食管癌贲门癌术后并发心律失常182例分析

我院胸心外科自１９９２年２月至１９９７年８月对６７３例食管癌贲门癌术后病人进行了连续心电监护，发生心律失常１８２例，发生率为２７％。现对其发生原因和围术期预防及处理讨论如下。资料与方法　本组１８２例中男１２７例，女５５例；年龄３２～８０岁，平均５８．２岁。术前心电图异常者３２例，包括冠状动脉供血不足１１例，窦性心动过速５例，窦性心动过缓４例，束支传导阻滞４例，高电压３例，低电压２例，室性早搏１例，其他２例；余者心电图正常。食管癌１７３例中，经左颈、胸二切口食管癌切除、胃代食管术１３０例；经右颈、…     

高龄食管贲门癌切除术后并发症原因分析及护理

目前 ,外科手术仍为食管癌、贲门癌的主要治疗手段之一。随着医学各学科的发展及护理水平的不断提高 ,高龄食管、贲门癌的外科治疗适应证进一步放宽 ,并取得了较满意的效果 [1]。但由于高龄病人的病理生理特点 ,术后并发症较其它年龄组高。 1 997年 1月至 2 0 0 0年 1 2月我院对 1 1 3例高龄食管、贲门癌病人施行了外科治疗 ,术后发生近期并发症 2 2例 ,发生率 1 9.5 %。现将发生并发症的原因分析及护理介绍如下。1　临床资料1 .1　一般资料1 1 3例中 ,男 78例、女 35例 ,年龄最大 86岁 ,最小 71岁 ,中位年龄 74.0岁。其中食管癌 69例 ,贲门…     

食管癌贲门癌术后并发心律失常180例分析

目的总结食管癌贲门癌术后180例病人发生心律失常的治疗经验。方法回顾性分析了820例食管癌贲门癌病人接受手术治疗后发生180例心律失常病例。结果发生的心律失常有窦性心动过速135例,占75%;房性早搏15例,房室交界性早搏11例,室性早搏8例,房颤6例,室上性心动过速5例,无一例死亡。术后心律失常多发生于术后48小时内。结论提高治疗效果的基本经验是充分的术前准备,围术期加强监护,针对其诱因采取相应预防措施,并针对其诱因采取相应治疗措施。     

贲门癌切除术后并发胰瘘2例

我们治疗了２例贲门癌切除术后胰瘘病人,现报道如下：临床资料２例病人均为男性。年龄分别为５０、５４岁。贲门癌均在全麻下行姑息切除、食管胃弓下吻合术。术中探查肿瘤均于胃小弯侧浸润穿透胃壁,与胰腺体尾部和胃左动脉旁肿大的淋巴结粘连成团。１例采用锐性分离胃与...     

食管癌贲门癌切除术后胃梗阻：附6例报告

１９７５～１９９０年施行食管癌贲门癌切除术３１６５例，术后发生胃梗阻６例，发生率０．１９％，梗阻原因有：移置胃扭转（２例）、膈肌食管裂孔太紧挤压幽门（２例），幽门受纤维粘连带压迫（１例）以及幽门受极大张力上提牵拉变扁（１例）。６例均行上腹正中切口二次手术，纤维粘连带压迫者行松解术，膈肌食管裂孔过紧者行扩张术，其余施行胃窦空肠吻合术，二次术后５例治愈，１例死亡，文中对该并发症的发生原因进行分析，并对     

食管癌贲门癌根治术对胆汁成分的影响

研究食管癌贲门癌根治术后对胆汁成分的影响。作者自１９９３年１１月至１９９４年６月共对２６例食管癌贲门癌根治术病人分别在术后３、５、７、１０天抽取十二指肠引流液中的胆汁分析其成分，了解胆汁成分的变化。结果发现术后胆汁总固体量明显下降，由术前１０２．２５±１３．７８ｍｇ／ｍｌ降至术后５１．４９±２．４７，胆盐及磷脂总固体量百分比明显下降，类脂质比率由术前５１．４９±２．４７，降至术后的３．８５±０．４７。胆汁成石指数由术前１．３８～１．６７升至术后２．０～３．５２。胆汁成分的变化，加之胆道动力学改变是食管癌贲门癌根治术后胆石症发病率增高的重要原因。     

38例食管癌贲门癌伴糖尿病的外科治疗体会

１９７２年至１９９６年我们共手术治疗食管癌贲门癌病人３６８０例，其中伴糖尿病者３８例，占同期手术的１．０３％，现将治疗经验总结报告如下：临床资料本组３８例中男２６例，女１２例。年龄４５～８１岁，中位数年龄６５．５岁。食管鳞癌２８例，其中位于胸上段者１...     

食管癌贲门癌术后急性呼吸功能障碍的防治体会

目的：探讨食管癌贲门癌术后急性呼吸功能障碍的防治措施。方法：回顾性分析我院11例食管癌和贲门癌切除术后急性呼吸功能障碍的临床资料。结果：食管癌和贲门癌术后急性呼吸功能障碍的发生率为0．62％。治愈率为81．81％。其发生与高龄、术前肺功能及合并疾病密切相关。结论：术前、术中、术后采取综合防治措施。对降低食管癌贲门癌术后急性呼吸功能障碍的发生率，提高治愈率具有重要的意义。     

食管癌术后并发乳糜胸的治疗体会

乳糜胸是胸部肿瘤术后严重并发症之一 ,多见于食管癌、贲门癌术后。我院 1992年 1月至 2 0 0 1年 5月行食管癌、贲门癌切除 3 2 6例 ,发生乳糜胸 5例 (1.5 3 % ) ,报告如下。临床资料本组 5例均为男性 ,年龄 49～ 62岁。上段食管癌 3例 ,中段食管癌 2例。乳糜胸均位于左侧胸。每日胸液 3 0 0～ 180 0ｍｌ。胸液苏丹Ⅲ染色阳性。本组行禁食、补液、营养支持治疗 ,胸液逐渐消失。消失时间 5～ 12ｄ ,平均 8ｄ。术后随访 1～ 2个月未见胸腔积液。讨　　论食管癌术后乳糜胸主要是术中损伤胸导管或其分支所致。由于胸导管的解剖特点 ,术中最易损…     

Combined photodynamic therapy and hyperbaric oxygenation in carcinoma of the esophagus and the esophago-gastric junction

Objectives: The photochemical reaction of photodynamic therapy (PDT) depends on the presence of molecular oxygen. Due to anoxic regions in tumor tissue and vascular shutdown during PDT the efficiency is limited. Therefore, the use of hyperbaric oxygen which increases the oxygen in tumor tissue, as well as the amount of singlet oxygen, may enhance the efficiency of PDT. Patients and methods: After diagnostic work-up, photosensitization was carried out with a hematoporphyrin-derivate 2 mg/kg BW 48 h prior to PDT. The light dose was calculated as 300 J/cm fiber tip. Thirty-one patients were treated by PDT alone and 44 patients received PDT under hyperbaric oxygen at a level of two absolute atmospheric pressure. Results: Improvement regarding stenosis-diameter could be obtained in both treatment arms with no significant difference (P=0.82). The dysphagia-score and tumor-length also decreased in both groups and showed a significant difference in favour of the PDT/HBO-group (P=0.0064 and P=0.0002, respectively). The median overall survival for the PDT-group was 7 months and for the PDT/HBO-group 12 months (P=0.0098). Conclusion: According to this prospective non-randomized study, combined PDT/HBO represents a new approach in the treatment of esophageal and cardia cancer which appears to have enhanced the efficiency of PDT.     

食管癌、贲门癌术后复发的再次手术

目的探讨食管癌、贲门癌手术后复发再手术的可能性及其适应证。方法作者总结了１９７９年至１９９６年的４４例食管癌、贲门癌术后复发患者进行再次手术的经验。男３６例,女８例,年龄４２～６８岁。食管癌术后２１例,贲门癌术后２３例。手术切除３４例,探查１０例。术后发生各类并发症７例次,发生率２０．５％,手术死亡２例,手术病死率５．８％。病理证实吻合口复发２６例,残留食管再发癌７例,癌残留食管床复发１例。淋巴结转移１５例,转移率４４．１％。结果术后生存５年以上４例,３年以上４例,２年以上３例,１年以上６例,１５例分别在１年及１年内死亡;探查者１０例分别于６～１３个月内死亡。结论对食管癌、贲门癌术后复发者,若病变未浸及动脉或气管,放疗后病变缩小,无远处转移,且心肺功能可以耐受手术者,都应积极再次手术。     

贲门癌患者外周血T淋巴细胞亚群及细胞因子表达的变化

目的 观察贲门癌手术患者机体免疫状态的变化.方法 采用流式细胞术检测97例贲门癌患者T淋巴细胞亚群(Th1、Th2、CD3+、CD4+、CD8+细胞),采用双抗体夹心酶联免疫吸附试验( ELISA)检测血清中白细胞介素(IL)-2、干扰素(IFN)-γ、IL-4、IL-10、可溶性白细胞介素-2受体R(sIL-2R)和肿瘤坏死因子(TNF)-β水平.结果 贲门癌患者术前外周血Th1/Th2细胞比值(0.43±0.13)较正常对照组(0.58±0.12)降低(P＜0.05),其Th1细胞表达的IL-2、IFN-γ等细胞因子水平低于正常对照组;Th2细胞表达的IL-4、IL-10细胞因子水平高于正常对照组(P＜0.05).T细胞介导的细胞免疫及血清sIL-2R和TNF-β水平与肿瘤TNM分期相关,其特征为:CD3+、CD4+细胞减少(P＜0.05),而CD8+细胞增加(P＜ 0.01);CD4 +/CD8+细胞比值下降(P＜0.01),血清sIL-2R和TNF-β水平升高(p＜0.05) 贲门癌根治术后1个月CD3+、CD4+细胞回升,CD8+细胞回降,同时血清sIL-2R和TNF-β水平降低(P＜0.01).结论 贲门癌患者外周血Th1/Th2细胞比值降低,细胞因子表达失衡,患者存在免疫功能抑制.     

食管癌,贲门癌手术入路的探讨

为了评估食管癌，贲门癌各种手术入路的优缺点，我们总结食管贲门癌手术２１２０例，其中病变位于食管颈，胸上，中，下段及贲门者分别为２６，２８０，９３６，４０８，４７０例，经左后外侧剖胸，包括左胸，左颈两切口者１９９５例，并发症６．６％（１３３／１９５５）；经右胸－腹正中－颈三切口者５８例，并发症２４．１％，（１４／５８）颈腹二切口者２０例；胸腹联合切口者３９例，并发症７．６％（３／３９）；经上腹正中切     

Biological evaluation of undifferentiated carcinoma of the esophagus

Background Patients with undifferentiated carcinoma of the esophagus (UEC) are rare and have a poor prognosis compared with those with differentiated squamous cell carcinomas (DECs). We compared clinicopathological and biological features of UEC and DEC, with emphasis on markers for epithelial cell origin, proliferation, and cell-cell adhesion. Methods Seven patients with UEC were compared with 21 with DEC. Immunohistochemical studies were performed by using monoclonal antibodies to cytokeratin, epithelial membrane antigen, p53, p21^WAF1/CIP1, Ki-67, E-cadherin, desmoglein-1, and thrombomodulin. Results Patients with UEC had a poorer prognosis because of hematogenous metastasis at the time of presentation (mean survival, 6.5±6.2 vs. 35.5±28.9 months;P<.05). Immunohistochemical findings for cytokeratin and epithelial membrane antigen suggest that some UECs had epithelial origins. The following immunohistochemical profile of UEC was consistent with its highly malignant properties: (1) reduced or negative expression of cell-cell adhesion molecules such as E-cadherin, desmoglein-1, and thrombomodulin, (2) high positive rate for p53 and Ki-67, and (3) negative expression of p21^WAF1/CIP1. Conclusions The immunohistochemical findings for UEC showed its high cell-proliferative activity and a high potential for metastasis. Clinical features of UEC were supported by the results of immunohistochemical findings.     

食管贲门癌术后经鼻肠管肠内营养应用体会

目的探讨食管癌术后经鼻肠管肠内营养的应用价值及最佳实施方法。方法总结并分析114例食管贲门癌切除术后经鼻肠管肠内营养病例资料。结果全部病例均完成留置鼻肠管,术后因脱管、患者拒绝、滴饲后出现腹胀未能够完成滴饲者24例,能够顺利完成滴饲者90例。术后吻合口瘘5例（颈瘘3例,胸瘘1例,纵隔瘘1例）,严重肺部感染1例,心律失常心衰2例,切口感染1例。结论食管癌术后经鼻肠管肠内营养有利于降低食管癌患者术后风险,较经空肠造口途径为优,经熟练掌握其要领后,患者均可顺利使用。     

经腹行Heller加改良Dor手术治疗贲门失弛症的临床疗效观察

目的 评价经腹行Heller术加改良Dor术治疗贲门失弛症的疗效.方法 经腹行Heller加改良Dor手术治疗贲门失弛症病人33例,其中18例术前及术后均行食管测压检查及24 h食管pH监测,对术前及术后食管下括约肌静息压(LESP)及24 h内食管反流次数、最长反流时间(min)、pH＜4.0时间(min)、pH＜4.0时间百分比(%)等指标进行统计学分析.结果 术后1例仍有吞咽困难,其余32 例症状明显好转.术后1个月复查食管测压检查及24 h食管pH监测,LESP值较术前明显下降(P＜0.001).24 h反流次数、最长反流时间、pH＜4.0时间、pH＜4.0时间百分比等指标较术前均有下降,差异均有统计学意义(P＜0.05).随访30例(90.9%,30/33例),其中症状消失22例(73.3%,22/30例),改善8例(26.7%,8/30例);术前经24 h食管下端pH监测证实其中3例(16.7%,3/18例)存在不同程度的胃食管反流,术后随访均无反流性食管炎发生.结论 经腹行Heller加改良Dor手术除能明显改善贲门失弛症的症状外,还能有效防止术后可能带来的胃食管反流,且手术操作较简单,创伤小,并发症少.

Abstract：

Objective To evaluate the effect of curing achalasia by transabdominally Heller-Dor operation. Methods To summarize 33 cases of achalasia treated by transabdominally Heller-Dor procedure and visit them postoperatvely. 18 patients receive pre- and post-operativemanometry and 24-hour-pH monitoring. The parameters including reflux frequency 、the longest lasting-time of reflux 、the total time(min) of pH ＜4.0 and the percentage( % ) of time of pH ＜4.0 were recorded and compared using statistical mothods. Results Symptom was significantly improved in 32 patients after surgery, while 1 patient remained dysphasia as pre-operative. The LESP, the reflux frequency、the longest lasting-time of reflux 、the total time(min) of pH ＜ 4.0 and the percentage ( % ) of time of pH ＜ 4.0 also declined after operations ( P ＜ 0. 05 ). 30 patients were followed up,22 (73.3% ,22/30) were cured and 8 had mild sypmtom. Reflux did not detected in 3 cases( 16.7% ,3/18 ) with preoperative reflux. Conclusion Transabdominally Heller-Dor operation could dramadically alleviate the symptoms of patients with achalasia, moreover, it could especially prevent the postoperative-reflux, and with the advantages of simple operations, little traumas.     

Intensive multimodality therapy for carcinoma of the esophagus and gastroesophageal junction

Background: We designed a trial of intensive multimodality therapy for carcinoma of the esophagus and gastroesophageal junction to assess tumor response and operability after neoadjuvant chemotherapy and to determine the impact of trimodality therapy on long-term survival. Methods: Thirty-two patients with resectable (clinical stage IIa, n=17; IIb, n=1; III, n=14) squamous cell cancer (n=15) or adenocarcinoma (n=17) were treated with neoadjuvant chemotherapy (cisplatin, 5-fluorouracil, leukovorin), resection, and postoperative chemoradiotherapy (hydroxyurea, 5-fluorouracil; 50–66 Gy). Results: Use of neoadjuvant chemotherapy yielded the following results: a measurable clinical response in 22 patients, stable disease in eight patients, disease progression in one patient, and death in one patient. Thirty-one patients underwent resection, with the following results: two operative deaths (6.5%) and nonfatal morbidity in 17 (59%); the median hospital stay was 13 days. Pathologic staging was stage 0, n=1; I, n=2; IIa, n=11; IIb, n=5; III, n=7; and IV, n=5. Postoperative chemoradiotherapy was completed in 23 patients with one death, for an overall treatment-related mortality rate of 12.5% (four of 32). At a mean follow-up of 22.5 months, median survival is 19.7 months and 14 patients are alive and disease free. Conclusions: Neoadjuvant therapy for cancer of the esophagus and cardia results in good tumor response. Esophagectomy in this setting can be accomplished with acceptable morbidity and mortality. Results of an interim analysis of survival are encouraging and suggest that further investigation of this regimen is warranted. Presented in part at the Annual Meeting of The Society of Surgical Oncology, Houston, Texas, March 17–20, 1994.     

Small-cell carcinoma of the esophagus

Summary A case of primary carcinoma of the esophagus is presented that consisted of poorly differentiated small-cell carcinoma. The patient underwent endoscopic treatment, first with an Nd: YAG laser and, finally, with bougienage and the insertion of a prosthesis in order to relieve dysphagia and improve the nutritional status and quality of life. Even though it is generally uncommon for laser therapy to be chosen as a primary mode of treatment, the results obtained should permit to overcome this lack of confidence in the choice of laser treatment for small-cell carcinoma of the esophagus.     

舒胆合剂对胆囊胆固醇结石的防治作用及机理

目的研究舒胆合剂对胆囊胆固醇结石有无预防及溶解作用,并初步探讨其机理。方法建立豚鼠胆囊胆固醇结石模型时,给予舒胆合剂,研究防石作用;建立模型后给予舒胆合剂,研究溶石作用。测定血、胆汁生化及肝、胆囊病理,探讨作用机理。结果防石组成石率（２１％）显著低于致石组（６７％）（Ｐ＜０．０１）;溶石组成石率（６０％）与致石组（６７％）无显著差异。防石及溶石组的肝脂肪变性均显著低于致石组。结论舒胆合剂有防石及缓解肝脂肪变性作用,但短期应用无溶石作用。