不同吸氧方式对食管癌患者术后低氧血症的影响

目的:比较2种不同吸氧方式对食管癌切除术患者术后的影响。方法:选择100例采用不同术式的食管癌切除术患者,采用随机双盲对照研究方法,评价采用面罩吸氧、鼻导管吸氧等不同的吸氧方式持续给氧,持续检测患者术后24h、48h、72h的各项生命体征,并观察不同吸氧方式患者术后并发症、住院天数的差异。结果:①采用两种方式吸氧的患者,其pCO2在术后24h、48h、72h没有统计学差异(P>0.05),其pO2在术后24h、48h有统计学差异(P<0.05),采用面罩吸氧可以获得更好的pO2,但术后72h采用两种方式吸氧的患者其pO2没有统计学差异(P>0.05);②采用两种方式吸氧的患者,其氧饱和度水平在术后24h、48h、72h基本没有差异(P>0.05);③采用面罩吸氧的患者,其术后并发症的发生率以及住院时间均比采用鼻导管方式少(P<0.05)。结论:食管癌切除术后患者可以采用面罩吸氧这种相对较适宜的吸氧方式,有效降低了食管癌根治术术后患者对缺氧状态的反应,提高了食管癌患者术后机体对缺氧的耐受性。     

食管癌放疗后手术脓胸的预防

目的研究食管癌放疗后手术脓胸的特点及预防。方法术前深静脉高营养，肠道消毒，穿孔病例控制毒血症。术中严格无茵操作，对食管穿孔、破损、残留处以碘伏，洁尔灭酊消毒，高频氩气电刀烧灼。关胸前碘伏，洗必泰，盐水反复冲洗。术后加强呼吸道及胸腔引流管管理，防止胸腔积液，合理使用抗生素。结果121例病人术后脓胸2例，占1．65％。结论食管癌放疗后手术团术前穿孔率高，胸内心肺脏器生理功能发生不同程度改变，术中肿瘤破损及残留机会多，易发生脓胸。本组术前、术中、术后采取严密施治，可有效地预防脓胸的发生。     

食管癌放疗后手术方式的效果比较

目的探讨食管癌放疗后手术方式的效果比较.方法将232例食管癌放疗后患者随机分为A、B两组(各116例)手术,手术方式为A组术式(右胸后外第6肋床切口、胸骨后胃代食管、左颈食管-胃吻合术或食管外置术),B组术式(右胸前外第4、5肋间切口、食管床胃代食管左颈食管-胃吻合术或食管外置术).分析两组术式的切除率、死亡率、手术时间、术中出血量、并发症发生率等情况.结果切除率A组100%,B组92.24%(P＜0.01);手术时间 A组较B组长;术中出血量 A组多于B组;并发症发生率A组为70.69%(82例)(吻合口瘘4例、脓胸1例、呼吸衰竭3例、低氧血症46例、严重心律失常25例、其他3例);B组为82.76%(96例)(吻合口瘘7例、脓胸4例、呼吸衰竭4例、低氧血症56例、严重心律失常21例、其他4例)(P＜0.05);死亡A组3例(2.59%)、B组4例(3.74%)(P＞0.05).结论鉴于A组切除率高于B组,并发症发生率低于B组,我们认为食管癌放疗后手术,A组手术方式优于B组手术方式.鬃     

食管癌放疗后的主动脉瘘

探讨食管癌放疗后主动脉瘘形成机制、先兆症状及预防措施。材料与方法食管癌放疗后发生食管─主动脉瘘并经尸检证实的１２例临床和病理资料分析。结果瘘均发生在放疗后１４个月内。瘘前先兆症状有剧烈胸背痛、低热、白血球数增高，Ｘ片上有明显穿孔征象。病理检查癌瘤仅侵及主动脉壁外膜层，但主动脉内、中、外膜三层均有明显炎症反应。结论放疗后的主动脉瘘与残存癌有关，但最终引起穿孔的直接原因是癌瘤合并的炎症。故有先兆症状的病人，应考虑积极抗炎治疗。     

乳腺癌低氧放疗的远期观察

目的:观察低氧对乳腺癌术后放疗皮肤保护作用和对远期疗效的影响。方法:选自1992年3月至1995年3月收治的乳腺癌根治术后患者158例。Ⅱ期91例,Ⅲ期67例。随机分为低氧放疗组85例,常规放疗组73例。应用电子线照射锁骨上、腋窝、胸壁和内乳区。低氧放疗组在放疗开始前吸入10.5%的低氧3～5min直至照射结束。总剂量50～55Gy/25～27次。结果:低氧放疗组照射野内的急性皮肤反应明显较常规放疗组轻,而且出现的晚,但照射野内的后期皮肤改变两组无明显差别。5年生存率分别为92.9%和94.5%,χ2检验无统计学意义。结论:低氧放疗对正常皮肤有明显保护作用,而对生存期无明显影响。     

食管癌术后预防性放疗前瞻性研究

食管癌术后预防性放疗前瞻性研究梅泽如项其昌吴维继蒋向民冯存伟穆怀德我院于１９８７年２月～１９８９年１１月，对食管中段及中下段癌术后按设计要求作随机分组，全部病例随访满５年。１材料与方法本研究选择食管中段及中下段癌根治术后病例，按术后病理有无淋巴结转移...     

180例可手术食管癌单纯放疗疗效分析

1958年1月～1987年12月我院收治了180例经组织学证实为食管癌并经外科医生确认病变可进行手术探查的病例,但因心肺功能不全,一般情况差,年迈或病人拒绝手术而未做手术仅行单纯根治性放疗。全组男性120例,女性60例。病变部位:上段27例,中段125例,下段28例。病变长度2～9cm,<5cm69例,>5cm112例。鳞癌178例,腺癌2例,髓质型136例,蕈伞型38例,腔内型6例。X线所见病变浅表,无明显梗阻或轻度梗阻占48/190(26.6%)。未手术原因:心功能不全21例;肺功能差36例;一般情况差9例;年迈(68～81岁)32例;病人或家属拒绝手术82例。治疗:采用60Co或8MV-X线直线…     

晚期食管癌内支架术后配合放疗疗效观察

目的观察食管高度狭窄的晚期食管癌，金属被膜内支架术后放射治疗的疗效。方法25例晚期食管癌，食管狭窄在2mm以下，其中7例呈梗阻状，1例伴食管瘘。共置入26个镍钛合金被膜内支架，2周后行外照射，DT60～70Gy。结果支架全部顺利置入，2周后均能进普食，并能接受根治性放疗，未出现并发症。6个月生存率71％，1年生存率25％，2年以上生存率13．1％。结论放置食管内支架加放疗，疗效确切，操作方便，能提高患者的生活质量和延长生存期。     

开胸术后低氧血症高危因素分析

近年来 ,开胸手术对肺功能的影响 ,国内外有不少文献报道 ,其中高龄患者、术前合并冠心病、心律失常者、术前肺功能中、重度阻塞性减退者、高体重肥胖等都被公认为是术后发生低氧血症及至ARDS的诱因。我们采用回顾性调查分析方法对山西省肿瘤医院胸外科 1999年 5月 - 2 0 0 0年 4月间胸外科手术后发生低氧血症的病例进行了总结回顾。1　资料与方法1.1　一般资料　本组病例 2 9例 ,其中男性 18例 ,女性 11例 ,年龄 46岁～ 76岁 ,其中 >6 0岁者 2 2例。贲门癌切除 ,食管—胃弓下吻合 10例 ;肺叶及全肺切除 9例 ;中段食管癌切除 ,食管—胃弓…     

Brachytherapy in oesophageal carcinoma

Patients with recurrent or locally advanced oesophageal carcinoma have a poor prognosis. Relief of dysphagia is often the goal of any further treatment. Several methods, including laser re-canalization, prosthetic intubation, dilatation, external beam irradiation (EBI) and intraluminal brachytherapy (IBT) can be used to alleviate dysphagia. In this retrospective review of 11 patients, eight with recurrent tumour and three newly diagnosed patients were treated with low dose rate IBT. Relief of dysphagia was achieved in nine patients, all of whom were able to maintain swallowing of at least a semi-solid diet until death or last follow-up. Toxicity was minimal, but survival was poor, with a median survival of only 3 months. IBT presents several advantages over other palliative methods, especially in recurrent tumours where re-treatment with EBI is often difficult because of normal tissue tolerance. Low dose rate IBT takes only 1–2 days to deliver, is highly effective, has little morbidity and the palliation achieved is relatively durable.     

Primary small-cell carcinoma of the oesophagus with spontaneous oesophageal perforation following chemotherapy

The authors describe a 66 year old woman with small-cell carcinoma of the oesophagus who developed a perforation following chemotherapy. Small-cell carcinoma of the oesophagus is a rare neoplasm, varying in appearance from a small mucosal lesion to a larger fungating mass, which in our patient presented as a bulky soft-tissue mass causing stricture. Pleural fluid collections which developed via a spontaneous oesophageal-pleural fistula were subsequently drained using percutaneously placed catheters. Radiologic management of this condition provided a successful and cost-effective means of patient care.     

Salvage definitive chemo‐radiotherapy for locally recurrent oesophageal carcinoma after primary surgery: Retrospective review

To determine the overall survival and gastrointestinal toxicity for patients treated with salvage definitive chemo‐radiotherapy after primary surgery for locoregional relapse of oesophageal carcinoma. A retrospective review of 525 patients who had a resection for oesophageal or oesophagogastric carcinoma at Princess Alexandra Hospital identified 14 patients treated with salvage definitive radiotherapy or chemo‐radiotherapy, following localized recurrence of their disease. We analysed the patient and treatment characteristics to determine the median overall survival as the primary end point. Gastrointestinal toxicity was examined to determine if increased toxicity occurred when the stomach was irradiated within the intrathoracic radiotherapy field. The median overall survival for patients treated with curative intent using salvage definitive chemo‐radiotherapy was 16 months and the 2‐year overall survival is 21%. One patient is in clinical remission more than 5 years after therapy. Age <60 years old and nodal recurrence were favourable prognostic factors. Treatment compliance was 93% with only one patient unable to complete the intended schedule. Fourteen per cent of patients experienced grade 3 or 4 gastrointestinal toxicity. Salvage definitive chemo‐radiotherapy should be considered for good performance status patients with oesophageal carcinoma who have a locoregional relapse after primary surgery. The schedule is tolerable with low toxicity and an acceptable median survival.     

Pre-operative estimation of complete resection for patients with oesophageal carcinoma

Three hundred and seventy-nine patients were studied retrospectively regarding the possibility of a complete resection of the oesophageal carcinoma based on the combined findings of pre-operative oesophagogoraphy and computed tomography (CT). One hundred and four out of 129 patients (96.1%) having lesions which did not demonstrate all three of the aforementioned factors (a lesion shorter than 8 cm, a normal oesophageal axis, and normal contact of the lesion with neighboring organs in CT) underwent a complete resection of the oesophageal lesion. Fifty-three percent of the patients ( ) with a lesion showing only one of these factors had a complete resection. Whereas, on the other hand, a complete removal of the malignancy was only possible in 22% of the patients with two or all three of the findings. Moreover, as a result of further analysis limited for resected cases, the number of positive factors in these pre-operative findings correlated with the advancement of the surgical stage, which reflected a curability in surgery and a rate of postoperative complications. In order to make adequate plans for the treatment of patients with advanced oesophageal cancer, the finding of (i) the length of lesion, (ii) a deep ulceration and deformity of the oesophageal axis and (iii) any abnormal contact in CT, are considered to be very useful.     

The contribution of smoking and smokeless tobacco to oesophageal squamous cell carcinoma risk in the African oesophageal cancer corridor: Results from the ESCCAPE multicentre case-control studies

Tobacco use is a well-established risk factor for oesophageal squamous cell carcinoma (ESCC) but the extent of its contribution to the disease burden in the African oesophageal cancer corridor has not been comprehensively elucidated, including by type of tobacco use. We investigated the contribution of tobacco use (smoking and smokeless) to ESCC in Tanzania, Malawi and Kenya. Hospital-based ESCC case-control studies were conducted in the three countries. Incident cases and controls were interviewed using a comprehensive questionnaire which included questions on tobacco smoking and smokeless tobacco use. Logistic regression models were used to estimate odds ratios (OR) and their 95% confidence intervals (CI) of ESCC associated with tobacco, adjusted for age, sex, alcohol use, religion, education and area of residence. One thousand two hundred seventy-nine cases and 1345 controls were recruited between August 5, 2013, and May 24, 2020. Ever-tobacco use was associated with increased ESCC risk in all countries: Tanzania (OR 3.09, 95%CI 1.83-5.23), and in Malawi (OR 2.45, 95%CI 1.80-3.33) and lesser in Kenya (OR 1.37, 95%CI 0.94-2.00). Exclusive smokeless tobacco use was positively associated with ESCC risk, in Tanzania, Malawi and Kenya combined (OR 1.92, 95%CI 1.26-2.92). ESCC risk increased with tobacco smoking intensity and duration of smoking. Tobacco use is an important risk factor of ESCC in Tanzania, Malawi and Kenya. Our study provides evidence that smoking and smokeless tobacco cessation are imperative in reducing ESCC risk.     

Prevalence of human papillomavirus among oesophageal squamous cell carcinoma cases: systematic review and meta-analysis

Background:

Oncogenic human papillomavirus (HPV) has been hypothesised as a risk factor for oesophageal squamous cell carcinoma (OSCC), but aetiological research has been limited by the varying methodology used for establishing HPV prevalence. The aims of this systematic review and meta-analysis were to estimate the prevalence of HPV DNA detected in OSCC tumours and the influence of study characteristics.

Methods:

Study-level estimates of overall and type-specific HPV prevalence were meta-analysed to obtain random-effects summary estimates.

Results:

This analysis included 124 studies with a total of 13 832 OSCC cases. The average HPV prevalence (95% confidence interval) among OSCC cases was 0.277 (0.234, 0.320) by polymerase chain reaction; 0.243 (0.159, 0.326) by in situ hybridisation; 0.304 (0.185, 0.423) by immunohistochemistry; 0.322 (0.154, 0.490) by L1 serology; and 0.176 (0.061, 0.292) by Southern/slot/dot blot. The highest HPV prevalence was found in Africa and Asia, notably among Chinese studies from provinces with high OSCC incidence rates.

Conclusions:

Future research should focus on quantifying HPV in OSCC cases using strict quality control measures, as well as determining the association between HPV and OSCC incidence by conducting large, population-based case–control studies. Such studies will provide a richer understanding of the role of HPV in OSCC aetiology.     

Continuing rising trend in oesophageal adenocarcinoma

Our study provides an update of the incidence of oesophageal cancer in the West Midland region of England and Wales from 1992-96. A total of 2,671 cases of oesophageal cancer were identified during the 5-year study period, with an age-standardised annual incidence (ASR) of 5.24 per 100,000 (95% CI: 5.02, 5.45). Similar numbers of adenocarcinoma and squamous cell carcinoma were found. Only 152 (5.6%) had no histology. There was a 5-fold difference in age-standardised annual incidence rates between males and females for adenocarcinoma of oesophagus, but no gender difference for squamous cell carcinoma. The parallel but higher ASR in males compared to females for adenocarcinoma of both oesophagus and cardia merits further investigation. The similarities in the patterns of age- and sex-specific rates and in the socioeconomic profiles could indicate a common aetiology for adenocarcinoma of oesophagus and gastric cardia. Quality control in Cancer Registries needs to focus on the accuracy and consistency of subsite classification to ensure that trends in incidence are identified. In the absence of accurate subsite classification of stomach cancers, the proportions of adenocarcinoma and squamous cell carcinoma of oesophagus (or the absolute rate of adenocarcinoma of oesophagus) may provide a useful tool in indicating whether adenocarcinoma of gastric cardia is likely to be increasing in incidence.