食管癌早期诊断对手术方式的影响

目的探讨食管癌早期诊断对手术方式的影响。方法对3 000名年龄41⁶9岁的农村健康成年人人群进行早期食管癌筛查。行胃镜检查后,内镜退至食管时进行2%卢氏碘染色,并对浅染色和不染色的黏膜进行活检,送病理检查。结果在3000人被检查对象中,查出食管黏膜轻度不典型增生700例,中度不典型增生6例。筛查出需要治疗的阳性患者共9例,其中食管黏膜中度不典型增生1例,食管黏膜高级别上皮内瘤变3例,食管黏膜鳞状细胞癌5例,其中,有3例黏膜病变<2 cm,2例黏膜病变>2 cm。在9阳性患者中,4例患者已经在上级医院行内镜下手术治疗。结论筛查并诊断出早期食管癌患者,可以选择内镜下手术治疗,减轻患者痛苦及经济负担,提高生存时间。     

早期和浅表性食管鳞状细胞癌内镜治疗现状

食管癌目前已成为我国主要恶性肿瘤之一,其发病率和病死率逐年增加,发病原因多而复杂。早期食管鳞状细胞癌是指局限于食管黏膜层的鳞状细胞癌,而侵犯到黏膜下层的鳞状细胞癌属于浅表性食管癌。随着内镜检查的普及和技术的进步,早期和浅表性食管鳞状细胞癌的诊断率不断提高,目前内镜下治疗的方法主要有内镜下切除和非切除治疗,其中内镜下切除治疗主要有内镜下黏膜切除术、内镜下黏膜剥离术等,相对于手术治疗,内镜下切除治疗具有安全、创伤小、操作简单、并发症少等优点,提高了患者的生存质量。但对于淋巴结转移风险较大的患者,若行内镜下治疗后,建议术后密切随访。随着针对较大病变的内镜下隧道式黏膜下剥离术等技术的开展,内镜下治疗将会为早期食管肿瘤的患者提供更好的治疗方案。     

内镜黏膜下隧道法切除早期食管癌及癌前病变的应用分析

目的 探讨内镜黏膜下隧道法在切除早期食管癌及癌前病变中的应用价值.方法 17例术前超声内镜检查判断病变局限于黏膜层,经黏膜活检发现食管上皮局灶癌变或重度不典型增生的患者,采用黏膜下隧道法的内镜下早期癌切除.结果 17例中,术后病理确诊鳞状上皮增生伴黏膜慢性炎4例,重度不典型增生5例,高至中分化鳞癌8例,其中T1a期7例,T1b期1例.有2例切除黏膜边缘重度不典型增生,1例黏膜下层切缘见癌细胞,其余病例均病灶完整切除.术后1例患者因迟发性出血转开胸手术治疗,其余患者均恢复良好.结论 黏膜下隧道法切除黏膜内早期食管癌及癌前病变安全、有效,更符合直视、充分暴露的外科原则,明显减少出血、穿孔的并发症风险,但其对病灶切除范围判断有一定困难,需在手术中充分注意.     

内镜下治疗伴发静脉曲张的上消化道早癌患者的出血风险

目的研究内镜下治疗伴发食管胃静脉曲张的上消化道早癌患者的出血风险。方法回顾性分析2005年4月至2011年8月行内镜下治疗伴发食管胃底静脉曲张的7例上消化道早癌患者的临床资料。静脉曲张采用LDRf分型进行分型。对于早癌或癌前病变采用内镜下黏膜剥离术（ESD）或内镜下黏膜切除术（EMR）治疗。结果本组7例患者行ESD或EMR,7例患者中4例早期胃癌,3例早期食管癌;6例食管静脉曲张,1例胃底静脉曲张。均完整切除病变,内镜下早癌治疗术中及术后均未发生静脉曲张出血。结论内镜下治疗伴发食管胃静脉曲张的上消化道早癌不增加静脉曲张的出血风险。     

33例远端胃部分切除术后食管癌的外科治疗

1991年2月至2008年9月,我们为33例远端胃部分切除术后食管癌病人行手术治疗,效果满意,总结报道如下.资料和方法本组中男30例、女3例;年龄47～71岁;首次病变为胃溃疡20例,十二指肠溃疡9例,复合型溃疡2例,早期胃癌2例.原手术均行远端胃部分切除,其中Billroth Ⅰ式13例,BillrothⅡ式20例.33例食管癌均经上消化道钡餐造影发现,其中20例经内窥镜检查病理证实.食管癌确诊时间距离首次胃部分切除6～40年,平均19.6年;其中Billroth Ⅰ式(18.3±7.8)年,Billroth Ⅱ式(20.0±8.6)年.食管上段癌1例,食管中段癌22例,食管下段癌10例;术后病理学均诊断为鳞癌.     

经食管床颈部吻合和胃斜形包套缝合治疗食管癌

1991年 2月至 1999年 12月 ,我们手术治疗胃经食管床颈部吻合食管癌病人 75 6例 ,临床疗效满意 ,总结报道如下。临床资料　全组 75 6例中男 5 17例 ,女 2 39例 ;年龄 36～80岁 ,平均 6 0岁。肿瘤生长在上段食管 4 3例 ,中段食管 5 81例 ,下段食管 132例。临床病理分期 (ＴＮＭ)为Ｉ期 2 5例 ,ＩＩａ期 117例 ,ＩＩｂ期 2 4 4例 ,ＩＩＩ期 32 1例 ,ＩＶ期 4 9例。其中鳞状细胞癌 734例 ,腺癌 14例 ,小细胞未分化癌 6例 ,癌肉瘤 2例。全部经内镜活检及术后病理检查确诊。手术方法　将贲门切断 ,局部间断缝合。打开或不打开弓上三角胸膜 ,将食…     

内镜下黏膜切除术治疗早期食管癌及癌前病变

目的 探讨内镜下黏膜切除术(EMR)治疗早期食管癌及癌前病变的临床价值.方法 分析2006年1月至2012年2月福建省立医院消化内镜中心90例行食管EMR治疗早期食管癌及癌前病变的临床资料,评价EMR手术的安全性及疗效.结果 90例中食管上段(距门齿15～23 cm)病变16例,食管中段病变(距门齿23 ～ 32 cm)52例,食管下段病变(距门齿32～ 40 cm)22例;病灶平均直径为(2.05±3.12) cm.所有病变均顺利完成EMR.切除标本大小为(3.55±2.71)cm.手术时间为(18 ～ 125) min,出血量为(10 ～70) ml,病灶整块切除率为24.4％(22/90).术中出血4例(4.4％),术后迟发性出血2例(2.2％),无1例食管穿孔发生;术后食管狭窄3例(3.3％),均予保守治疗好转.90例均接受随访,随访时间(4 ～60)个月,术后5年内病变复发5例,总复发率为5.6％ (5/90),无癌复发死亡病例.结论 EMR治疗早期食管癌及癌前病变具有安全性和有效性.     

内镜下黏膜多环套扎切除术治疗食管癌前病变和食管早癌的近期疗效和安全性分析

目的探讨内镜下黏膜多环套扎切除术（EMBL）治疗食管癌前病变和早癌的近期疗效和安全性。方法回顾性分析2012年1-11月在复旦大学附属中山医院内镜中心接受EMBL治疗的21例食管癌前病变和早期食管癌患者的临床资料,总结治疗效果及术后并发症发生情况。结果21例患者均顺利完成EMBL术。手术时间（21．0±8．3）min。术后无皮下气肿、纵隔气肿、气胸及迟发性出血病例。2例患者术后1个月出现食管创面狭窄,经气囊扩张术后症状缓解。术后病理示：中度不典型增生1例,中-重度不典型增生2例,重度不典型增生10例,原位癌2例,早期鳞癌6例。除1例早期鳞癌患者因癌灶距离切缘仅1mm,遂追加开胸食管癌根治术外,其余患者切缘均阴性。随访期间未见复发病例。结论EMBL术可有效治愈食管癌前病变和早期食管癌,具有微创、安全、操作简单的优点。     

同时性多原发食管癌

目的 探讨同时性多原发食管癌的临床特点、诊断和治疗.方法 采用回顾性研究的方法,对收治的32例同时性多原发食管癌的临床资料进行总结、分析.结果 全组食管双原发灶30例,三原发灶2例,共66个病灶,其中位于颈段22个,胸上段10个,胸中段19个,胸下段15个.66个病灶中,鳞癌65个,腺癌1个.32例中术前确诊26例.32例均采用手术治疗,其中4例行探查手术,1例行姑息切除手术,余27例行完全性切除手术.术后病理食管残端阳性2例.术后出现并发症8例.术后随访28例,1、3和5年生存率分别为76.9％、43.3％和14.8％.结论 完善的术前检查可显著提高同时性多原发食管癌的确诊率,手术是其较好治疗方法.     

4例肺功能重度受损患者食管胸下段癌切除术中纵隔镜的应用

2010年10月至2011年5月我们应用纵隔镜为4例肺功能重度受损的食管胸下段癌患者行食管癌切除术,取得了良好效果,现报道如下. 资料和方法 4例术前均行上消化道钡餐、纤维内镜及病理活检检查,确诊为食管鳞癌,均为男性;年龄53～ 64岁,平均61.5岁 呼吸道准备至少1周,术前检查除肺功能重度受损外无手术禁忌术前肺功能主要指标.     

En bloc resection of a large semicircular esophageal cancer by endoscopic submucosal dissection

A semicircular esophageal cancer, approximately 7 cm wide, was detected in the middle to lower esophagus of an 81-year-old gentleman during an esophagogastroduodenoscopy. Thorough examinations using chromoendoscopy and endoscopic ultrasonography led to preoperative diagnosis of an intramucosal tumor. With informed consent, the patient underwent endoscopic submucosal dissection (ESD), a novel endoscopic treatment. A successful en bloc resection by ESD was completed without complications. The resected specimen measured 72 mm by 35 mm, and the cancer was contained in an area of 66 mm by 32 mm. Histologic assessment revealed squamous cell carcinoma, microinvasive into the mucosal layer, but without vessel infiltration. Six months after ESD, mild stenosis remained, but dilation was no longer needed, and esophagogastroduodenoscopy with chromoendoscopy and biopsy revealed no residual or recurrent cancer.     

Transthoracic Esophagectomy After Endoscopic Mucosal Resection in Patients with Early Esophageal Carcinoma

Introduction  For patients with esophageal carcinoma limited to the mucosa endoscopic mucosal resection (EMR) is the therapy of choice whereas surgical resection is advocated for submucosal tumors. Methods  This study analyzes the histopathologic results of patients with early esophageal carcinoma who underwent EMR prior to transthoracic esophagectomy. Sixteen patients with early esophageal carcinoma and EMR as first line treatment were included in this retrospective study. Ten patients underwent transthoracic esophagectomy because of submucosal infiltration combined incomplete tumor resection at the lateral/basal resection margin. In one patient each, surgical therapy was indicated due to submucosal infiltration or incomplete resection only. Three patients underwent surgical resection due to residual neoplasia within an esophageal stenosis following EMR. Surgical specimens were examined for pT and pN stage according to the UICC. Results  Three patients had a squamous cell carcinoma (SCC) and 13 patients an adenocarcinoma (AC), nine patients with a long segment Barrett’s esophagus. The distribution of the pT stages was as follows: 6× pT0 (no histopathologic evidence of residual tumor), 1× pT1m1, 1× pT1m2, 3× pT1m3, 1× pT1sm1, 1× pT1sm2, 1× pT2, and 2× pT3. Three of 16 patients (18.8%) with a pT1sm1, pT2, and pT3 stage had nodal metastases. In all three patients metastatic nodes were located in the mediastinum. In two patients, a second carcinoma was detected during histopathologic work-up (1× AC in the cardia and 1× SCC in the cervical esophagus). Conclusion  The data of this highly selected patients indicate that the boundary between the therapy of mucosal and submucosal tumors is not as clear as stated. Therefore, treatment of early esophageal carcinoma demands a close interdisciplinary cooperation.     

T1bSM2期食管鳞状细胞癌内镜治疗的安全性和有效性分析

目的回顾性分析内镜切除术治疗T1bSM2期(黏膜下层≥200 μm)早期食管鳞状细胞癌的安全性、有效性。 方法选取2009年1月至2017年7月于解放军总医院第一医学中心接受内镜切除术治疗且术后病理提示病变累及M3层(黏膜肌层)、SM1层(黏膜下层<200 μm)和SM2层(黏膜下层≥200 μm)的79例患者为研究对象,根据浸润深度分为相对适应证组和拓展适应证组,分析比较两组患者的基本资料及术后并发症的差异,Kaplan-Meier生存分析总体生存率及无进展生存率。 结果两组患者的基本资料、术后并发症、预后、总体生存率及无进展生存率比较,差异无统计学意义。 结论对于T1bSM2期食管鳞状细胞癌,内镜切除术也是一种可以选择的治疗方式。     

Early esophageal cancer: pattern of lymphatic spread and prognostic factors for long-term survival after surgical resection

OBJECTIVE: The objective of this study was to assess the prevalence and pattern of lymphatic spread in patients with early squamous cell and adenocarcinoma and identify prognostic factors for long-term survival after resection and lymphadenectomy. SUMMARY BACKGROUND DATA: Limited endoscopic approaches without lymphadenectomy are increasingly applied in patients with early esophageal cancer. MATERIAL AND METHODS: A total of 290 patients with early esophageal cancer (157 adenocarcinoma, 133 squamous cell cancer) had surgical resection with systematic lymphadenectomy. Specimens were assessed for prevalence and pattern of lymphatic spread. Prognostic factors were determined by multivariate analysis. RESULTS: None of the 70 patients with adenocarcinoma limited to themucosa had lymphatic spread, as compared with 2 of 26 with mucosal squamous cell cancer. Lymphatic spread was more common in patients with submucosal squamous cell cancer as compared with submucosal adenocarcinoma (36.4% versus 20.7%). Although lymph node metastases were usually limited to locoregional lymph node stations in early adenocarcinoma, distant lymphatic spread was frequent in early squamous cell cancer. On multivariate analysis, only histologic tumor type and the presence of lymph node metastases were independent predictors of long-term survival. Five-year survival rate was 83.4% for early adenocarcinoma versus 62.9% for early squamous cell cancer and 48.2% versus 79.5% for patients with/without lymphatic spread. DISCUSSION: Prevalence and pattern of lymphatic spread as well as long-term prognosis differ markedly between early esophageal squamous cell and adenocarcinoma. Limited resection techniques and individualized lymphadenectomy strategies appear applicable in patients with early adenocarcinoma.     

Endoscopic mucosal resection as a staging technique to determine the depth of invasion of esophageal adenocarcinoma

Background

Endoscopic ablation and vagal-sparing esophagectomy offer the potential for reduced morbidity in patients with high-grade dysplasia or early esophageal adenocarcinoma, but neither includes a lymphadenectomy. Although adequate for intramucosal tumors, both are potentially inadequate for patients with submucosal tumor invasion given the high prevalence of nodal metastases with these lesions. Currently there is no test including endoscopic ultrasound that can accurately determine whether a small tumor is confined to the mucosa or has penetrated into the submucosa. The aim of this study was to compare the pathologic depth of invasion by endoscopic mucosal resection with findings and outcome after surgical resection to assess the accuracy and reliability of endoscopic mucosal resection for staging early esophageal adenocarcinoma.

Methods

From 2001 to 2003, 7 patients presented with small, endoscopically visible adenocarcinomas. All underwent endoscopic mucosal resection followed by surgical resection.

Results

Analysis of the resected specimens confirmed that the endoscopic mucosal resection had accurately determined the depth of tumor invasion in all patients, and had completely excised the lesion in all but 1 patient (86%). Lymph node dissection was included as part of the resection in 2 patients with submucosal invasion by endoscopic mucosal resection, and a vagal-sparing esophagectomy was used in the 5 patients with only intramucosal tumors. All patients are alive and disease-free at a median follow-up of 7 months.

Conclusions

Endoscopic mucosal resection accurately determines the depth of tumor invasion, and should be used as a staging procedure in patients with early esophageal cancer when therapies that do not include a lymphadenectomy are considered.     

Endoscopic contact Nd:YAG laser resectional vaporization (ECLRV) and esophageal dilatation (ED) in advanced malignant obstruction of the esophagus.

Malignant esophageal obstruction in patients with advanced and metastatic carcinoma is unsuitable for surgery. Palliative treatment must provide adequate swallowing with minimum complications in these often seriously ill patients. Twenty consecutive patients underwent endoscopic Nd:YAG contact laser resection and vaporization (ECLRV) and esophageal dilatation (ED) for advanced esophageal carcinoma since August, 1985. Average duration of the disease when first referred was 7.2 months. Tumor cell type was either squamous cell carcinoma (n = 11) or adenocarcinoma (n = 9). Tumor location was distal (n = 14), middle (n = 5), or upper (n = 2). Mean tumor length was 7.5 cm. Mean preoperative luminal diameter was 1 mm, with total obstruction in ten (50%) patients. The operative procedure in all patients was under general anesthesia with endotracheal tube intubation. Rigid and flexible endoscopes were both used as indicated. Mean postoperative luminal diameter was 15 mm. All but four were able to swallow fluids on the first postoperative day, followed by semisolids the next day without discomfort. Minor perforation was noted in three cases and managed in two conservatively. One more patient had difficulty in swallowing due to extra-esophageal compression, in spite of a technically successful laser therapy. Percutaneous endoscopic gastrostomy (PEG) was carried out in eight cases. Eleven patients were retreated successfully for recurrent obstruction and two were treated more than twice, at a mean of six-week intervals. Endoscopic contact laser resectional vaporization with esophageal dilatation was relatively safe and provided an improved quality of life in this preliminary study group, providing a mean survival of 18.5 weeks (range 2-50 weeks).     

�ھ��Ĥ�°��������������Ӧ֤��������ʳ���۰�69����Ч����

??Outcomes evaluation of endoscopic submucosal dissection for relative indication group of early esophageal squamous cell carcinoma in aged patients: An analysis of 69 cases LI Bing??QI Zhi-peng??ZHOU Ping-hong??et al. Endoscopy Center and Endoscopy Research Institute??Zhongshan Hospital??Fudan University??Shanghai 200032??China
Corresponding author??ZHONG Yun-shi??E-mail??zhong.yunshi@zs-hospital.sh.cn
Abstract Objective To evaluate the safety??efficacy and long-term outcomes of endoscopic submucosal dissection (ESD) for relative indication group of early esophageal squamous cell carcinoma in aged patients. Methods The clinical data of early esophageal squamous cell carcinoma treated by ESD from January 2008 to December 2013 in the Endoscopy Center of Zhongshan Hospital, Fudan University were analyzed retrospectively. A total of 69 cases of elderly patients were with the relative indications from the part of endoscopic treatment of Guidelines for Diagnosis and Treatment of Carcinoma of the Esophagus April 2012 edited by the Japan Esophageal Society and no additional treatment were picked out. The incidence of complications and long-term outcomes were observed and analyzed. Results 62 (89.9%) cases were infiltrated to muscularis muscular (M3)??7 (10.1%) cases were infiltrated into submucosal within 200 μm (SM1); 6 (8.7%) cases were lymphatic infiltration. There were 1 (1.4%) case with postoperative bleeding who underwent endoscopic hemostatic procedures after the ESD??2 (2.9%) cases with perforation who underwent the endoscopic suturing closure and 22 (31.8%) cases with esophageal stricture after operation. The recurrence rate was 11.6% (8/69) and the median recurrence time was 24 months. Liver and lymph node metastasis were existed in 1 case. As a result??the 5-year disease-free survival rate was 86.2%. The 5-year overall survival rate was 90.0% in the case of 4 patients (5.8%) died??and the median survival time was 56 months. Conclusion ESD could achieve comparatively ideal long-term outcomes in the treatment of early esophageal squamous cell carcinoma of aged patients without additional treatment, which has high safety and effectiveness.     

Carinal resection for bronchogenic carcinoma

The purpose of this study was to evaluate the results of carinal resection for bronchogenic carcinoma in our institute. From 1981 to 1999, 24 carinal resection were performed for squamous cell carcinoma (n = 19), adenoid cystic carcinoma (n = 2), small cell carcinoma (n = 1), adenocarcinoma (n = 1), and mucoepidermoid carcinoma (n = 1). Nineteen underwent sleeve pneumonectomy, 2 had carinal resection without lung resection, 2 had carinal resection with right middle and lower lobectomy, and 1 had wedge pneumonectomy. In the patients with sleeve or wedge pneumonectomy, there were 5 operative death and 3 patients had survived for more than 3 years. Two patients with low-grade malignant tumors underwent carinal resection without lung resection and survived more than 10 years. We believe that limited carinal resection for low-grade malignant tumors are safe and valuable procedure. Careful selection of patients with sleeve or wedge pneumonectomy is mandatory.