覆膜食管支架治疗食管癌放疗后并发食管狭窄及食管瘘的临床效果

 目的 评价覆膜食管支架治疗食管癌放疗后并发食管狭窄或食管瘘的临床效果。方法 回顾性分析58例食管癌放疗后并发食管狭窄及食管瘘的患者,所有患者均在X线监视下放置Z形全覆膜食管支架,分析支架置入的疗效及安全性。结果 58例食管支架均放置成功,术后患者进食恢复通畅、瘘口封闭,各种临床症状得到有效迅速缓解,放置成功率及治疗有效率均为100.0%。术后出现胸痛52例(89.7%),恶心呕吐31例(53.4%),轻度消化道出血21例(36.2%),前两项经对症处理后可有效控制,后者自行好转。结论 采用覆膜食管支架治疗食管癌放疗后并发的食管狭窄及食管瘘简便、安全、疗效确切,值得推广。     

Double-ring esophageal sign: pathognomonic for esophageal lipomatosis

The peculiar appearance of the proximal esophagus on CT attributed to esophageal lipomatosis is not well recognized. We have recently encountered seven cases from over a period of 2 months and report them to reach a broader audience of radiologists who may be unaware of its existence. Its typical CT features should lead to the correct diagnosis and be differentiated from other fatty lesions known to involve the esophagus, namely, lipoma and liposarcoma.     

食管支架在复杂性食管狭窄中的研究进展

【摘要】 食管狭窄为常见的消化类疾病,其中复杂性食管狭窄的患病比例逐年上升。支架置入术作为有效治疗手段已经成功应用于多数食管狭窄,但置入后不良反应限制了食管支架在治疗复杂性食管狭窄中的应用和推广。随着新技术及治疗方案日益进步,用于复杂性食管狭窄的食管支架成为新的研究方向,其中以高聚物线材为主体的生物可降解支架因其优异的组织相容性及可降解性有希望成为解决复杂性食管疾病的有效途径。文章从复杂性食管狭窄治疗现状、食管支架的临床使用情况以及新型技术的应用前景作介绍,以期为用于治疗复杂性食管狭窄的新型食管狭窄治疗方案提供研究依据和方向。     

食管静脉曲张硬化治疗后食管发生狭窄的相关因素

目的回顾性分析食管静脉曲张硬化治疗后食管狭窄发生的相关因素。方法收集解放军总医院行食管静脉曲张硬化治疗后发生食管狭窄的32例,与同期未发生狭窄的30例对照分析其临床特点,包括病因、狭窄部位、狭窄程度、硬化次数、硬化点数、硬化剂量及治疗结果等。通过相关因素分析,筛选出狭窄发生的危险因素。结果食管静脉曲张硬化治疗后狭窄发生以食管下段为主,狭窄发生部位距门齿距离为(37.31±2.15)cm;平均直径为(7.51±1.45)cm;平均硬化治疗次数为(4.68±1.68)次;总硬化剂量为(105±41.32)ml;狭窄需行内镜下球囊扩张治疗者16例。多因素分析表明,狭窄的发生与硬化剂量及治疗总次数相关;而与年龄、性别、硬化点数等因素无关。结论科学掌握硬化治疗剂量、部位与次数,对预防食管静脉曲张硬化治疗后狭窄的发生有重要意义。     

Early esophageal cancer

Early esophageal cancer (EEC) accounted for only seven (4.7%) of 148 cases of esophageal cancer diagnosed at the authors' hospital between 1977 and 1984. Two patients with EEC had squamous cell carcinoma and five had adenocarcinoma arising in Barrett's mucosa. All seven patients had associated clinical findings, including low-grade gastrointestinal bleeding (three cases), odynophagia (one case), and chronic reflux symptoms due to underlying reflux esophagitis and Barrett esophagus (three cases). Since Barrett esophagus is a premalignant condition, the high proportion of adenocarcinomas in this series presumably reflects the more frequent radiologic evaluation of symptomatic patients with Barrett esophagus. On esophagography, four patients had 3-4.5-cm polypoid intraluminal masses that could not be distinguished radiographically from advanced esophageal carcinoma. In the other three patients, esophagrams revealed secondary achalasia, irregular flattening of the esophageal wall, and diffuse nodularity of the mucosa. The authors conclude that "early" esophageal cancers are not necessarily small cancers, since they may undergo considerable intraluminal or intramural growth and still be classified histologically as EEC. Radiologists should be aware of these findings, since EEC has an excellent prognosis with a 5-year survival approaching 90%.     

Early esophageal carcinoma accompanied by esophageal varices: a case report

This is a case report of early esophageal carcinoma accompanied by esophageal varices. Our conclusion from the experience is that when an esophagogram is performed on a patient with esophageal varices an air-contrast study in addition to an ordinary barium study should be performed as a routine examination.     

CT of esophageal neoplasms

Considerable controversy surrounds the use of computed tomography (CT) in the staging of esophageal carcinoma. New evidence suggests that CT is extremely useful in the selection of patients who may benefit from surgery and/or adjuvant therapy. Additionally, CT can also plan the most efficacious surgical approach. The principles and problems of staging esophageal carcinoma are discussed and useful criteria are presented.     

Update on esophageal radiology

This article reviews the current status of double-contrast radiography in diagnosing pharyngeal tumors and opportunistic esophagitis and the radiologic evaluation of esophageal motility disorders in patients with chest pain. Double-contrast pharyngography is a valuable technique for detecting pharyngeal tumors. These lesions may be manifested by an intraluminal mass, mucosal irregularity, or asymmetric distensibility. Furthermore, barium studies may demonstrate lesions involving the valleculae, tongue base, lower hypopharynx, and pharyngoesophageal segment that are difficult to visualize at endoscopy. Double-contrast radiography is also a valuable technique for detecting opportunistic esophagitis and for differentiating the underlying causes. Mucosal plaques should suggest Candida esophagitis, whereas discrete ulcers should suggest herpes esophagitis, and one or more large, relatively flat ulcers should suggest cytomegalovirus esophagitis. Finally, in evaluating patients with chest pain, in only a small percentage are esophageal motility disorders found to be a possible cause of their pain. Instead, the majority are found to have cardiac disease, structural esophageal lesions, or gastroesophageal reflux, so that barium studies are more useful in documenting normal motility or structural abnormalities in these patients.