内镜下植入缓释化疗粒子治疗晚期食管癌的临床疗效观察

[目的]观察内镜下植入缓释化疗粒子治疗晚期食管癌的临床疗效。[方法]选取13例晚期食管癌导致的食管管腔梗阻的患者行内镜下植入5-氟尿嘧啶（5-FU）缓释粒子治疗,每个植入点植入5～6粒,观察患者治疗后症状及梗阻缓解情况及近期疗效。[结果]全部病例均顺利完成治疗,未发生出血、穿孔等并发症;肝、肾功能及血常规检查未见异常。13例治疗前吞咽困难分级示Ⅱ级5例、Ⅲ级8例,治疗后Ⅱ级5例全部转为工级,Ⅲ级8例中转为Ⅰ级、Ⅱ级各3例;13例中完全缓解0例,部分缓解7例,病情稳定4例,2例无缓解,平均有效率为84．6％。[结论]晚期食管癌管腔梗阻的患者行内镜下植入5-FU缓释粒子治疗,是一种安全有效、毒副作用少、耐受性好的姑．息治疗方法。     

内镜化疗粒子植入缓解进展期胃癌梗阻症状观察

目的:对12例进展期胃癌浸润引起胃流出道不全梗阻患者行内镜下缓释5-氟尿嘧啶(5-FU)粒子植入治疗,观察其缓解不全梗阻的疗效。方法:内镜下对胃癌梗阻部结节及浸润处多点或密集型植入粒子(每粒含5-FU1.67 mg)45～60粒,平均注射5-FU缓释粒子90 mg。癌灶旁另注射香菇多糖注射液3 mg。结果:12例患者共施行粒子植入治疗16次,未发生出血、穿孔等并发症;肝、肾功能及血常规检查未见异常。缓解不全梗阻显著有效3例,明显有效4例,有效3例,无效2例,总有效率83.3%。1次治疗后症状缓解持续时间平均22 d。2例患者不全梗阻症状缓解后转外科手术治疗。结论:植入用缓释5-FU局部抗癌持续时间为15～30 d,作用时间远长于静脉或局部注射水剂化疗药物,对缓解胃癌浸润引起的流出道梗阻、改善患者全身状况有一定作用,并能为部分患者转行外科手术创造时机和条件。     

内镜下植入化疗粒子联合支架植入治疗进展期胃癌恶性梗阻16例

目的:探讨内镜下5-FU化疗粒子植入联合支架植入治疗进展期胃癌恶性梗阻的临床价值.方法:选择进展期胃癌病灶伴流出道梗阻的病例16例,在胃镜引导下进行支架植入联合多点植入5-FU化疗粒子45-60粒,平均注射5-FU化疗粒子100-200 mg.结果:16例患者共施行粒子植入治疗26次,支架植入18次临床上缓解不全梗阻显...     

内镜超声下植入化疗粒子治疗进展期胃癌的临床研究

目的 探讨超声内镜引导下5-FU化疗粒子植入治疗进展期胃癌的临床价值.方法 选择进展期胃癌病灶伴流出道梗阻的病例,在超声胃镜引导下进行多点植入5-FU化疗粒子45～60粒,平均注射5-FU化疗粒子100 mg,并进行治疗前后的病灶三维扫描.结果 23例患者共施行粒子植入治疗33次.内镜观察标准完全缓解1例,部分缓解15例,稳定6例,恶化1例.临床上缓解不全梗阻显著有效6例,明显有效7例,有效9例,无效2例,总有效率91.4%.结论 超声内镜引导下5-FU化疗粒子植入治疗进展期胃癌安全、可靠,并发症少.超声内镜三维扫描对化疗疗效的判断可作为一种新的评价方法.     

植入5-Fu缓释粒子治疗中晚期食管贲门癌癌性狭窄20例

对20例中晚期食管贲门癌患者在内镜下局部注射5-Fu缓释粒子,每周1次,2周为1个疗程,观察治疗前后肿瘤大小变化及狭窄程度缓解情况。结果显示癌肿有不同程度缩小,狭窄程度减轻,无明显毒副作用。内镜下植入5-Fu缓释化疗粒子,对于身体耐受力差或不愿手术治疗的中晚期食管贲门癌患者的癌性狭窄,是一种有效、毒副作用少、耐受性好的姑息治疗方法。     

内镜下哑铃型气囊导管扩张器联合化疗粒子植入治疗食管癌术后吻合口恶性狭窄69例

食管癌术后吻合口恶性狭窄有一定的发病率,严重影响患者的生活质量与预后。确诊时多无法再行手术治疗,全身化疗副作用大,且无法有效地缓解梗阻症状,内镜下微创治疗为目前治疗的主要手段,主要包括扩张、微波、射频、支架置入、化疗药物注射等治疗方法,但单一方法的治疗多较局限且疗效不够持久。内镜下哑铃型气囊导管扩张联合化疗粒子植入治疗可有效缓解梗阻症状,同时缓释粒子局部化疗使症状缓解更持久。我院自2007年1月至2010年1月采用内镜下哑铃型气囊导管扩张联合化疗粒子植入治疗了69例食管癌术后复发并吻合121狭窄患者,疗效确切,现报道如下。     

经内镜局部化学治疗晚期食管癌胃癌疗效分析

目的 探讨氟尿嘧啶＋顺铂（5-FU＋DDP）局部化学治疗食管癌、胃癌的近期疗效和副作用。方法 将确诊晚期食管癌、胃癌患者86例随机分为两组，A组48例应用5-Fu250mg＋DDP20mg经内镜分点注射于肿瘤表面和周边，B组38例应用5-Fu500mg＋DDP40mg静脉滴注，内镜下观察对肿瘤的直接影响及对食管内梗阻的影响。结果 A组和B组有效率分别为60．42％、39．47％（P〈0．05），中位生存期分别为9．8个月和7．6个月。主要副反应为白细胞减少和胃肠道反应，无治疗相关死亡病例。结论 5-FU＋DDP联合局部化疗晚期食管癌胃癌有效，可改善患者的生活质量，延长生存期。     

内镜下支架介入治疗晚期食管癌癌性梗阻临床疗效评价

目的 评价内镜下放置覆膜食管支架治疗晚期食管癌癌性梗阻的临床疗效.方法 选择晚期食管癌癌性梗阻218例为治疗组,同期放弃内镜介入治疗的晚期食管癌癌性梗阻30例为未治疗组,在内镜介导下对治疗组癌性狭窄放置覆膜支架.术后随访观察支架置入成功率、梗阻改善状况及生存期.结果 治疗组112例支架成功植入,成功率为97.25%.治疗组6月、12月和18月的累积生存率分别为97%、88.5%、68%,未治疗组6月、12月和18月的累积生存率分别为51%、33.7%和21.4%.结论 内镜下放置覆膜支架是治疗晚期食管癌理想的方法之一,能最大程度地解决癌性梗阻,提高患者的生存质量.     

内镜下化疗粒子植入治疗消化道癌性梗阻的疗效观察

一些消化道癌性梗阻者确诊时已无法手术治疗,全身化疗副作用大,且无法有效缓解梗阻症状.内镜化疗缓释粒子瘤体内植入是根据化疗的基本原理开展的内镜新技术,我院自2004年1月至2006年8月对32例伴梗阻症状的消化道恶性肿瘤患者进行了该项治疗,疗效确切,现报告如下.     

内镜下局部化疗联合内支架置入治疗食管癌性狭窄30例疗效观察

目的评价内镜下局部注射化疗药物并置入支架治疗食管癌性狭窄的疗效。方法 30例患者经内镜及病理确诊为晚期食管癌,均局部注射化疗药物后置入支架治疗,在癌体基底周边及中央注射药物5-FU及顺铂,再置内支架。结果吞咽困难缓解率为100%,癌体缩小有效率60%。结论内镜下局部注射化疗药物并置入内支架治疗食管癌性狭窄是一种较为理想和有效的方法,其操作简单,易于掌握。     

Endoscopic examination of the upper esophagus by withdrawal of endoscope over guide wire.

Upper gastrointestinal (UGI) endoscopy is an important diagnostic modality in evaluation of patients with upper gastrointestinal (GI) disorders. However, lesions located in the cricopharyngeal area and upper esophagus can be missed, as this area may not be well visualized during endoscopy. This study was conducted to study the utility of a new technique of endoscopic examination of the upper esophagus by withdrawal of endoscope over guide wire in diagnosing esophageal disorders. Patients with suspected upper esophageal disorders on history and radiological investigations were assessed using guide wire assisted endoscopic examination during withdrawal of the endoscope. In this technique, endoscope is inserted into the esophagus under vision and thereafter the whole of esophagus, stomach and proximal duodenum is examined. The endoscope is then withdrawn into the mid-esophagus, a guide wire is fed into the biopsy channel, and thereafter inserted into the esophagus. Once guide wire has been advanced into the esophagus, the endoscope is withdrawn gently over the guide wire into esophagus carefully examining for lesions in upper esophagus and cricopharyngeal area. Twenty cases of various abnormalities localized to the upper esophagus were studied. The final diagnosis in these patients was cervical esophageal web (10), post transhiatal esophagectomy leak (4), heterotopic gastric mucosa (3), posttraumatic esophageal perforation (2), and Zenker's diverticulum (1). Intact web was detected in 2 patients and in 8 patients fractured web was seen. Guide wire assisted examination of upper esophagus improved the ability to visualize and characterize these lesions and no complications were encountered as a result of this procedure. Endoscopic examination of the upper esophagus by withdrawal of endoscope over guide wire is safe and effective in diagnosing anatomical abnormalities of the upper esophagus that may be missed or poorly characterized during standard endoscopy.     

Feasibility and safety of string, wireless capsule endoscopy in the diagnosis of Barrett's esophagus

BACKGROUND: Capsule endoscopy is a major technological advancement in the visualization of the small bowell. Its utility in the evaluation of the esophagus is mainly limited by its rapid and unpredictable transmission, thus limiting the number of pictures of the esophagus, in particular, the distal esophagus. METHODS: Strings were attached to the wireless capsule endoscopy device to allow its controlled movement up and down the esophagus. Microbiologic cultures of the capsule's surface after high-level disinfection were carried out after the procedure. At the time of recording, discomfort associated with the procedure was documented. Patient preference compared with conventional EGD was recorded. An independent endoscopist blinded to the EGD diagnoses assessed the diagnostic accuracy of pictures obtained. OBSERVATIONS: Fifty patients with Barrett's esophagus were enrolled: 28 with short-segment Barrett's and 22 with long-segment Barrett's. The procedure was safe (no strings were disrupted, and no capsule was lost), and it rendered negative microbiologic cultures after high-level disinfection. The mean recording time was 7.9 minutes; all patients with both short- and long-segment Barrett's esophagus were successfully identified. The difficulty/discomfort associated with swallowing the device, throat discomfort, gagging, moving the capsule (up and down and upon retrieval of the capsule) was none or minimal in 74%, 98%, 96%, 94%, and 76%, respectively. A single capsule was used in 24 studies, and the majority of patients (92%) preferred string-capsule endoscopy to EGD. CONCLUSIONS: String-capsule endoscopy was feasible, safe, and highly acceptable, and was preferred by patients and may prove to be more cost effective than screening EGD.     

窄带成像辅助氩等离子凝固术治疗Barrett食管的临床应用

目的 探讨内镜窄带成像技术（NBI）辅助氩等离子凝固术（APC）治疗Barrett食管的价值.方法 86例经内镜检查及病理诊断的Barrett食管,分别在普通模式及NBI模式下观察食管黏膜,以NBI放大观察病变的腺管开口形态及毛细血管结构形态.对所有NBI阳性部位均取活检,并以病理结果为标准,随机分为两组.Barrett食管的诊断时都用NBI内镜,治疗组42例,在NBI内镜辅助下进行APC治疗,内镜进入食管后,把APC探针经活检钳孔道伸出镜外1 cm,定位于需治疗黏膜1～2 cm处,以保证APC安全使用;对照组44例,在普通内镜下行APC治疗.于第3、6个月对两组进行内镜及病理随访.结果 两组治疗后第3、6个月从内镜、病理随访的有效率来看,治疗组与对照组的差异无统计学意义（P〉0.05）.结论 NBI辅助APC治疗Barrett食管能有效逆转Barrett上皮,并提高高级别上皮瘤样变的检出率,减少Barrett上皮逆转的治疗次数,且能部分缓解功能性胃肠病的症状,治疗安全.     

胃肠道双重对比造影对胃食管反流病的诊断意义

目的 探讨胃食管反流病的X线检查方法及造影表现.方法 总结2004～2005年胃肠造影诊断胃食管反流病（GERD）的患者431例,男226例,女205例,平均年龄62岁.双重造影表现与内镜检查结果进行对照.造影诊断标准为5 min内至少有1次钡剂从胃内向食管反流.反流钡剂限于食管下段为轻度反流,反流钡剂到达食管中段为中度反流,反流钡剂到达食管上段为重度反流.结果 431例患者中,87.24%为轻度反流,7.66%为中度反流,5.10%为重度反流.反流体位95.82%为左前斜位,4.18%为左前斜和右前斜位都有反流.本组资料中35例进行了内镜检查,17例证实,18例内镜检查阴性.结论 胃肠造影可直观地观察到胃内钡剂向食管的反流,操作简单,对临床诊断GERD有重要的参考价值.     

Motion - All patients with GERD should be offered once in a lifetime endoscopy: arguments for the motion.

Proton pump inhibitor therapy is so successful at relieving reflux-related symptoms and healing esophageal erosions that it has supplanted formal diagnostic techniques, such as endoscopy and esophageal pH monitoring, for the initial management of gastroesophageal reflux disease. The response to antisecretory therapy is not indicative, however, of Barrett's esophagus or esophageal adenocarcinoma. Patients with prolonged and severe reflux symptoms, especially if they are over the age of 60 years, are at risk of these complications. For them, endoscopy is the only appropriate investigation for detecting Barrett's esophagus and dysplasia or cancer. Because of the difficulty in distinguishing dysplasia from inflammatory and regenerative changes, endoscopy should be undertaken while the patient is on effective antisecretory therapy. Endoscopy should be offered only to patients who are suitable for further therapy (especially esophagectomy), and only if they understand the implications of abnormal findings. The published evidence suggests that the application of clear guidelines would not overwhelm health care resources, and that fewer than 20% of patients with Barrett's esophagus would eventually undergo endoscopic surveillance.     

Phase II study of cisplatin, 5-FU, and allopurinol in advanced esophageal cancer

Forty patients with advanced squamous cell carcinoma of the esophagus were treated with a combination of cisplatin, 5-FU (by continuous 5-day infusion), and allopurinol; 37 are evaluable for response. Thirteen remissions (35%) were obtained, including three complete and ten partial, with a median duration of 9 months. After chemotherapy, seven responding patients underwent a surgical procedure, which was radical in four. The most frequent side effects were nausea and vomiting. This regimen is effective and can be included in a multimodality approach.     

Barrett食管75例临床治疗观察

目的 研究不同方法治疗Barrett食管(BE)患者的疗效,探索各种治疗方法产生效果的可能机制,筛选出合理有效、实用的Barrett食管治疗方案.方法 经胃镜及活检确诊的Barrett食管患者75例,随机分为5组,对照组(A组):未给予治疗;抑酸药组(B组):口服奥美拉唑20 mg,2次/天;胆汁吸附剂组(C组):口服铝碳酸镁1000 mg,每日3次;抑酸药 胆汁吸附剂组(D组):口服奥美拉唑20 mg,2次/天;口服铝碳酸镁1000 mg,3次/天;氩气凝固术(APC) 抑酸药及胆汁吸附剂组(E组):行内镜下氩气凝固术治疗,之后口服奥美拉唑20 mg,2次/天,口服铝碳酸镁1000 mg,3次/天.各组均治疗3个月.治疗前、治疗后1个月及3个月后观察临床症状及内镜下表现.结果 各治疗组的临床症状均较治疗前明显改善,与对照组比较均有显著性差异(P＜0.05);各治疗组比较,症状缓解率无明显差异(P＞0.05).对照组和单纯药物治疗组的Barrett食管黏膜均未见明显缩小,E组能使91.3%的Barrett食管患者Barrett食管黏膜消除.结论 抑酸药和(或)胆汁吸附剂不能使Barrett食管逆转,但可消除临床症状;APC 抑酸药及胆汁吸附剂方案可以消除症状,也可消除Barrett食管黏膜,安全性好,是治疗Barrett食管的一种合理可行、有效实用的方法.