食管胃分层吻合法在食管癌切除的应用

食管胃分层吻合法在食管癌切除的应用洪永寿副主任医师黄文献，吴培仁，王希平，张文山漳州市医院（３６３０００）食管胃吻合术是食管瘤、贲门癌切除术后重建消化道最常见的方法，吻合口瘘及狭窄是食管胃吻合术后二个严重并发症，为了解决这二个并发症，各家采用不同的吻...     

胃大部切除术后食管癌的外科治疗——一种新方法的临床应用

胃大部切除术后食管癌的外科治疗──一种新方法的临床应用吴心愿，张祥福，官国先福建医学院附属协和医院肿瘤科（福州市３５０００１）作者对胃大部切除术后食管中段癌１例应用残胃脾胰体尾移植至左胸内行食管中段癌切除、食管残胃弓上吻合、空肠Ｒｏｕｘ－Ｙ重建消化道...     

胸骨后横结肠代食管术治疗上,中段食管癌49例报告

我院应用胸骨后横结肠代食管治疗上、中段食管癌49例,术后并发症发生16例次,无手术死亡。作者认为:由于横结肠取材容易,抗酸能力强,对血氧供应需求较小,可以保证包括咽下段食管在內的食管切除术后代食管长度的需要,是代食管的理想移植物。另外,本术式由于胃的生理位置没有改变,术后病人恢复较快。应用本术式,代食管的横结肠通过胸骨后间隙,改变了食物通道的位置,有利于术后放射治疗。可望由此提高生存年限。     

空肠P袢代胃术在胃大部切除术后食管下段、贲门癌手术中的临床应用

[目的]探讨空肠P袢代胃术在胃大部切除术后食管下段、贲门癌手术治疗的可行性及临床疗效。[方法]对12例胃大部切除术后食管下段、贲门癌患者，手术切除病灶后，采用空肠P袢代胃。[结果]全组无手术死亡发生，无吻合口瘘及狭窄。术后生存5年以上2例。患者对术后生活质量感到满意。[结论]运用空肠P袢主动脉弓下食管空肠吻合代胃，对胃大部切除术后发生的食管下段、贲门癌进行手术切除，重建消化道，是一种安全、实用、疗效满意的手术方法。     

经食管床超胸顶食管胃吻合治疗食管癌143例

2002年3月～2006年5月，我们在胸段食管癌切除术中，经食管床超胸顶食管胃吻合治疗胸段食管癌进行消化道重建143例，取得了令人满意的临床疗效，现报告如下。[第一段]     

106例结肠代食管术的经验分析

目的:评价结肠代食管术在食管重建外科的地位。方法:回顾分析1979年4月-2004年10月106例结肠代食管术的临床资料,随访治疗结果。结果:本组无住院死亡。72例良性狭窄者,术后长期生存,进食正常。食管癌34例,28例获得随访,术后1、3、5年生存率分别为85.7%、57.1%及28.6%。结论:结肠代食管术对颈段食管良性狭窄者,特别适合已行胃大部切除术后食管癌患者的食管重建;选用左结肠动脉为蒂部滋养血管,降结肠及部分横结肠经胸骨后顺蠕动移植至颈部吻合是最常用的术式;改进手术操作和减少并发症,对扩大此术式的应用范围尤为重要。     

食管胃套入吻合法防止吻合口瘘的近期效果

为了减少食管胃吻合口瘘的发生，我科自1995年10月至2003年6月，采用食管胃深套叠吻合法行食管、贲门癌切除后重建69例，效果满意，现报告如下。     

重建His角预防食管癌术后返流的临床研究

胃食管返流是食管－胃胸腔内吻合术后常见并发症，严重影响了患者的术后生存质量，干扰了术后综合治疗。我科自１９９５年４月～１９９８年２月，共实施食管癌切除后重建Ｈｉｓ角预防胃食管返流术１４２例，随访３～３４个月并经实验检查，无胃食管返流。材料与方法１．一...     

食管癌外科治疗体会

［目的］探讨外科治疗食管癌的经验。［方法］自１９８８年至１９９８年对１００例食管癌施行切除术,其中上段８例,中段７２例,下段２０例,手术入路计经左颈、右胸、腹部三切口１８例,右胸、腹部二切口４９例,右胸后外侧单切口５例,左后外侧单切口 ２８例,切除食管后均作食管胃一层间断吻合重建消化道。［结果］住院死亡４例,死亡率为４％,术后发生吻合口瘘２例。术后５年生存率为３７．２％（１６／４３）。［结论］食管癌的手术入路应取决于病灶的所在部位;主张一层食管胃吻合术重建消化道;为了提高食管癌术后的生存率,必须作广泛的食管切除及彻底的淋巴结清扫。     

预防食管胃吻合口狭窄的方法探讨

预防食管胃吻合口狭窄的方法探讨张勇，丁仕国，姚玉春，何纯，王先毅四川省盐亭县肿瘤研究所（６２１６００）食管胃吻合口狭窄是食管贲门癌切除术后远期较严重的并发症之一。据资料统计报道，其发生率为０．５～５．９％。我科从１９９４年７月—１９９４年１２月对一组...     

食管扩张术与食管支架置入术50例食管癌应用

总结食管扩张术和食管支架置入术在治疗50例食管癌狭窄中的临床经验.食管癌良性狭窄的病例,无论选择食管扩张术,还是选择支架置入术,其吞咽困难的症状基本改善.食管癌恶性狭窄的病例,基本上都选择食管支架置入术,术后其吞咽困难评分从4级降至1～2级,平均生存6～7个月.     

Esophageal carcinoma with prominent spindle cells

Eight cases of esophageal carcinoma with prominent spindle cells (carcinosarcoma or pseudosarcoma) were studied using the avidin-biotin immunoperoxidase method and monoclonal antibodies to various keratins and vimentin. In all eight cases positive immunoreactivity for keratin was found in carcinomatous areas and for vimentin, in the spindle cells. It is interesting that five cases demonstrated focal immunoreactivity to keratin in the spindle cell component. Trace positivity to vimentin was seen in the carcinomatous areas in one case. These findings are consistent with the hypothesis that esophageal carcinoma with prominent spindle cells is of epithelial origin and may represent a morphologic variant of squamous cell carcinoma.     

Esophageal carcinoma with respiratory tract fistula

An experience with 27 patients with malignant respiratory tract fistula (RTF) is presented. The RTF was related to carcinoma of the thoracic esophagus in all the patients, involved the trachea in 11, left main bronchus in 7, right main bronchus in 3, and was more distal in 6 patients. Metastases were detectable in only four patients (15%) at the time of RTF diagnosis. Bronchoscopy examination in 13 patients prior to RTF development showed tracheobronchial invasion or impingement in all. The RTF was present at initial presentation in 11 patients (Group I), and developed after/during radiation therapy (RT) in 16 patients (Group II). Median survival from tumor diagnosis was 17 weeks in Group I and 37 weeks in Group II, while survival from RTF diagnosis was 16 weeks in Group I and II weeks in Group II.     

Esophageal Cancer Associated with Gastric Cancer

Among a total of 1,137 patients with esophageal cancer, therewere 44 cases of esophageal cancer associated with gastric cancer,an incidence of 3.9%. The majority of the patients were between60 and 70 yr old. Forty-two patients were male and two werefemale. Eleven of these patients had a third cancer. Six had multiplecancers in the esophagus and/or stomach. Eighteen patients hadearly gastric cancer. Thirty-two of the cancers were synchronousand 12 were metachronous. Of these 44 patients, 21 had familyhistories of cancer, 37 were smokers, and 36 were drinkers.Twenty-five patients received surgery for all of their cancers,and two patients received resection of only esophageal cancer.Of these 27 patients. five patients lived more than 5 yr. Themost frequent cause of death in our series was esophageal cancer(52.9%). Surgical treatment of all of the cancers is desirable. Whenthis is impossible, the surgery must be emphasized for the esophagealcancer in most cases.     

“Layer-to-Layer” Esophagogastric Anastomosis Combined with Intrathoracic Esophageal Mucosal Extention in Patients with Esophageal and Cardia Cancer

Objective: To evaluate the clinical value of intrathoracic esophagogastric “layer-to-layer” anastomosis with esophageal mucosa extended varied in plane and to study the effective methods to prevent anastomotic leaking or stricture postoperatively. Methods: From May 1985 to December 2002, 2 240 esophageal and stomach cardia cancer patients treated by intrathoracic esophagogastric “layer-to-layer” anastomosis with esophageal mucosa extended varied in plane were retrospectively analyzed. Results: There was no anastomotic leaking and severe stricture in all above cases. Conclusion: Intrathoracic esophagogastric “layer-to-layer” anastomosis with esophageal mucosal extended varied in plane is an effective method to prevent anastomotic leaking and stricture postoperatively.     

Radiological Imaging in Patients with Esophageal Carcinoma

Diagnostic imaging is carried out in patients with esophageal carcinoma in order to decide on thetherapeutical procedure,to control therapy,to document complications and to assess concomitant diseases.Chest X-rays and esophagograms give a 2-dimensional view of the X-ray absorption in a-dimensionalexamination volumes,the diagnostic accuracy thus being limited by overshadowing.Because of the robustexamination technique,the broad availability and the low costs chest X-rays are usually used for short-termcontrols under therapy and follow-up.Esophagography is carried out in order to asses the exact locationand length of a known esophageal carcinoma prior to therapy and in order to assess peristaltic disturbancesand fistulas.CT and MRI provide tomographic images with a spatial resolution of up to 1 mm allowingthe reconstruction of high-resolution images not only in the transversal but also in any other plain.Thediagnostic accuracy of esophagography is comparatively high in T1-T3 stages (80%-90%).T1 and T2tumors cannot be diagnosed by CT and MRI,because both methods do not visualize the mucosa (unlikeesophagography and endoscopy) and the esophageal wall layers (unlike EUS).Infiltration depth tends tobe overestimated in T1 and T2 carcinomas and to be underestimated in T3 and T4 cancers.CT andMRI cannot detect metastases in normally sized lymph nodes and cannot accurately differentiate betweenbenign and malignant lymphadenopathy in enlarged nodes with a reported sensitivities and specifities of60% and 74%,respectively.However,further prospective studies using up to date CT and MR technologyare needed to assess the present diagnostic situation.CT and MRI do not only visualize the mediastinum,but also the lungs,the pleura and the skeleton as well as the neck and the abdomen thus providing acomprehensive overview of the TNM stage in 3 body regions.     

安替可合并放射治疗食管癌疗效观察

应用安替可配合放射治疗对 6 4例食管癌做前瞻性随机研究 ,用药组 30例 ,对照组 34例。 2组均采用60 Co常规照射 ,剂量为DT70Gy。用药组在放疗期配合口服安替可。随访率为 10 0 %。完全缓解率 :用药组为 73 33% ,对照组为 44 12 % (P <0 0 5 )。 1、2、3年生存率 :用药组分别为 76 6 7%、6 3 30 %、5 0 0 % ,对照组分别为 47 0 6 %、32 35 %及2 0 5 9% ( P <0 0 5 )。初步研究结果提示 ,安替可配合放射治疗可提高疗效 ,有一定放射增敏作用     

Relationship of Esophageal Dysplasia to Associated Head and Neck Cancer in Patients with Esophageal Carcinoma

To investigate the relationship between esophageal dysplasiaand the development of both esophageal cancer (EC) and headand neck cancer (HNQ, a clinicopathological study was performedin 113 patients with EC who underwent esophagectomy withoutany preoperative treatment. The incidence of dysplastic lesionsin the resected esophagus was determined by a whole-organ stepwisecutting method. Synchronous or metachronous primary HNC waspresent in 25 patients, all of whom were male (Group A) andabsent in both 70 male patients (Group B) and 18 female patients.A total of 628 dysplastic lesions were found in 79 patients;67 of them were graded as carcinoma in situ (CIS) in 26 patients,44 as severe dysplasia (SD) in 16 patients, 182 as moderatedysplasia (MOD) in 59 patients, and 335 as mild dysplasia (MID)in 58 patients. The incidence of CIS, SD and MOD was low infemales, slightly increased in Group B, and markedly increasedin Group A, and the differences between Group A and Group Band between Group A and females were statistically significantThere was a sex difference in smoking and alcohol consumption,only a few smokers or drinkers being female, whereas there wasno significant difference between Groups A and B in smokingand alcohol consumption. CIS, SD or MOD in the esophagus appearto be closely related to both EC and HNC, and patients withEC associated with CIS, SD or MOD are at increased risk of developingHNC.