内镜直视下放置食管支架治疗食管狭窄的可行性研究

１９９６年１２月起,我院采用国产食管金属带膜支架在内镜直视下放置的方法,治疗各种良、恶性疾病所致的食管狭窄,收到良好的效果,现报道如下：一、临床资料：本组共３２例,男２２例,女１０例,年龄４０～８４岁,平均６５岁;食管癌术后吻合口狭窄１１例,食管癌术后复发６例,无法手术食管癌８例,贲门癌４例;食管癌放疗后狭窄３例。狭窄长度为３～１５ｃｍ,其中３～５ｃｍ２２例,６～１０ｃｍ８例,１０ｃｍ以上２例。狭窄内径为０．３～０．５ｃｍ,狭窄位于食管上段１例,中段１７例,下段１４例。临床均有吞咽困难,按吞咽能…     

镍钛记忆合金内支架治疗高位食管癌性狭窄的临床研究

１９９８年９月－２０００年１１月,我院经内镜直视下,用镍钛记忆合金内支架治疗晚期食管癌及食管支气管疹患者３６例,提高患者的生活质量,近期疗效显著。 一、治疗对象：本组男２７例,女９例,年龄４５～８４岁,平均６７岁。发病至就诊时间０．５～７２个月,平均６．２４月。均经内镜检查病理证实为食管上段鳞癌,其中晚期食管癌性狭窄２４例,食管癌放疗后复发５例,食管癌术后吻合口复发４例,食管支气管瘘３例。病灶长度１－１３ｃｍ,平均６．３４±２．６７ｃｍ。瘘口大小 ０．５～０．８ｃｍ２例,１ｃｍ１例。吞咽困难按Ｓｔ…     

带膜食管支架治疗食管癌并发食管气管瘦7例体会

近３年来,我院应用带膜食管支架治疗食管癌并发食管气管瘘患者７例,取得较满意疗效,现报告如下。 临床资料：本组男５例,女２例;年龄５２～７５岁。均为晚期食管中上段癌。主要临床表现为进行性吞咽困难５～９个月,突发进食呛咳２～４天,其中４例为放疗两疗程后突发,５例有不同程度的肺部炎症。食管吞钡造影示食管病变长５～１０ｃｍ,瘘口 ０．３～０．６ｃｍ。诊断为食管气管瘘４例,食管左主支气管瘘２例,食管右主支气管瘘１例。 治疗方法：所用支架为不锈钢丝“Ｚ”型骨架,内外覆以硅橡胶薄膜,长１０～１４ｃｍ,内径１．４…     

内镜下微波合并扩张术治疗食管狭窄15例报告

我院１９９３年２月～１１月在内镜直视下应用微波和食管扩张器综合治疗食管良恶性狭窄１５例，共２２次，取得良好效果，现报告如下。１．一般资料：本组１５例均为男性，年龄１８－７０岁，平均５１岁，其中食管癌、食管贲门癌术后吻合口良性狭窄及吻合口复发癌１３例；放疗后复发癌１例；重度食管静脉曲张治疗后疤痕性狭窄１例。狭窄部位：食管上段２例，中段１０例，食管－胃吻合口３例。狭窄长度：＜２ｃｍ７例，２－３ｃｍ３例，４－５ｃｍ３例，环形膜状狭窄２例。狭窄症状程度和时间：滴水不进３例，仅能进流汁１２例。症状持续时间…     

食管结核误诊为食管癌2例报告

例１　女,４９岁。自觉吞咽受阻,纳差一年,加重半月。钡餐Ｘ线透视示：食管中、下段可见３．０ｃｍ长之管腔狭窄,该段粘膜显示破坏中断,以上管腔轻度扩张,并有逆蠕动。胃镜所见;距门齿３５～３８ｃｍ处之食管后壁粘膜粗大、溃烂,有１．５ｃｍ×２．０ｃｍ×１．０ｃｍ之包块,边界不清,表面高低不平,质较硬、脆,触之出血,表面覆白厚苔,活检病理报告为鳞状细胞重度不典型增生。临床不能确诊,即去外地医院检查,诊断为食管癌,行手术治疗,术后病检确诊为食管结核。经抗结核,抗炎及支持治疗半年后痊愈。例２　男,６０岁。因吞…     

右胸,上腹双切口行中,下段食管癌切除86例报告

１９９４～１９９８年,我们采用右胸、上腹双切口行胸中下段食管癌切除、胃食管右胸顶部吻合重建消化道８６例,取得较好效果。现报告如下。１　临床资料本组男７７例,女９例;年龄３６～７４岁;病程２０天至１１个月。术前均诊断为食管癌,均有程度不同的吞咽困难。病变位于胸中段食管７４例,胸下段食管１２例;病变长度为３～１１ｃｍ,平均６．３ｃｍ。本组均采用右胸、上腹双切口行食管癌切除、胃食管右胸顶部吻合术（其中５例用吻合器吻合）。食管癌病变全部切除,病理报告为鳞癌８３例,鳞腺癌１例,小细胞未分化癌１例,食管结…     

改良隧道式食管胃吻合术治疗食管贲门癌96例

目的研究治疗食管贲门癌减少吻合口瘘、增强抗反流效果、防止吻合口狭窄的术式。方法对隧道式食管胃吻合术作如下改进：①在隧道下口下方１ｃｍ处另作切口进行吻合，加强吻合口后壁，使重建后的Ｈｉｓ角锐化；②隧道宽于食管横径１＿１５ｃｍ。治疗食管贲门癌９６例。男５７例，女３９例；年龄４２－７３岁；其中食管癌６４例（中段３９例，下段２５例），贲门癌３２例。结果本组９６例全部成功，皆无吻合口瘘，术后２个月钡餐Ｘ线检查无吻合口狭窄，无胃食管反流。结论改良隧道式食管胃吻合口术可增强抗反流效果，防止吻合口狭窄。     

食管下段弥漫性肌肉肥大一例

病例：女性,２５岁。３个月前出现纳差、嗳气,伴进食后胸闷、上腹饱胀、阵发性胸骨后疼痛和吞咽困难而就诊。查体：体温３６．５℃;心率８０次／分;呼吸１８次／分;血压１６／１０ｋＰａ。营养较差,消瘦,神志尚清,双肺呼吸音轻,浅表淋巴结未及肿大,皮肤粘膜无黄染。Ｂ超检查示：肝、胆、脾未见异常。Ｘ线检查示：贲门失弛缓症。术中见食管下段至贲门部壁层呈均匀性增厚,边界清,上段食管扩张,切除标本送检。病理检查：带部分胃切除食管一段,胃９ｃｍ×５ｃｍ,未见明显病变;食管长１２ｃｍ,病变长１０．５ｃｍ,周长１２ｃｍ…     

腔内置管放疗、热疗及局部给药治疗晚期食管癌

晚期食管癌患者的最大威胁是食管狭窄 ,吞咽困难 ,营养不济而迅速失去生命。我们采用食管腔内置管低剂量率照射、同步腔内射频温热及腔内局部用药的联合治疗手段 ,治疗 36例晚期食管癌患者 ,取得明显疗效。一、对象和方法1 对象 :36例食管癌患者 ,男 2 5例 ,女 11例 ,年龄 44～86岁 ,平均年龄 72 5岁。全部病例均为以吞咽困难为主诉的晚期食管癌患者。病变部位 :上段 3例 ,中段 2 1例 ,下段12例。病灶长度 :>10ｃｍ 8例 ,10～ 4ｃｍ 2 3例 ,<4ｃｍ 5例。病理检查 :鳞癌 31例 ,腺癌 3例 ,2例未能进行病理分型。2 器材 :硅橡胶热放疗四腔单…     

内镜引导气囊扩张术临床应用

近一年来我们采用内镜引导气囊扩张术治疗食管、贲门及其手术后吻合口狭窄２４例，取得较好疗效，优于其它扩张方法，介绍如下：一、临床资料：男１６例，女８例，年龄１５～６８岁，平均４６岁。原发病为：食管癌６例、贲门癌３例，贲门失弛缓症２例，误服硫酸后食管狭窄１例，食管癌和贲门癌术后吻合口狭窄１２例。均有进流质困难，食后呕吐，胸骨后疼痛，消瘦，严重营养不良等症状，经作食管吞钡检查，狭窄部宽０．２～０．６ｃｍ，长０．３～１．５ｃｍ。二、方法：气囊管的制备：取直径２～３ｍｍ较硬质地塑料管６０～８０ｃｍ长，前端…     

A comparative study of the lengths of different reconstruction routes used after thoracic esophagectomy

Background

A challenge in esophageal reconstruction after esophagectomy is that the distance from the neck to the abdomen must be replaced with a long segment obtained from the gastrointestinal tract. The success or failure of the reconstruction depends on the blood flow to the reconstructed organ and the tension on the anastomotic site, both of which depend on the reconstruction distance. There are three possible esophageal reconstruction routes: posterior mediastinal, retrosternal, and subcutaneous. However, there is still no consensus as to which route is the shortest.

Methods

The length of each reconstruction route was retrospectively compared using measurements obtained during surgery, where the strategy was to pull up the gastric conduit through the shortest route. The proximal reference point was defined as the left inferior border of the cricoid cartilage and the distal reference point was defined as the superior border of the duodenum arising from the head of the pancreas.

Results

This study involved 112 Japanese patients with esophageal cancer (102 men, 10 women). The mean distances of the posterior mediastinal, retrosternal, and subcutaneous routes were 34.7?±?2.37 cm, 32.4?±?2.24 cm, and 36.3?±?2.27 cm, respectively. The retrosternal route was significantly shorter than the other two routes (both p?<?0.0001) and shorter by 2.31 cm on average than the posterior mediastinal route. The retrosternal route was longer than the posterior mediastinal route in only 5 patients, with a difference of less than 1 cm.

Conclusion

The retrosternal route was the shortest for esophageal reconstruction in living Japanese patients.

     

Esophagectomy in esophageal perforations: an analysis

This study aimed to study the factors that are associated with urgent esophagectomy for the treatment of esophageal perforations and the impact of this therapy. A retrospective review of all esophageal perforations treated at a tertiary care hospital from January 1984 to January 2012 was performed. Compiling demographics, cause and site of perforations, time to presentation, comorbidities, radiological tests, the length of perforation, the hemodynamic status of the patient, type of treatment required, and outcomes were performed. Univariate, multivariate, and Cox regression analyses were conducted. Of 127 cases of esophageal perforation, it was spontaneous in 44 (35%), iatrogenic in 53 (44%), foreign body ingestion in 22 (17%), and traumatic perforation in 7 (6%) cases. Overall, 85 of the 127 (67%) patients were managed operatively, 35 (27.6%) patients were treated conservatively, and 7 (6.3%) patients were treated by endoscopic stent placement. Of the 85 patients who were managed operatively, 21 (16.5%) required esophagectomies, 13 (15.3%) had esophagectomy with immediate reconstruction, 5 (5.9%) patients had esophagectomy followed by delayed reconstruction, and 3 (3.5%) patients failed primary repair and required an esophagectomy as a secondary definitive procedure. Multivariate analysis revealed that esophagectomy in esophageal perforations was associated with the presence of benign or malignant esophageal stricture (P = 0.001) and a perforation >5 cm (P = 0.001). Mortality was mainly associated with the presence of a benign or malignant esophageal stricture (P = 0.04). The presence of pre‐existing benign or malignant stricture or large perforation (>5 cm) is associated with the need for an urgent esophagectomy with or without immediate reconstruction. Performing esophagectomy was not found to be a significant prognosticator for mortality.     

Motility of the transverse colon used for esophageal replacement

The authors studied the motility of transverse colon used for reconstruction of the pharyngogastric transit after esophagectomy. The study included 10 patients who underwent esophagectomy 15 to 201 months (median, 48.5 months) before motility evaluation. Nine patients underwent operation because of caustic injury and one, because of esophageal cancer. The age of the patients ranged from 19 to 54 years (median, 36 years). A manometric esophageal catheter with five side holes spaced 5 cm apart (using the continuous perfusion method) was used to record motility. In three patients, it was not possible to introduce the manometric catheter inside the colon interposition. In the other seven, most of the time there was no contraction when motility was recorded. In four, there was contraction only in the segment 2 to 5 cm below the upper esophageal sphincter. In three, there were peristaltic or simultaneous contractions of long duration, sometimes associated with dry or wet swallows. The motility of colon interposition used to restore transit after esophagectomy is similar to that described for the colon. The contractions may be the consequence of graft distention after successive swallows.     

EMR combined with chemoradiotherapy: a novel treatment for superficial esophageal squamous-cell carcinoma

BACKGROUND: Esophagectomy or chemoradiotherapy (CRT) are the procedures of choice for patients with superficial esophageal squamous-cell carcinoma. However, esophagectomy is highly invasive, and CRT is associated with the risk of local failure. A study was conducted of a novel treatment, EMR combined with CRT, for patients with superficial esophageal carcinoma. EMR was performed for the purpose of complete local tumor control and chemoradiotherapy was performed for regional and distant control. METHODS: EMR combined with CRT was performed for patients with esophageal carcinoma invading the muscularis mucosae or upper submucosa who refused esophagectomy. The planned treatment after EMR was 40 to 46 Gy of external beam radiation to the mediastinum, including the supraclavicular fossa or cardia. Chemotherapy was given during weeks 1 and 5 (5-fluorouracil, 700 mg/m(2) per 24 hours in a 120-hour infusion, and cisplatin 15 mg/m(2) per day intravenously on days 1 to 5). RESULTS: During the study period, 16 patients underwent EMR combined with CRT (EMR plus CRT group) and 39 patients with similar stage cancer underwent esophagectomy (surgical resection group). None of the patients in the EMR plus CRT group have had local recurrence or metastasis. Overall survival rates at 5 years in the EMR plus CRT and surgical resection groups were estimated to be, respectively, 100% and 87.5%. CONCLUSIONS: Although this study was not randomized, the results suggest that EMR combined with CRT is a safe and effective method for treating patients with superficial esophageal carcinoma. The results were equivalent or, in view of the lower degree of invasiveness, superior to surgical resection.     

Tumor seeding of the jejunostomy site after transhiatal esophagectomy for esophageal carcinoma

A 65-year-old male patient with squamous cell carcinoma of the esophagus had a transhiatal esophagectomy after a prophylactic tube jejunostomy. The tube was removed 3 weeks after surgery. Ten months later, a painless 2-cm abdominal mass was noted at the previous jejunostomy site. Subsequent segmental resection of the jejunum disclosed metastatic squamous cell carcinoma of the esophagus. It is possible that tumor seeding may develop at the jejunostomy site after transhiatal esophagectomy for esophageal carcinoma.     

Surgical resection of gastrointestinal stromal tumor of esophagus following preoperative imatinib treatment: a case report

We report a case of esophagectomy after a primary esophageal gastrointestinal stromal tumor (GIST) was preoperatively treated with imatinib mesylate. A 71-year-old woman was diagnosed with an esophageal submucosal tumor by upper gastrointestinal endoscopy at her health checkup. The tumor was located at the lower thoracic esophagus immediately above the esophagogastric junction and measured 4.5 cm in size. It was diagnosed as GIST of the esophagus for reasons of its high susceptibility to imatinib mesylate. Preoperative treatment with imatinib was performed in an attempt to preserve the esophagus. Although the tumor size was decreased by 36% after the 6-month treatment, transhiatal esophagectomy was required for complete resection, and esophageal preservation could not be accomplished.     

Clinical application of gastrointestinal decompression in anastomotic fistula after McKeown esophagectomy for esophageal cancer

AbstractCervical anastomotic fistula is one of the most common complications after McKeown esophagectomy for esophageal cancer, leading to septic shock and even death. It is therefore very important to provide effective symptom management after diagnosis of anastomotic fistula. Placing the gastrointestinal decompression tube beside the anastomotic site and connecting the tube to a gastrointestinal decompression disk could support the prevention and treatment of anastomotic fistula after surgical treatment of esophageal cancer.Thirty-eight patients with anastomotic fistula after undergoing McKeown esophagectomy for esophageal cancer in our hospital from April 2017 to January 2021 were divided equally into control and observation groups according to the gastrointestinal decompression method used. Gastrointestinal decompression tubes were placed 45 to 50 cm from the incisors in the control group or 25 to 30 cm from the incisors in the observation group. The treatment efficacy was compared between the 2 groups.The drainage time, length of hospital stay after anastomotic fistula detection, and fistula healing time in the observation group were significantly shorter than those in the control group (P < .05 for all).Placing the gastrointestinal decompression tube connected to a gastrointestinal decompression disk next to the anastomotic site is a simple procedure and may significantly improve the drainage time, length of hospital stay, and fistula healing time of patients who develop anastomotic fistula resulting from McKeown esophagectomy for esophageal cancer.     

Esophageal reconstruction with remnant stomach:A case report and review of literature

The number of patients developing esophageal cancer after gastrectomy has increased.However,gastric remnant is very rarely used for reconstruction in esophageal cancer surgery because of the risk of anastomotic leakage resulting from insufficient blood flow.We present a case of esophageal cancer using gastric remnant for esophageal substitution after distal gastrectomy in a 57-year-old man who presented with a 1-month history of mild dysphagia and a background history of alcohol abuse.Gastroscopy showed a 1.2 cm × 1.0 cm bulge tumor of the lower third esophagus with the upper margin located 39 cm from the dental arcade.Computed tomography of the chest showed lower third esophageal wall thickening.The patient underwent en bloc radical esophagectomy with a two-field lymph node dissection of the upper abdomen and mediastinum via a left-sided posterolateral thoracotomy through the seventh intercostal space.The upper end of the esophagus was resected 5 cm above the tumor.The gastric remnant was used for reconstruction of the esophago-gastrostomy and placed in the left thoracic cavity.The patient started a liquid diet on postoperative day 8 and was discharged on the 10 th postoperative day without complications.In this report,we demonstrate that the gastric remnant may be used for reconstruction in patients with esophageal cancer as a substitute organ after distal gastrectomy.     

Survival outcomes of 220 consecutive patients with three‐staged thoracoscopic esophagectomy

Patients with thoracic esophageal cancer are often treated by minimally invasive esophagectomy. However, the long‐term survival benefits of minimally invasive esophagectomy remain unclear. Two approaches are available for thoracoscopic surgery: one with the patient in the left lateral decubitus position (LLDP), and the other with the patient in the prone position (PP). We investigated the survival benefit of thoracoscopic esophagectomy according to the tumor stage and patient position during the thoracoscopic procedure. We reviewed the records of 220 consecutive patients with esophageal cancer treated from 1998 to 2012. In total, 146 and 74 patients were treated with thoracoscopic esophagectomy in the LLDP and PP, respectively. No patients were initially proposed to be candidates for esophagectomy by thoracotomy during the study period. Data collection was performed with a focus on survival and recurrent disease. Among all the 220 patients, the overall 5‐year survival rates were 83.7%, 74.1%, 45.5%, 78.6%, 44.2%, 29.4% and 24.3% in the patients with pStage IA, IB, IIA, IIB, IIIA, IIIB and IIIC disease, respectively. Despite the greater number of dissected mediastinal lymph nodes in the PP procedure, there were no significant differences in the survival curves between the LLDP and PP procedures. The long‐term results of thoracoscopic esophagectomy are comparable and acceptable. The PP procedure was not confirmed to offer a superior survival benefit to the LLDP procedure in this retrospective study.     

A case of superficial carcinoma of the esophagus on esophageal varices

We report a case of superficial esophageal carcinoma in a patient with esophageal varices. Esophagogram revealed a 2 cm large irregular mucosal elevation during work-up for esophageal varices which was acertained on endoscopical examination to be carcinoma. Biopsy material showed moderately differentiated squamous cell carcinoma. Subtotal esophagectomy was performed followed by reconstruction by cervical esophagogastrostomy through the retrosternal route. Few resected cases of esophageal carcinomas accompanied by esophageal varices have been reported because 1) early radiographic abnormalities of small superficial esophageal carcinomas can be overlooked in the case of large varices and 2) the number of operable cases is limited because of associated liver cirrhosis.