that the EGC nomogram had significantly good fit for 1- and 2-year survival intervals (P = 0.998 and 0.879, respectively). The actual and predicted survival outcomes showed good agreement, suggesting that the survival predictions from the nomogram are well calibrated externally.ConclusionsA preexisting nomogram for predicting disease-free survival (DFS) of EGC after surgery was externally validated. The nomogram is useful for accurate and individual prediction of DFS, patient prognostication, counseling, and follow-up planning.     

食管癌和贲门癌切除机械吻合术后早期并发症及死因分析

为探讨食管癌和贲门癌切除机械吻合术后早期并发症,并对发生原因及死亡原因进行分析。行食管癌和贲门癌切除410例,均行食管与胃机械吻合。结果示,术后发生吻合口瘘5例(1·2%),其中3例死亡,2例保守治愈;术后乳糜胸3例(0·7%),其中1例行开胸探查结扎胸导管治愈,另2例保守治愈;胸腔内出血3例(0·7%),均经积极地二次开胸探查止血治愈;肺部感染26例(6·3%),其中1例感染严重死亡,另25例治疗后痊愈;吻合口狭窄1例(0·2%),经胃镜下食管扩张治愈。     

胃部分切除术治疗早期胃癌的临床疗效

目的探讨胃部分切除术治疗早期胃癌的临床疗效。方法收集2008年1月至2011年1月间收治的早期胃癌患者124例,其中行胃部分切除术的62例作为观察组,行常规远端胃切除术的62例作为对照组,比较两组患者的疗效。结果观察组患者术后15、30、60 min的胃排空功能均显著优于对照组(P<0.05),术后60 min胆囊收缩功能显著优于对照组(P<0.05)。术后6个月,观察组的身体质量指数(BMI)显著高于对照组(P<0.05);观察组患者术后远期并发症显著低于对照组(P<0.05)。两组患者的3年复发率和生存率的差异无统计学意义(P>0.05)。结论胃部分切除术治疗早期胃癌可有效改善患者的胃排空和胆囊收缩功能,保留BMI水平,减少远期并发症和复发率,值得推广应用。