内镜下射频治疗晚期食管癌37例疗效总结

目的:探讨内镜下射频治疗食管癌狭窄梗阻的疗效。方法:对37例3、4级狭窄梗阻的食管癌采用内镜下射频治疗。结果:显效22例、有效13例,总有效率达94.6%,不良反应是持续恶心、剧烈会厌反射、胸前区灼热痛、上腹部胀痛。结论:内镜下射频治疗3、4级食管癌在缓解梗阻和解决进食方面近期疗效显著,操作简单,安全可靠。     

内镜下射频结合食道支架治疗食管恶性梗阻的临床分析

目的：探索经内镜射频、扩张结合食道支架治疗食管恶性梗阻的临床应用价值。方法：在内镜直视下,运用射频电极、扩张器和食道支架对食道癌术后复发病灶和晚期食道癌所致管腔狭窄进行治疗。25例食道恶性梗阻内镜不能通过患者,其中18例患者经过1次射频治疗后胃镜顺利通过狭窄口,后再行食道支架置人;7例患者经过2次射频治疗后食道管腔变宽但胃镜仍不能通过,予扩张后行食道支架置入。结果：25例患者随访1—12个月,无严重并发症,所有患者经治疗后营养迅速恢复,停止静脉补液。结论：经内镜下射频、扩张结合食道支架置入术是食道恶性梗阻较理想的姑息治疗方法,且设备价廉,操作简单,安全性高,易于推广应用。     

内镜下射频结合食道支架治疗食管恶性梗阻的临床分析

目的:探索经内镜射频、扩张结合食道支架治疗食管恶性梗阻的临床应用价值.方法:在内镜直视下,运用射频电极、扩张器和食道支架对食道癌术后复发病灶和晚期食道癌所致管腔狭窄进行治疗.25例食道恶性梗阻内镜不能通过患者,其中18例患者经过1次射频治疗后胃镜顺利通过狭窄口,后再行食道支架置入;7例患者经过2次射频治疗后食道管腔变宽但胃镜仍不能通过,予扩张后行食道支架置入.结果:25例患者随访1-12个月,无严重并发症,所有患者经治疗后营养迅速恢复,停止静脉补液.结论:经内镜下射频、扩张结合食道支架置入术是食道恶性梗阻较理想的姑息治疗方法,且设备价廉,操作简单,安全性高,易于推广应用.     

内镜下射频与氩离子凝固术联合治疗晚期大肠癌性陕窄

[目的]探讨内镜下射频与氩离子凝固术联合治疗大肠癌引起的肠道梗阻.[方法]随机选择23例大肠癌导致肠梗阻的病人,采用射频联合氩离子凝固术对肿瘤组织进行反复多次治疗.[结果]23例晚期大肠癌患者经射频与氩离子凝固术联合治疗1～2次后,梗阻的肠道扩张,肠道梗阻症状解除,有效率为100%,治疗后无穿孔和明显出血.[结论]内镜下射频联合氩离子凝固术治疗晚期大肠癌癌性狭窄有效,且操作简单,易于推广应用.     

纤维内镜引导下的食管扩张术262例报告

为了探讨纤维内镜引导下的食管扩张术治疗食管和贲门处狭窄的临床疗效。我院于1991年1月1日～2004年12月30日应用纤维内镜引导下的食管扩张术治疗食管和贲门处狭窄262例。结果3例扩张失败。259例扩张治疗后，进食阻挡缓解250例，缓解率95．4％；其中完全缓解150例，占57.3％。进食缓解晋升Ⅰ级者51例，晋升Ⅱ级者92例，晋升Ⅲ级者70例。初步研究结果提示．食管癌术后单纯吻合口狭窄、膜状型，病史不超过3个月者．是食管扩张术的最佳适应证。     

内镜下射频与氩离子凝固术联合治疗晚期大肠癌性狭窄

[目的]探讨内镜下射频与氩离子凝同术联合治疗大肠癌引起的肠道梗阻。[方法]随机选择23例大肠癌导致肠梗阻的病人，采用射频联合氩离子凝同术对肿瘤组织进行反复多次治疗。[结果]23例晚期大肠癌患者经射频与氩离子凝同术联合治疗1～2次后，梗阻的肠道扩张，肠道梗阻症状解除，有效率为100％，治疗后无穿孔和明显出血。[结论]内镜下射频联合氩离子凝固术治疗晚期大肠癌癌性狭窄有效，且操作简单．易于推广应用。     

口服糜蛋白酶治疗食管癌异物梗阻的临床疗效

目的：观察口服糜蛋白酶治疗食管癌术后吻合口狭窄和放射治疗后食管壁纤维化导致食管狭窄，而出现食管异物梗阻的临床疗效和毒副作用。方法：52例病例均为病理证实，食管狭窄，不同的异物梗阻。随机分为：治疗组，应用糜蛋白酶联合甘露醇治疗，配合消炎、消肿治疗。对照组采用消炎、消肿和口服甘露醇治疗。结果：治疗组28例患者，20例有效，8例无效，有效率71．4％（20／28）。对照组24例，6例有效，18例无效，有效率25．0％（6／24）。无效者借助胃镜取出异物。其中毒副作用：食管粘膜出血2例，胸骨后疼痛加重3例。结论：糜蛋白酶联合甘露醇治疗食管癌管腔狭窄导致异物梗阻是可行的，安全的。     

胃镜下食管及贲门狭窄的扩张及支架治疗

 无论是食管、贲门部肿瘤以及肿瘤术后引起的吻合口狭窄 ,还是误服化学药物引起的瘢痕狭窄 ,均可造成患者进食困难 ,严重影响患者的生存质量。我科从 1999开始应用国产萨氏扩张器、美国波士顿公司 3级扩张球囊 (ＣＲＥ)配合国产及进口食管内支架进行治疗 ,在电视胃镜下对 4 3例食管狭窄患者行扩张、支架治疗共 6 6例次均获成功 ,现报告如下。1　资料与方法1.1　一般资料　　本组男 37例 ,女 6例 ,年龄 6～ 74岁。平均年龄 5 8岁。其中食管贲门癌术后吻合狭窄 19例、食管癌 12例、食管纵隔瘘 1例 ,腐蚀性食管炎 1例。吻合口狭窄多发生在术后 2个月以内 ,有 2例狭窄部扭曲成角变形。食管癌病史 1～ 2年不等 ,食管纵隔瘘系在硬化剂治疗后 2 0天产生。腐蚀性食管炎发生在自残服药后 2个月。　　根据患者进食情况以及Ｘ线、内镜检查 ,将狭窄分为 4度[1] 。0度 :患者完全不能进食 ,狭窄处直径 <2ｍｍ ;1度 :只能进流质 ,吻合口狭窄直径 <5ｍｍ ;2度 :只能进半流质 ,有梗阻感 ,狭窄口直径 <10ｍｍ ;3度 :能进饮食 ,但有梗阻感 ,吻合口直径 >10ｍｍ。本组 0度 13例 ...     

纤维内镜引导下的食管扩张术262例报告

为了探讨纤维内镜引导下的食管扩张术治疗食管和贲门处狭窄的临床疗效。我院于1991年1月1日～2004年12月30日应用纤维内镜引导下的食管扩张术治疗食管和贲门处狭窄262例。结果3例扩张失败。259例扩张治疗后,进食阻挡缓解250例,缓解率95.4%;其中完全缓解150例,占57.3%。进食缓解晋升Ⅰ级者51例,晋升Ⅱ级者92例,晋升Ⅲ级者70例。初步研究结果提示,食管癌术后单纯吻合口狭窄、膜状型,病史不超过3个月者,是食管扩张术的最佳适应证。     

金属内支架在治疗食管狭窄中的应用

目的 阐述自膨式金属内支架(Self—Expanding Metallic Stent,SEMS)在治疗食管狭窄性疾病,如食管癌、贲门癌、食管吻合口狭窄中的应用价值。方法 本组病例17例,其中食管癌7例,贲门癌1例,食管吻合口狭窄9例,采用SEMS18根,在X线监视下,标定狭窄部位,再行球囊扩张后,置入SEMS。结果 SEMS置入术本组病例成功率100％。术后病人吞咽功能均得以恢复,吞咽困难由术前2级、3级改善到0级水平,并无严重并发症的出现,大大提高了病人的生存质量和生存期。结论 应用SEMS治疗中晚期食管癌、贲门癌及食管术后吻合口狭窄所致的食管狭窄、梗阻是一种操作简便、安全、疗效明显、快捷、很受患者欢迎和临床医生认可的介入治疗新方法。     

A STUDY OF ENDOSCOPIC TREATMENT OF ADVANCED ESOPHAGEAL AND GASTRIC CARCINOMA

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A case of esophageal squamous cell intraepithelial neoplasia with positivity for type 16 human papillomavirus successfully treated with radiofrequency ablation

Esophageal cancer is the eight most common cancer worldwide and the sixth cause of cancer related death with squamous cell carcinoma (SCC) accounting for almost half of all esophageal cancers. Persistent human papilloma virus (HPV) infection has been suspected to play an active role in esophageal carcinogenesis but a clear association has not still been proven and no specific indications or guidelines for possible endoscopic and surgical therapeutic approaches to this clinical scenario are available. We report a case of a 62-year-old woman with histological diagnosis of high-grade intraepithelial squamous neoplasia of distal esophagus associated with cytological modifications resembling cervical HPV infection and with a positive INNO-LiPA assay for genotype 16 HPV. A single session of radiofrequency ablation (RFA) was performed on the dysplastic esophageal area with complete endoscopic eradication as confirmed by the following endoscopic, histologic and microbiologic examinations. Our report might give further strength to the hypothesis of an etiological role of HPV in selected cases of esophageal carcinogenesis and opens a discussion on the possible use of Radio Frequency Ablation as an effective and safe endoscopic treatment for both early squamous cell neoplasia and HPV esophageal colonization.     

内镜微波治疗晚期食管及贲门癌性梗阻的临床探讨

自1989年1月～1990年2月,25例晚期食管及贲门癌性梗阻患者经内镜微波组织凝固(MTC)治疗。其中食管癌12例,贲门癌13例,吞咽困难全部得到改善,18例患者可进软食。本文综述了MTC治疗的特点,认为内镜MTC对晚期食管及贲门癌性梗阻的治疗是一种安全有效的姑息疗法。     

经十二指肠营养管行鼻饲联合放疗治疗食管癌的疗效观察

目的：探讨经鼻十二指肠营养管行鼻饲联合放疗治疗重度进食梗阻食管癌患者的价值。方法：选取2010年1月至2013年1月共60例有重度梗阻症状的食管癌患者,随机分为2组,一组30例经鼻饲联合放疗,另一组30例单独放疗同时给予静脉营养支持,比较两组患者在放疗过程中营养状况的变化、放疗导致疼痛的耐受程度、住院费用及住院时间。结果：鼻饲组较非鼻饲组,营养状态好、放疗所致疼痛症状轻、住院时间短且费用少。结论：鼻饲联合放疗对进食梗阻症状明显的食管癌患者是一种比较好的治疗方案。     

高温射频消融治疗周围型肺部恶性肿瘤

目的CT引导经皮肺穿刺高温射频消融治疗89例周围型肺部恶性肿瘤的近期疗效观察.方法集束聚能刀高温射频消融治疗89例周围型肺部恶性肿瘤,包括原发性周围型肺癌65例,肺转移癌24例,共计226个肿瘤.结果胸部CT或X线平片复查,肿瘤经射频消融治疗后绝大多数病例的肿瘤在3个月左右明显缩小(CR+PR,82.0%).术后并发症包括气胸32例、少量血胸3例和局部疼痛15例.结论高温射频消融治疗周围型肺部恶性肿瘤,近期疗效确切,严重并发症少,是一种较为安全有效的治疗方法.     

Endoscopic treatment options for cholangiocarcinomas

Cholangiocellular carcinoma (CCC) is a very aggressive tumor, which remains highly resistant to current chemoradiation therapies. Death is usually caused by the tumor burden. However, biliary obstruction, which leads to cholangitis and liver failure, is also a cause of death. Therefore, relief of biliary obstruction is one of the key palliative treatment options for patients with hilar or distal CCC. Radiologic or endoscopic insertions of stents (plastic or self-expanding metal) are definite biliary drainage options. Whereas stents alone can help achieve relief of bile duct obstruction, endoscopic ablative interventions with photodynamic therapy or radiofrequency ablation are also useful in destroying intraluminal tumor. Destroying the tumor leads to an increase in the luminal diameter of the obstructed bile duct, allowing for placement of more or larger diameter stents, and thus improving bile flow. Besides decreasing morbidity associated with obstruction, ablative therapies such as photodynamic therapy have also been associated with improved survival in a sub-group of patients with CCC and should therefore be incorporated into the treatment algorithm of any center treating patients with CCC.     

Endoscopic assessment and management of early esophageal adenocarcinoma

Esophageal carcinoma affects more than 450000 people worldwide and the incidence is rapidly increasing. In the United States and Europe, esophageal adenocarcinoma has superseded esophageal squamous cell carcinoma in its incidence. Esophageal cancer has a high mortality rates secondary to the late presentation of most patients at advanced stages. Endoscopic screening is recommended for patients with multiple risk factors for cancer in Barrett’s esophagus. These risk factors include chronic gastroesophageal reflux disease, hiatal hernia, advanced age, male sex, white race, cigarette smoking, and obesity. The annual risk of esophageal cancer is approximately 0.25% for patients without dysplasia and 6% for patients with high-grade dysplasia. Twenty percent of all esophageal adenocarcinoma in the United States is early stage with disease confined to the mucosa or submucosa. The significant morbidity and mortality of esophagectomy make endoscopic treatment an attractive option. The American Gastroenterological Association recommends endoscopic eradication therapy for patients with high-grade dysplasia. Endoscopic modalities for treatment of early esophageal adenocarcinoma include endoscopic resection techniques and endoscopic ablative techniques such as radiofrequency ablation, photodynamic therapy and cryoablation. Endoscopic therapy should be precluded to patients with no evidence of lymphovascular invasion. Local tumor recurrence is low after endoscopic therapy and is predicted by poor differentiation of tumor, positive lymph node and submucosal invasion. Surgical resection should be offered to patients with deep submucosal invasion.     

内镜下联合治疗晚期食管癌的评估

本文报道内镜下应用激光、电凝电切、微波联合治疗晚期食管癌严重梗阻并施以局部化疗２０例，同时与激光加局部化疗方法进行对比分析。结果表明，一次治疗后总有效率为７５％，二次后为１００％。本方法不仅可以快速缓解梗阻症状，改善进食状况，延长生存期，而且安全，无出血、穿孔等明显合并症。本文作者还对内镜下治疗食管癌方法的利弊进行了讨论。