食管平滑肌肉瘤的诊断与治疗

目的探讨食管平滑肌肉瘤的诊断和治疗方法.方法总结分析5例食管平滑肌肉瘤的诊断及手术治疗经验,石蜡标本行CD117、CD34、肌特异性肌动蛋白(SMA)免疫组化检查.结果本组仅2例术前经食管镜活检获得病理确诊,2例考虑为食管癌,1例诊断为纵隔肿瘤.术后病理诊断2例合并鳞状上皮癌.3例行食管部分切除获得长期生存;1例行肿物切除加术后放疗,3年半后死亡;1例行探查术,7个月后死亡.免疫组化检查,CD117和CD34均为阴性,4例SMA阴性,1例阳性.结论仅部分食管平滑肌肉瘤术前可以确诊;对于术前未确诊的食管肿瘤和侵犯食管壁而未能确定其来源的纵隔肿瘤,需要术中冰冻病理检查以确定其性质;食管平滑肌肉瘤需行CD117、CD34和SMA等免疫组化检查以排除间质瘤;本病行食管部分切除可获得较满意的疗效.     

大电量电化学介入治疗晚期食管贲门癌7例报告

电化学介入治疗食管、贲门癌是近年开展的一种新疗法。本院在离体标本实验研究和病理组织学研究的基础上,采用单次大电量(800~1080库仑)介入治疗晚期食管、贲门癌7例。全部病例均提高了经口进食质量,5例提高3级,2例提高2级。维持进食时间52~160天。本组病例未发生穿孔、出血、心率紊乱等并发症。我们认为对病变范围较大,管壁全周受累的晚期病例,大电量电化学介入治疗可使肿瘤组织细胞得到大量杀伤。从而有效地缓解狭窄、梗阻症状,提高生存质量。大电量电化学介入治疗应严格掌握适应证,以免造成管壁坏死穿孔等严重并发症。电化学介入治疗晚期食管、贲门癌操作简便、痛苦小、近期疗效显著,值得推广。     

上腹部手术后食管癌外科治疗5例报告

我院自2000-2004年收治的206例食管癌中,有5例病人曾行上腹部手术治疗,平均年龄为56岁,男4例,女1例,均因诊断为胃溃疡、十二指肠溃疡或上消化道穿孔,曾行上腹部手术治疗,其中4例行胃大部切除术,1例行剖腹探查术,术后病理均为良性病变。5例病人术前均经内镜及病理检查证实,其中3例为胸下段食管癌,行食管、胃弓下吻合术;1例为胸中段食管癌,行食管、胃弓上吻合术;1例胸上段食管癌,行食管胃胸廓入口处吻合术。     

中晚期食管癌电化学治疗38例近期疗效观察

目的:HTSS]探讨电化学食道铂金电极治疗38例中晚期食管贲门癌的临床疗效.方法:在X线下定位,将食道铂金电极置入食管肿瘤段,接肿瘤电化学治疗仪,电压6V～7V,电流60mA～120mA,总电量800C～1500C,最大可达2500C,时间90分钟～240分钟,逐渐加大电压,保持病人能接受的刺激量,治疗结束时需逐渐降低电压后关机,拨出电极.结果:38例患者中33例随访6～8个月,16例解除梗阻、完全缓解,14例部分缓解,1例并发食管支气管瘘,7例无效.结论:本方法无痛苦,适用于年老体弱不能耐受手术的患者.     

食管癌切除术中气管、支气管损伤的处理体会

食管中、上段癌如侵及气管、支气管在肿瘤切除中可造成损伤,我院自1984～1990年在食管癌切除1726例中,有10例损伤。报告如下:1 临床资料男性9例,女性1例。食管中段癌7例,上段癌2例,复发再手术1例。均行食管胃颈部吻合术。术前半量放疗3例,全量1例。损伤部位:左主支气管5例,右主支气管2例,左主支气管伴隆突部1例,总气管2例。术后除颈部感染2例外,无胸腔感染及气管狭窄并发症。2 讨论2.1 原因食管癌就诊时多为中、晚期病人,肿瘤外侵或区域淋巴结转移均可累及气管、支气管。术中由于切除肿瘤和清除淋巴结时有损伤气管、支气管之可能。术前行放疗之病人,放疗至手术间隔时间太     

食管、胃肿瘤螺旋CT检查探讨

 目的 探讨食管、胃肿瘤的CT检查方法及对术前临床分期的指导意义。方法 60例患者，其中食管癌 25例，贲门癌 15例，胃癌 20例，均经手术病理证实，采用低张充水法行螺旋CT扫描。结果 60例患者CT检查可清楚显示病变区食管壁、胃壁增厚，管腔狭窄，轮廓改变以及病变向管腔外浸润程度及周围器官、淋巴结转移情况。结论 低张充水法螺旋CT扫描，可以清楚显示食管癌、胃癌向管壁内外浸润的程度，对术前肿瘤分期及治疗方案选择有重要指导意义。     

体表超声诊断胸段食管癌的临床价值

目的探讨体表超声对胸段食管癌诊断价值.方法探头置于胸骨上窝及胸骨左侧第3-5肋间隙,以心脏、血管为声窗,观察食管壁厚度、蠕动情况、粘膜回声及食管腔大小.结果食管癌组食管壁增厚、粘膜回声连续性中段、僵硬,与正常组及食管良性病变组比较,有显著性差异(P＜0.01),8例手术证实食管旁淋巴结转移,超声检出5例.结论体表超声诊断胸段食管癌,简便易行,为临床病理分期及选择治疗方案提供依据,具有重要的临床价值.     

内镜下电化学介入术姑息治疗食管癌48例分析

我院地处太行山区,食管癌发病率高,有些食管癌患者就诊时,已属中晚期。癌性狭窄严重影响病人的营养摄入,直接危及生命。传统的外科手段,由于其创伤大,病人难于接受或存在手术禁忌症而不能手术。从1997年2月至1999年2月采用内镜下行电化学介入术,对48例中晚期食管癌患者进行姑息治疗,大大改善病人的进食状况,提高了生活质量,现报告如下。资料与方法一、临床资料　本组48例中晚期食管癌患者,男30例,女18例,年龄47～88岁,平均年龄67.7岁。术前均表现吞咽困难。治疗前均行食管造影、内镜检查及病理检查。其中癌性狭窄位于颈段食管3例,胸上段9例,…     

成人正常食管壁厚度CT测量结果分析

[目的]分析不同部位正常食管壁厚度的CT测量结果,为勾画食管癌肿瘤靶区提供参考。[方法]用CT扫描福建省肿瘤医院160例成人正常食管,其中男女各80例。选取食管壁最厚处测量其厚度,用SPSS17.0软件包分析。[结果]男性颈段食管壁比胸上、中、下段厚（P=0.000）,胸上段与胸中、下段之间无统计学差异（P〉0.05）。女性颈段食管壁比胸上、中、下段厚（P=0.023,P=0.042,P=0.001）。胸上段与胸中、下段之间无统计学差异（P〉0.05）。男性胸上段食管壁比女性厚度（P=0.011）,其余各段无统计学差异。各段食管壁最厚处〉5mm的达60%以上。[结论]不同段正常食管壁的厚度是不同,颈段较厚。各段食管壁最厚处〉5mm的达60%以上,明显影响对CT上食管癌肿瘤靶区的判断。     

食管癌的X线气钡双重造影与CT影像学诊断136例分析

为了探讨食管癌应用X线气钡双重造影与CT检查影像学诊断价值 ,回顾性分析我院 1 998年 1月 - 2 0 0 2年 5月经病理证实的 1 36例食管癌患者随访资料。 1 36例食管癌患者均行X线气钡双重造影检查 ,其中 81例行CT检查。结果 :1 )X线气钡双重造影检出食管癌 ,髓质型 67例 ,蕈伞型 1 2例 ,溃疡型 2 3例 ,缩窄型 34例 ;2 )CT显示食管壁增厚 81例 ,食管壁内软组织肿块 65例 ,食管腔闭塞 2 6例 ,周围脂肪间隙消失 34例 ,颈部、锁骨上及纵隔淋巴结转移 2 1例。初步研究结果提示 ,X线气钡双重造影不仅能观察管腔内改变 ,而且能显示管壁动力学改变。该检查简便易行 ,是食管癌的首选检查方法。CT检查对管壁和周围组织器官的浸润有较高的诊断价值 ,是食管癌临床治疗不可缺少的重要依据     

术前新辅助化疗联合手术切除治疗局部晚期食管癌的疗效观察

【摘要】目的:研究术前紫杉醇+顺铂新辅助化疗联合手术切除在局部晚期食管癌治疗中的临床效果。方法:选取2014 年 1 月 ～2016 年 12 月我院治疗局部晚期食管癌患者 60 例,进行随机分组,对照组 30 例仅在术后给予化疗治疗,观察组 30 例在手术前应用紫杉醇+顺铂新辅助化疗方案治疗,再进行手术治疗,比较两组患者食管癌完全切除率、1年复发率。结果:观察组食管癌完全切除率明显高于对照组,1年复发率低于对照组,差异均有统计学意义(P ＜0. 05)。结论:术前应用紫杉醇+顺铂新辅助化疗联合手术切除治疗局部晚期食管癌临床效果理想。     

Prognostic significance of lymphocyte infiltration following preoperative chemoradiotherapy and hyperthermia for esophageal cancer

Purpose: Lymphocyte infiltration (LI) around cancerous lesions is an important immune response. The purpose of this study is to evaluate the prognostic significance of LI after preoperative treatment for esophageal cancer.

Methods and Materials: Preoperative chemoradiotherapy (CR therapy), either bleomycin 30 mg or cisplatin 120 mg/m² plus radiation 30 Gy, was performed on 51 cases with esophageal cancer, while hyperthermo-chemoradiotherapy (HCR therapy) was also indicated in 71 cases. Using resected specimens, both the histopathologic effectiveness and degree of LI to cancerous lesions were evaluated.

Results: The incidences of the cases in which preoperative treatment was effective were 56% and 92.3% in LI (−) and LI (++) group (p < 0.05). The presence of LI resulted in favorable prognosis; the 5-year survival rates of LI (++) and LI (+) patients were 75.5% and 46.1%, both of which were significantly better than LI (−) (27.8%, p < 0.05 and p < 0.01, respectively). Especially among cases whose preoperative treatment was moderately effective, a multivariate analysis revealed LI to be a favorable prognostic factor independent of other clinicopathologic factors (p = 0.0171). Regarding the preoperative treatment, the incidence of LI (++) was higher in the HCR group (16.9%) than in the CR group (2.0%, p < 0.01).

Conclusions: LI appears to be a prognostic predictor after preoperative CR therapy while, in addition, simultaneous hyperthermia may stimulate LI in cases with esophageal cancer.     

周期素D1蛋白表达对食管癌预后的影响

目的探讨食管癌周期素Ｄ１（ｃｙｃｌｉｎＤ１）蛋白表达对预后的影响,评估食管癌治疗后的生存情况。方法１９７９年１１月至１９９６年１２月,１６４例食管癌患者在我院接受术前放疗及根治性食管癌切除术。放疗前活检标本和放疗后手术标本均经病理证实为鳞状细胞癌。采用前后两野垂直照射,肿瘤剂量３０～４０Ｇｙ,１５～２０次／３～４周。常规免疫组化ＳＰ方法检测ｃｙｃｌｉｎＤ１蛋白表达。结果食管鳞癌放疗前、后标本的ｃｙｃｌｉｎＤ１蛋白表达阳性率分别为６２．５％（６５／１０４）和６０．８％（９３／１５３）,且放疗不能改变ｃｙｃｌｉｎＤ１蛋白表达水平。放疗后标本ｃｙｃｌｉｎＤ１蛋白表达程度不同,其生存率亦不同（Ｐ＝０．０５５）;表达者与不表达者比较,生存率差异有显著性（Ｐ＝０．０２）。尤其对无淋巴结转移者,放疗前、后ｃｙｃｌｉｎＤ１蛋白的表达,均能明显地预示生存情况。结论ｃｙｃｌｉｎＤ１蛋白表达可以预测食管癌的预后,放疗对其表达无明显影响,有可能作为食管癌临床分期的参考指标。     

Percutaneous Electrochemotherapy in Primary and Secondary Liver Malignancies – Local Tumor Control and Impact on Overall Survival

BackgroundLocal nonsurgical tumor ablation currently represents a further option for the treatment of patients with liver tumors or metastases. Electrochemotherapy (ECT) is a welcome addition to the portfolio of local therapies. A retrospective analysis of patients with liver tumors or metastases treated with ECT is reported. Attention is given to the safety and efficacy of the treatment over time.Patients and methodsEighteen consecutive patients were recruited with measurable liver tumors of different histopatologic origins, mainly colorectal cancer, breast cancer, and hepatocellular cancer. They were treated with percutaneous ECT following the standard operating procedures (SOP) for ECT under general anaesthesia and muscle relaxation. Treatment planning was performed based on MRI preoperative images. The follow-up assessment included contrast-enhanced MR within at least 1–3 months after treatment and then after 5, 7, 9, 12, and 18 months until progression of the disease or death.ResultsOnly mild or moderate side effects were observed after ECT. The objective response rate was 85.7% (complete response 61.9%, partial 23.8%), the mean progression-free survival (PFS) was 9.0 ± 8.2 months, and the overall survival (OS) was 11.3 ± 8.6 months. ECT performed best (PFS and OS) in lesions within 3 and 6 cm diameters (p = 0.0242, p = 0.0297)_. The effectiveness of ECT was independent of the localization of the lesions: distant, close or adjacent to vital structures. Progression-free survival and overall survival were independent of the primary histology considered.ConclusionsElectrochemotherapy provides an effective valuable option for the treatment of unresectable liver metastases not amenable to other ablative techniques.Key words: electrochemotherapy, liver metastases     

环氧合酶2及端粒酶在食管癌组织和切缘中的表达及其临床意义

 目的　探讨环氧合酶2（COX-2）和端粒酶在食管癌组织和手术切缘中的表达及其临床意义,分析其在食管癌中的诊断和预后价值。方法　应用组织芯片技术和免疫组织化学EnVision法检测82例食管癌患者肿瘤标本及手术切缘组织和40例正常食管上皮组织（NEET）中COX-2和端粒酶的表达情况, 并分析其与临床病理诸因素之间及预后的关系。结果　82例食管癌组织中COX-2阳性68例（82.9 %）,端粒酶阳性72例（87.8 %）;82例食管癌手术切缘组织中COX-2阳性24例（29.3 %）,端粒酶阳性15例（18.3 %）,均高于正常食管上皮组织[5例（12.5 %）和2例（5.0 %）]（均P＜0.05）。COX-2和端粒酶在食管癌组织及手术切缘的表达与食管癌TNM分期、病理分化程度及淋巴结转移相关 （均P＜0.05）,在手术切缘的表达还与吻合口癌密切相关（P＜0.01）。食管癌手术切缘中COX-2和端粒酶蛋白阳性表达患者术后生存率明显低于阴性表达患者（P＝0.000）;在食管癌组织和手术切缘中,COX-2与端粒酶的表达均呈正相关( r＝0.786、0.218,均P＜0.05）。结论　COX-2和端粒酶在食管癌发生、侵袭和转移中起重要作用;COX-2和端粒酶在手术切缘的活性可作为早期预测吻合口复发的依据,并可作为评价手术效果和预后的指标。     

Magnetic stent hyperthermia for esophageal cancer: an in vitro investigation in the ECA-109 cell line

Magnetic stent hyperthermia (MSH) is a novel approach for targeted thermotherapy for esophageal cancer, which is based on the mechanism that inductive heat can be generated by the esophageal stent upon exposure under an alternative magnetic field (AMF). A positive effect of MSH on esophageal cancer has been demonstrated, however, there is no study on the in vitro effects of heating treatment or of the effects of AMF exposure on human esophageal cancer cells. This study aimed to investigate the effect of MSH and of AMF exposure in esophageal cancer cells. Inductive heating characteristics of esophageal stents were assessed by exposing the stents under AMF. A rather rapid temperature rise of the Ni-Ti stent when subjected to AMF exposure was observed and the desired hyperthermic temperature could be controlled by adjusting the field parameter of the AMF. Human esophageal squamous carcinoma (ESCC) ECA-109 cells were divided into four groups: the control group, the water-bath heating group, the MSH group and the AMF exposure group. Hyperthermic temperatures were 43, 48 and 53?C and the treatment time was in the range of 5-30?min. The MTT assay, apoptotic analysis and TUNEL staining were applied in the current investigation. Exposure of ECA-109 cells under AMF with a field intensity of 50 to 110?kA/m had negligible effect on cell viability, cell necrosis and apoptosis. Hyperthermia had a remarkable inhibitory effect on the cell viability and the effect was dependent on the thermal dose (temperature and time). The optimal thermal dose of MSH for ECA-109 cells was 48?C for 20-30?min. The study also elucidated that there was a difference in the effects on cell necrosis and apoptosis between the heating mode of water bath and MSH. The data suggest that MSH may have clinical significance for esophageal cancer treatment.     

可切除食管癌术前与术后放化疗对比Meta分析

目的 食管癌患者就诊时大多属中晚期,单纯手术疗效不佳,需结合放化疗提高疗效,但手术与放化疗治疗顺序备受争议.本研究通过对比中晚期可切除食管癌术前与术后放化疗2种治疗模式的疗效及安全性,探寻治疗食管癌的有效治疗模式,为指导临床实践提供理论依据.方法 计算机检索The Cochrane Library、Embase、PubMed、Web of Science、CBM和CNKI,同时辅佐其他检索途径,检索2016-10前所有关于对比食管癌术前放化疗与术后放化疗的临床研究.随机对照研究(randomized controlled trial,RCT)采用Cochrane质量评价标准评价文献质量,非随机对照研究采用纽斯卡尔-渥太华量表(newcastle-ottawa scale,NOS)质量评价标准评价文献质量,统计学分析采用Review Manager 5.3软件.本Meta分析遵循系统综述与荟萃分析优先报告条目(PRISMA)规范.结果 共纳入1个RCT和5个非随机对照研究,Meta分析结果显示,1年生存率(OR=1.24,95％CI:0.96～1.61,P=0.09)、3年生存率(OR=1.25,95％CI:1.00～1.55,P=0.05)、5年生存率(OR=1.39,95％CI:0.93～2.06,P=0.11)和术后并发症发生率(OR=1.45,95％CI:0.81～2.60,P=0.21)差异均无统计学意义.亚组分析显示,国内人群1年生存率(OR=1.30,95％CI:0.48～3.58,P=0.61)、国外人群1年生存率(OR=1.37,95％CI:0.79～2.38,P=0.26)、国内人群3年生存率(OR=1.16,95％CI:0.90～1.49,P=0.25)和国外人群3年生存率(OR=1.55,95％CI:1.00～2.41,P=0.05)差异均无统计学意义.结论 中晚期可切除食管癌术前放化疗与术后放化疗疗效及安全性相似.临床上可酌情考虑后决定手术与放化疗治疗顺序,但仍有待大量多中心、前瞻性随机对照临床实验证实.     

食管癌、贲门癌术后心律失常的原因分析

目的 探讨食管癌、贲门癌术后心律失常的原因.方法 对我科收治的600例食管癌、贲门癌患者临床资料进行回顾性分析.结果 600例食管癌、贲门癌患者术后共发生心律失常136例.不同年龄、术前心电图表现、肿瘤部位的患者术后心律失常的发生率:＜60岁者和≥60岁者分别为10.4％、25.0％;术前心电图检查正常者和异常者分别为6.3％、87.6％;食管癌、贲门癌患者分别为24.5％、14.4％,各组比较差异均有统计学意义(P均＜0.05).结论 高龄、术前心电图异常、手术方式、术后并发症与术后心律失常的发生密切相关.     

调强放疗联合紫杉醇加奈达铂及重组改构人肿瘤坏死因子α治疗局部进展期食管癌的近期疗效临床观察

目的 探讨调强放疗(IMRT)联合紫杉醇加奈达铂(TP)及注射用重组改构人肿瘤坏死因子α(rhTNF-α)治疗食管癌的近期疗效及安全性,并评价食管癌部位与食管狭窄的相关性.方法 对40例罹患不同部位食管癌的患者进行ⅠMRT+TP方案+rhTNF-α治疗.评价近期疗效及不良反应,另外,按食管癌发生部位将患者分为颈胸上段组和胸中下段组,进一步比较两组的近期疗效和不良反应以及食管狭窄情况.结果 40例患者中CR 20例(50%),PR 16例(40%),总有效率为90%(36/40).治疗相关血液学不良反应以白细胞减少为主,非血液学不良反应均较轻微.治疗后食管癌颈胸上段组和胸中下段组的中度及以上食管狭窄发生率分别为63.64%(14/22)和11.11%(2/18),差异有统计学意义(P<0.001).结论 食管癌同步放化疗联合重组改构人肿瘤坏死因子α治疗食管癌疗效确切,不良反应均可耐受,但颈胸上段食管癌放疗后食管狭窄程度较重,应加以重视.     

Clinical significance of plasma D-dimer levels in patients with esophageal cancer

A hypercoagulable stage has been found in a great number of the patients with malignant.[1] Markers of the activation of coagulation were developed, and D-Dimer (DD) was found higher in cancer patients.[2] The present study was to assess the clinical significance of the changes in D-dimer levels in patients with esophageal cancer.MATERIALS AND METHODSPatientsA group of 33 patients diagnosed as esophageal cancer were investigated between Jan. 1997 and Oct. 1999. There were 19 males a…