扩张性金属支架治疗食管狭窄8例

扩张性金属支架治疗食管狭窄８例张燕１王明春１刘剑英２Ｓｕｂｊｅｃｔｈｅａｄｉｎｇｓｅｓｏｐｈａｇｅａｌｓｔｅｎｏｓｉｓ／ｅｔｉｏｌｏｇｙ；ｅｓｏｐｈａｇｅａｌｓｔｅｎｏｓｉｓ／ｔｈｅｒａｐｙｕｓｅ；ｅｓｏｐｈａｇｅａｌｎｅｏｐｌａｓｍｓ／ｃｏｍｐｌ...     

记忆合金支架治疗食管贲门癌性狭窄43例

记忆合金支架治疗食管贲门癌性狭窄４３例王国华许法根张玉吴旦徐玉玉江苏省常州市戚墅堰铁路医院消化内科２１３０１１ＳｕｂｊｅｃｔｈｅａｄｉｎｇｓＥｓｏｐｈａｇｅａｌｎｅｏｐｌａｓｍｓ／ｃｏｍｐｌｉｃａｔｉｏｎＥｓｏｐｈａｇｅａｌｓｔｅｎｏｓｉｓ／ｔｈ...     

内镜下食管支撑架治疗晚期食管癌18例

内镜下食管支撑架治疗晚期食管癌１８例杜永清焦建华张萍丁乃纯许雄飞江苏省江阴市利港胃病诊治中心２１４４４４ＳｕｂｊｅｃｔｈｅａｄｉｎｇｓＥｓｏｐｈａｇｅａｌｎｅｏｐｌａｓｍｓ／ｔｈｅｒａｐｙ主题词食管肿瘤／治疗中国图书资料分类号Ｒ７３５１１对象和...     

食管癌术后复发与转移再手术治疗

食管癌术后复发与转移再手术治疗济宁市第一人民医院（２７２１１１）刘炳学李迎新周广华高连方张申我们采用再次手术治疗食管癌术后复发与转移患者５４例，取得满意效果。现分析如下。１资料与方法本组男３９例，女１５例；年龄＜５０岁２７例，５１～６０岁１９例，＞６...     

化疗微波放疗序贯治疗食管癌46例

化疗微波放疗序贯治疗食管癌４６例刘新群陈子让李相芬河南省南阳市第二人民医院４７３０１２ＳｕｂｊｅｃｔｈｅａｄｉｎｇｓＥｓｏｐｈａｇｅａｌｎｅｏｐｌａｓｍｓ／ｔｈｅｒａｐｙＭｉｃｒｏｗａｖｅｓ／ｔｈｅｒａｐｅｕｔｉｃｕｓｅ主题词食管肿瘤／治疗微波...     

食管癌根治术后预防性放疗的临床研究

目的探讨食管癌根治术后放射治疗的价值方法 1989-01/1994-06对80例食管癌根治术后行术后预防性放疗,用配对法与同期单纯手术治疗80例食管癌进行对比.结果单纯手术组1,3,5年生存率为76.3%,37.5%,22.5%,术后放疗组1,3,5年生存率为77.5%,56.3%,32.5%(直接法计算生存率),两组差异有显著性意义(P<0.05,卡方检验),无淋巴结转移者术后放疗组1,3,5年生存率较单纯手术组明显提高,有显著差异(P<0.01),淋巴结阳性者1,3,5年生存率两组无统计学意义.结论术后放疗复发率低,无淋巴结转移者术后应放疗,术后放疗组5年生存率高于单纯手术组.     

食管癌放疗后食管-支气管瘘10例治疗体会

1999年以来 ,我们应用国产全覆膜金属内支架植入治疗食管癌放疗后引起的食管 -支气管瘘 ,取得满意疗效。现报告如下。临床资料 :本组 10例患者 ,男 8例 ,女 2例 ;年龄 4 3～ 75岁 ,平均 5 8岁。均有放疗史 ,放疗后并发食管 -支气管瘘 1～ 13年。其中食管上段 4例 ,食管中下段 6例。方法 :根据病变长度选择支架 ,一般长度大于病变 4 cm。术前用稀释的泛影葡胺进行食管造影 ,以明确瘘的位置、狭窄长度及程度 ,确定采用内支架的长度及内径。术前 12小时禁食禁水。手术前 15分钟肌注 6 5 4 - 2、安定各 10 mg,用 5 m l丁卡因咽部喷雾麻醉。安放…     

内镜下扩张治疗食管狭窄24例

1对象和方法1．1对象1994－01／1997－10我院在内镜直视下采用沙氏扩张管治疗食管癌术后狭窄24例．治疗共52次．8例经扩张管扩张2次，4例扩张3次，4例扩张4次，8例扩张1次.22例均取得满意效果，总有效率为91．6％，2例失败，占8．33％.本组24例患者均为男性，年龄在41岁～62岁之间.食管癌术后狭窄16例，贲门癌术后吻合口狭窄3例，晚期食管癌内境下注射无水酒精，症状缓解一段时间后又狭窄不能进食者5例，病程为3d~14mo.24例患者均经内镜及X线摄片检查证实狭窄口径为1mm~6mm不等，狭窄长度无法定.普通内镜及国产沙氏扩张管Ⅰ～Ⅴ种型号，扩…     

食管癌贲门癌切除术后连续1083例无吻合口瘘及近期狭窄手术经验

目的预防吻合口瘘及狭窄．方法食管癌术后吻合口瘘的发生原因很复杂，除大家熟知的一些常见原因外，如吻合口吻合有张力，供血不良，感染，胸腔负压，食管缺乏浆膜外；作者发现，术后坐位或立位胃及其内容物的重力牵拉作用对吻合口瘘的发生起重要作用，据此，作者设计了纵隔胸膜包盖悬吊术，主要用于弓上吻合，手术要点为：按常规方法游离胃及食管，吻合方法为：①首先沿主动脉弓上缘胸椎前缘及左锁骨下动脉左缘将纵隔胸膜剪开，上翻游离至胸膜顶，形成一个长方形胸膜瓣，长约4cm，宽约3cm．②胸膜瓣游离成功后，剪开胸内筋膜，将食管牵至主动脉弓上，按套入式吻合缝合前3排，不再缝合第4排，这样，吻合口不内翻，减少狭窄机会．③游离胸膜瓣展开，将其下缘间断缝合在吻合口下方的胃壁上，距吻合口约3mm～4mm，④用一根长4号丝线按围巾式吻合法将缝线上好，注意：①缝线离吻合口的距离与第一排离吻合口的距离要一致，约2．5cm，胃壁上两针之间距离不要太近，以免打结后胃包绕食管太紧，造成吻合口上方食管扩张受限，②食管上的缝针一定要经胸膜进针，穿过食管肌层，但勿穿透粘膜层，在经胸膜穿出，这样明显提高这一针的耐牵拉力．③吻合完成后，胃底包绕食管一周，胸膜瓣紧密包盖在吻合口上．而且，一切     

食管癌外照射加腔内放疗121例

食管癌外照射加腔内放疗１２１例陈东福Ｓｕｂｊｅｃｔｈｅａｄｉｎｇｓｅｓｏｐｈａｇｅａｌｎｅｏｐｌａｓｍｓ／ｒａｄｉｏｔｈｅｒａｐｙ；ｂｒａｃｈｙｔｈｅｒａｐｙ；ｒａｄｉｏｔｈｅｒａｐｙｄｏｓａｇｅ主题词食管肿瘤／放射疗法；近距离放射疗法；放射治疗剂...     

食管癌后程加速超分割三维适形放疗与食管癌后程加速超分割放疗的疗效评价

目的 评价后程加速超分割三维适形放疗与食管癌后程超分割放疗的疗效。方法 将54例食管鳞癌患者前瞻随机分组至后程加速超分割三维适形放疗（LCAH3DCRT）组和后程加速超分割放疗（LCAHRT）组。放疗方法均为前2／3天疗程普通模拟机定位常规放疗40Gy，后1／3疗程LCAH3DCRT组改为CT模拟定位加速超分割三维适形放疗（1．6Gy／次，2次／d，5d／周，20-28Gy），总剂量为60-68Gy，全疗程37-40天；LCAHRT组加速超分割放疗至上述相当剂量。结果 LCAH3DCRT组和LCAHRT组5年生存率分别为31％和22％，LCAH3DCRT组生存率高于LCAHRT组（P=0．028）；3、4、5年无瘤生存率分别为34％、32％、31％和28％、26％、21％，LCAH3DCRT组无瘤生存率均高于LCAHRT组（P值均〈0．05）。LCAH3DCRT组和LCAHRT组1、2、3、4、5年局部控制率分别为78％、73％、61％、59％、56％和58％、37％、30％、28％、25％，LCAH3DCRT组局部控制率高于LCAHRT组（P值均〈0.05）。结论 后程加速超分割三维适形放疗可作为食管癌的首选方法之一，它提高了5年生存率和局部控制率。     

The impact of prior radiotherapy on fatal complications after self‐expandable metallic stents (SEMS) for malignant dysphagia due to esophageal carcinoma

The esophageal stent has been demonstrated to serve as a safe and effective palliative treatment for advanced inoperable esophageal carcinoma. However, the safety of esophageal stents in patients with prior radiotherapy (RT) remains debated. This article aims to investigate the impact of prior RT on the incidence of fatal complications after self‐expandable metallic stents for palliation of malignant dysphagia because of esophageal carcinoma. Between January 2007 and July 2010, 93 patients with malignant dysphagia because of esophageal carcinoma underwent placement of self‐expandable metallic stents in our hospital. Patients were retrospectively separated into two groups: patients with RT before stent placement (RT group, n = 57) and patients with no treatment before stent placement (no RT group, n = 35).The median survival after stent placement was 77 days (7–842 days) in the RT group and 246 days (15–878 days) in the no RT group. Improvement in dysphagia score was similar in both groups. The fatal complications included fatal gastrointestinal hemorrhage and uncontrolled pneumonia. The incidence of fatal gastrointestinal hemorrhage and uncontrolled pneumonia were 28.1% and 5.7% (P = 0.009), 28.1% and 5.7% (P = 0.009), respectively. Logistic regression analysis showed a significant interaction between prior RT and fatal gastrointestinal hemorrhage (relative risk 7.82, 95% confidence interval 1.54–39.61; P = 0.013). Mortality of massive hemorrhage was 5.7% (2/35), 0% (0/4), 12.5% (3/24), and 44.8% (13/29), respectively, in patients who received 0, 1Gy～49Gy, 50Gy～60Gy, and >60Gy (χ² = 17.761; P = 0.000). Logistic regression analysis disclosed prior RT did not significantly increase the risk of uncontrolled pneumonia (relative risk 1.47, 95% confidence interval 0.21–10.12; P = 0.697).     

食管癌不同超分割方法放疗前瞻性研究

目的通过不同超分割方法放疗寻求食管癌有效的放疗技术。方法前瞻性随机将124例食管癌分为全程超分割组（30例），前程超分割组（30例），后程超分割组（34例），常规放疗组（30例）4个组进行研究，超分割放疗每日2次，每次120Gy，2次间隔6h以上，超分割剂量全程DT：68～70Gy，前、后程组超分割剂量34～36Gy。常规放疗前、后程组DT：34～36Gy，常规组剂量68～70Gy，每日1次，每次2Gy。结果放疗剂量与下咽困难症状改善，4个组基本相同，无明显差异；伴有胸背痛的病人接受放疗后症状改善4个组差异无统计学意义；肿瘤消失情况或治疗结束肿瘤残留情况全程组好于其他3个组，但差异无统计学意义。放射性食管炎全程和前程组明显高于后程和常规放疗组（P〈0．01），放疗剂量在20～50Gy发生较多。20Gy以下和50Gy以上放疗剂量发生率相对较低。放射性气管炎和肺炎发生率4个组均低。其他并发症有恶心、呕吐、白细胞下降反应，但4个组差异无统计学意义。结论本组前瞻性研究从肿瘤消失率和残留情况看全程超分割组优于其他3个组；全程和前程超分割组放射性食管炎的发生率明显高于后程超分割组与常规放疗组。     

A comparison of surgery and radiation therapy for cT1 esophageal squamous cell carcinoma

Surgery and radiation therapy have been used to treat esophageal squamous cell carcinoma. However, treatment outcomes have not yet been extensively investigated. The aim of this study was to compare surgery and radiation therapy for clinical T1 esophageal squamous cell carcinoma. A total of 67 clinical T1 esophageal squamous cell carcinoma patients were treated between January 1997 and December 2005; 29 had undergone radical esophagectomy (surgery group) and 38 were treated with definitive radiation therapy (radiation group). The mean patient age was lower in the surgery group than in the radiation group. In surgery group, respiratory complications, anastomotic leaks, recurrent nerve palsies, and anastomotic stenosis occurred in 7, 8, 6, and 5 patients, respectively. In radiation group, leucopenia, esophagitis, pericarditis were observed in 15, 3, and 3 patients, respectively. The 5‐year overall survival rate for the surgery group was 68.9%, and 74.3% for the radiation group. There were no significant difference between groups (P= 0.3780). The 5‐year relapse‐free survival rate in the surgery group was 61.8% and 38.8% in the radiation group. The relapse‐free survival rate was significantly higher in the surgery group than in the radiation group (P= 0.0051). The 5‐year overall and relapse‐free survival rates for tumors invaded into but not through the muscularis mucosa were 83.3% and 75.0%, respectively, in the surgery group and 78.8% and 33.3%, respectively, in the radiation group. There were no significant differences. The 5‐year overall survival rates for patients with tumors that invaded the submucosal layer was 64.9% in the surgery group and 66.5% in the radiation group. This difference was not significant (P= 0.8712). The 5‐year relapse‐free survival rate in the surgery group (56.0%) was significantly higher than that in the radiation group (41.8%; P= 0.0219). In conclusion, surgery may become a standard treatment for cT1 esophageal cancer that can offer longer relapse‐free survival, particularly for patients with tumors that invade the submucosa.     

食管癌CT扫描在放射治疗中的价值

目的研究CF扫描所示肿瘤大小的准确性，依此以肿瘤为射野中心，采用合理的照射野方法1993－12／1996－12病理和CT扫描的食管癌患者77例.取3个层面，绘制并测量相应照射野的大小及正常组织的受量．结果CT所示肿瘤的大小与手术标本比较P＞0．05.放疗组的肿瘤各径线均大于手术组.非对称性浸润，以管腔为射野中心，经典的照射野大小（前宽6．0cm，后斜野5．0cm），≥35．1％的患者90％的等剂量曲线不能包全肿瘤.如以肿瘤为射野中心，前野宽7．0cm，两后斜野为6．0cm，80．7％的患者80％～90％的等剂量曲线包全肿瘤、剂量分布均匀．如肿瘤直径＞5．1cm，先前后对穿野尔后采用分野的照射技术．采用容积-剂量百分比直方图，50％，20％肺最大受量体积分别为18％，49％该剂量临床上很少发生急性放射性肺炎结论证实了食管癌CT扫描的准确性和可靠性，应作为放疗前常规检查方法之一.定位应以肿瘤为中心，确保80％～90％的等剂量曲线包全肿瘤.应据CT所示肿瘤大小，外侵形状，灵活选择照射野.     

自体血照射回输提高食管癌患者抗辐射的作用

目的探讨自体血液照射回输提高食管癌患者抗辐射能力及对机体正常组织的合理防护．方法食管癌患者６６例随机分为研究组（自体血液照射回输加放疗）和对照组（常规放疗组）．观察两组急性放射性食管炎的发生率及研究组患者血疗前后ＩＬ２，Ｔ淋巴细胞亚群的变化．结果急性放射性食管炎发生率：研究组为１２１％（４／３３），对照组６０６％（２０／３３，Ｐ＜００１）；发生急性放射性食管炎的平均放疗剂量（Ｘ±ＳｃＧＹ）研究组４０５０±８２２，对照组２４６０±６０９（Ｐ＜００１）；研究组血疗前后ＩＬ２，Ｔ淋巴细胞亚群也都有非常显著变化．结论自体血液照射回输可提高食管癌患者抗辐射功能，可能是低剂量辐射刺激诱发机体的适应性和刺激机体的免疫功能，提高了正常组织对放疗的耐受量而不对肿瘤组织起保护作用．     

Ulcer in the gastric tube for esophageal replacement: a comparison of 12 esophageal cancer patients with or without postoperative radiotherapy

BACKGROUND AND AIMS: Ulcer in the gastric tube for esophageal replacement, which was caused by peptic factors or postoperative radiotherapy (Rx), are occasionally reported. The aim of this study was to clarify the clinicopathologic features of the ulcers in the gastric tube. METHODS: In 62 patients with a reconstructed gastric tube, after esophagectomy for esophageal cancer, esophagogastroduodenoscopy was performed. Ulcers of the gastric tube were detected in 12 patients: six with postoperative Rx and six without Rx. The 12 patients with gastric tube ulcers (GU-group) were reviewed and compared to the remaining 50 patients without ulcers of the gastric tube (Control-group). Clinicopathologic features of gastric tube ulcers were compared between the patients with and without Rx. RESULTS: There was no difference in any parameter between the patients of the GU- and Control-groups. Comparing the patients of the GU-group with and without Rx, the ulcers of the gastric tube in the patients without Rx were frequently located in the lower part of the gastric tube (P = 0.067), detected in a later period after surgery (P = 0.055), associated with cervical esophagitis (P = 0.03), and less associated with gastritis (P = 0.03). In three patients of the GU-group without Rx, Helicobacter pylori was detected in the gastric tube. Two of the three patients had a history of peptic ulcers before surgery, and had recurrence of the gastric tube ulcers. CONCLUSIONS: Gastric tube ulcers without postoperative Rx may have different characteristics compared to those induced by Rx.     

Comparison of salvage chemoradiation versus salvage surgery for recurrent esophageal squamous cell carcinoma after definitive radiochemotherapy or radiotherapy alone

A consensus treatment strategy for esophageal squamous cell carcinoma (ESCC) patients who recur after definitive radiochemotherapy/radiotherapy has not been established. This study compared the outcomes in ESCC patients who underwent salvage surgery, salvage chemoradiation (CRT) or best supportive care (BSC) for local recurrence. Ninety‐five patients with clinical stage I to III ESCC who had completely responded to the initial definitive radiochemotherapy or radiotherapy alone and developed local recurrence were enrolled in this study. Fifty‐one of them received salvage esophagectomy, and R0 resection was performed in 41 patients, 36 underwent salvage CRT, and the remaining eight patients received BSC only. The 5‐year overall survival was 4.6% for the 87 patients receiving salvage surgery or CRT, while all patients in the BSC group died within 12.0 months, the difference was statistically significant (P = 0.018). The 1‐, 3‐, 5‐year survival rates in the salvage surgery and salvage CRT groups were 45.1%, 20.0%, 6.9% and 51.7%, 12.2%, 3.1%, respectively, there was no difference of overall survival between the two groups (P = 0.697). Patients also presented with lymph node relapse had inferior survival compared to those with isolated local tumor recurrence after salvage therapy. In the salvage surgery group, infections occurred in eight patients, and three developed anastomotic leakage. In the salvage CRT group, grade 2–4 esophagitis and radiation pneumonitis was observed in 19 and 3 patients, respectively. Seven patients (19.4%) developed esophagotracheal fistula or esophageal perforation. This study of salvage CRT versus salvage surgery for recurrent ESCC after definitive radiochemotherapy or radiotherapy alone did not demonstrate a statistically significant survival difference, but the frequency of complications including esophagotracheal fistula and esophageal perforation following salvage CRT was high.     

三种类型腔内管置管术姑息治疗晚期食管癌的对照研究

目的评价自制腔内管、ＷＣＥＰ系列腔内管、带膜ＧｉａｎｔｕｒｃｏＺ支架三者姑息治疗晚期食管癌的优缺点．方法按应用腔内管的类型不同分成自制管组（６０例）、ＷＣＥＰ组（２２例）、ＳＥＭＳ组（１８例），从置管术条件的需求、技术成功率、吞咽功能改善情况、并发症发生率等方面进行临床对照研究．结果各组的成功率差异无显著性（Ｐ＝０６３３２）．三组吞咽功能置管前无显著性差异（Ｐ＝０２１３５），置管后有明显差异（Ｐ＝０００８７），ＧｉａｎｔｕｒｃｏＺ支架改善吞咽功能较其他两类的腔内管好．三组间术中、术后的并发症发生率均无显著性差异（Ｐ＝０６６３４，０１６３４），但所发生的并发症却明显不同．结论带膜ＧｉａｎｔｕｒｃｏＺ支架改善吞咽功能及阻断食管呼吸道瘘口明显优于管型腔内管．管形腔内管适用于临时置管及术中置管     

食管"Z"型支架术后局部粘膜血流量及通透性变化分析

目的研究实验犬食管支架术后2,24 h局部粘膜血流量的变化,食管对PEG400通透性的变化,以及食管粘膜电镜下形态的变化.方法选择成年健康犬12只,均分两组,分别置入"Z"型食管支架,采用多谱勒血流仪检测支架术后2,24 h局部粘膜血流量的变化,与正常食管粘膜进行比较.支架术后2 h选择第1组实验犬进行食管持续恒压PEG400灌流,2 h后取出置架部位的食管组织及等量正常食管组织,通过气相色谱分析法检测组织中PEG400的含量,并进行比较.第2组实验犬于术后24 h同样方法进行气相色谱分析.电镜分析支架术后2 h及24 h粘膜结构的变化.结果支架术后2,24 h局部粘膜血流量较正常食管均明显减少;术后2 h食管组织中PEG400的含量较正常明显升高,主要表现为一些低分子量的PEG400,术后24 h PEG400的通透性进一步增强,可检测到一些高分子量的PEG400;电镜发现支架术后上皮细胞间桥粒明显减少、破坏,细胞间隙扩大,上皮基底膜破坏,术后24 h较2 h变化更为明显.结论支架置入可导致食管局部粘膜血流量明显降低,从而促进粘膜的损害;支架术后上皮细胞间连接及粘膜结构破坏明显,对PEG400通透性显著升高,从而为外源性致病原的介入创造条件.这些均说明支架对粘膜具有明显的破坏作用.