贲门失弛症并发食管癌与贲门癌

目的提高贲门失弛症并发食管、贲门癌的诊断和治疗水平.方法回顾12例贲门失弛症伴发食管、贲门癌的诊断治疗和病理.结果 12例贲门失弛症伴发食管、贲门癌病例中,手术治疗4例,其中2例生存超过3年.1例于手术后半年死亡,1例术后不足半年,放化疗6例,均于半年至一年半内死亡.结论 1.食管、贲门癌易被贲门失弛症的症状所掩盖.2. Heller手术并不能降低食管癌的发生率,应每年随访1次. 3.贲门失弛症伴发食管癌发生比率较高,也是食管癌的高发人群.4 .术后病人如有症状早就诊可以早期发现.5 .同时发生癌和异时发生癌的机会相近.Heller术前应常规内镜检查排除食管贲门癌以防漏诊.     

早期食管癌自然生存状态的长期观察

目的 观察拒绝治疗的早期食管癌患者的自然发展状态.方法 1985年至1990年间,在河南省林州市食管癌高发现场,完成内镜筛查4800例.按内镜下观察为浅表黏膜病变,经活检病理诊断为原位癌、黏膜内癌或鳞癌的标准,共检出132例早期食管癌患者,其中48例因不同原因拒绝治疗.对48例未经治疗的食管癌患者进行随访,观察其自然发展状态.随访期间,有40例患者曾做过1～4次内镜复查.结果 随访至2005年12月31日,48例患者中,5例仍生存,43例死亡,其中死于食管癌者38例,占79.2%;死于非癌疾病者5例,占10.4%.全组生存时间≥5年者37例,患者的5、10、15和20年生存率分别为77.1%、39.6%、25.0%和10.4%.结论 食管癌从早期发展到晚期是一个漫长的演变过程,这对于食管癌的早期诊断和选择治疗时机很有帮助.如果要评价早期食管癌的治疗效果,应充分考虑其自然发展史的领先时间偏倚.     

贲门腺棘癌四例报告

贲门腺棘癌临床上少见,作者等手术切除4例,占同期手术治疗贲门癌的0.4％(4/1000),现报告如下。例1,男,50岁。因上腹部饱胀伴进食不畅1年。X线消化道钡餐检查诊断贲门癌,剖左胸手术切除(R_1)。贲门部溃疡型癌5×4.5cm,已外侵浆肌层。病理诊断贲门腺棘癌。术后生存3个月死于肝转移。例二,男,59岁。因食后上腹疼痛和进食受阻     

放疗同时化疗治疗晚期贲门癌

回顾分析了 90例晚期贲门腺癌患者的临床资料 ,随机分为放化组、单放组、单化组 ,其 3、5年生存率分别为32 4%、12 5 % ;4 8%和 18 9% ;3 1%、0。结果提示 ,晚期贲门癌放射治疗同时化疗能提高患者的长期生存率。     

脐尿管癌14例临床分析

背景与目的:脐尿管癌临床少见.本研究旨在探讨脐尿管癌的诊断与治疗方法,以提高其疗效.方法:回顾性分析中山大学肿瘤防治中心及中山大学附属第一医院1994年5月至2007年4月收治的14例脐尿管癌临床资料.结果:本组患者最常见的临床症状为血尿和膀胱刺激症状,膀胱镜检查主要表现为膀胱顶部宽基底肿物,影像学检查征象常见膀胱顶前壁与腹壁之间质软组织肿块影,常浸润膀胱壁.本组病例腺癌13例,恶性间质细胞瘤1例.7例行扩大性膀胱部分切除术患者中,1例术后24个月局部复发,6例随访14～120个月,中位随访42个月无复发:3例行全膀胱切除 尿流改道术,其中2例分别随访16个月和84个月无复发,1例术后3个月死于手术并发症;1例在外院行膀胱部分切除术,术后10个月局部复发;3例晚期未切除者行化疗,2例肿瘤无进展生存7个月和8个月,1例化疗后6个月死于肿瘤.本组病例1年、5年生存率分别为85.7%和61.2%.结论:扩大性膀胱部分切除术是值得推荐的手术方式.首次手术彻底切除肿瘤及对晚期及术后复发转移患者积极的综合治疗,是提高脐尿管癌疗效的关键.     

同时性食管及贲门双原发癌的诊断和外科治疗

目的:探讨食管贲门双原发癌的诊断和外科治疗方法.方法:对21例食管贲门双原发癌病例的临床资料进行回顾性分析.结果:21例中1例失访.随访1年生存率70.0%(14/20);3年生存率47.1%(8/17);5年生存率16.7%(2/12).结论:及时发现食管贲门双原发癌、扩大切除范围可有效提高患者生存时间.     

胃镜下微波凝固治疗食管 贲门-胃底癌348例临床疗效评价

目的:评价微波凝固疗法治疗晚期食管癌和贲门-胃底癌348例的临床疗效.方法:选择晚期食管癌142例和晚期贲门-胃底癌206例为治疗组,选择放弃任何治疗的晚期食管癌和贲门-胃底癌102例为对照组,在胃镜下对治疗组瘤体进行微波凝固疗法,对照组仅进行支持对症治疗.结果:经1～2个疗程微波凝固疗法,治疗组有效率为92.82%,6、12、18和24个月累积生存率分别为97.0%、88.6%、81.0%、72.1%.生存期为9.5±1.4个月,最长为3年.而对照组病情逐渐加重,6、8和12个月的累计生存率分别为55.0%、31.0%和0,生存期为3.5±0.67个月,且微波凝固治疗费用低、创伤和并发症少.结论:微波凝固疗法是治疗晚期食管癌和贲门-胃底癌较理想的方法之一,有利于缓解癌性狭窄,提高患者的生存时间.     

早期贲门癌及癌前病变的内镜微创治疗研究

目的：内镜微创治疗早期贲门癌及癌前病变，探讨治疗价值。方法：应用内镜黏膜切除（Endoscopic mucosal resection。EMR）和氩离子凝固（Argon plasma coagulation，APC）方法治疗高发区门诊及内镜筛检出的早期责门癌及癌前病变104例108个病灶，统计分析病变位点分布、适应证、并发症及随访情况。结果：1）74．1％的病灶位于贲门12点至3点位，25．9％的病灶位于其他点位，差异有统计学意义（P〈0．01）。2）EMR治疗前后病理：有4个病灶为中度不典增生、术后1个病灶被诊断为黏膜内癌；有36个病灶重度不典型增生，其中术后有3个病灶被诊为黏膜内癌，1个病灶被诊为早期浸润癌；10个病灶黏膜内癌，术后1个灶诊为早期浸润癌。3）EMR组治疗成功率96％，2个灶术后诊为早期浸润癌追加手术。4）APC组早期贲门癌治疗成功率为83．3％，癌前病变治疗成功率为100％。5）EMR组合并出血发生率为4．0％；APC组出血发生率1．7％，无其他并发症。6）EMR组随访3年生存率为100％，5年生存率为92．3％；APC组5年生存率为100％。结论：1）早期贲门癌及癌前病变存在高发部位，对该部位精细观察和活检，有望提高贲门病变检出率。2）将随诊6个月以上内镜及病理诊断无好转的中度不典型增生纳入治疗范围，可有效避免治疗不足。3）黏膜下注药是减少内镜治疗并发症的重要措施。4）EMR和／或APC治疗方法简便易行、安全有效、易于推广。     

内镜细胞采取器在早期贲门癌诊断中的应用：附100例观察

贲门癌在我国已被列为最常见恶性肿瘤之一。在食管与贲门,贲门与胃的肿瘤中分别占67％和41％。贲门癌发病率高且晚期多,因早期症状轻微,甚至无吞咽碍障,又因贲门部特有的解剖关系,使现有的诊断方法早诊率低而漏诊率高。上海1985年内镜协作组贲门癌1,451例分析中X线照片能肯定贲门癌诊断者占51.48％,可疑癌26.71％,竟有21.8％漏诊,内镜活检阳性率85.94％,刷检阳性率86.94％。食管贲门拉网阳性率较高可达95.65％,对早期诊断有意义。但由于检查时的痛苦大,定位     

原发性卵巢类癌6例及文献复习

目的:探讨卵巢类癌的临床和病理特点、治疗及预后.方法:回顾性分析中国医学科学院中国协和医科大学肿瘤医院1975年9月～2008年9月治疗的6例原发性卵巢类癌临床病理资料,并进行文献复习.结果:6例患者中5例(83.3%)发生下腹痛症状,检查发现盆腹腔肿物;2例(33.3%)发生类癌综合征表现;2例合并卵巢畸胎瘤.全部患者接受手术治疗,术后均无辅助治疗.病理组织学类型分别为:岛状型4例,小梁型1例,粘液型1例.手术病理分期:Ⅰ A期3例,Ⅰ C期3例.1例Ⅰ C期患者术后1个月发生肿瘤复发转移,行全身化疗后肿瘤未控.术后5个月死于本病.其余54例患者随诊9个月至33年,除1例死于原发肺癌外,4例均无瘤生存.结论:原发卵巢类癌非常罕见,诊断需除外转移性类癌.本病为低度恶性,早期患者可单纯手术治疗.多数预后良好.本组复发病例化疗疗效差.     

Aneuploidy of tumor cells in cases of gastric cancer with esophageal invasion: Another indicator of poor prognosis

The prognosis of patients with gastric cancer with esophageal invasion is extremely poor. To evaluate factors related to this poor prognosis, we analyzed 200 patients with gastric cancer located in the upper third of the stomach. These patients underwent gastrectomy and were divided into two groups in terms of the presence (E[+] group; n=62) or absence (E[-] group; n=138) of histological evidence of esophageal invasion. Even when apparently curative surgery was performed, the 5-year survival rate of patients with E[+] gastric cancer (45.8%) was significantly lower than of patients with E[-] gastric cancer (71.6%). In the E[+] group, the 5-year survival rate of patients who had tumors with infiltrative growth and DNA aneuploidy was only 10.0%. These patients had a high frequency of peritoneal metastasis at operation (5/16; 31.3%); even when apparently curative operations were performed, 50% of these patients died from peritoneal metastatic recurrence within 2 years after surgery. Gastric adenocarcinoma with esophageal invasion accompanied by infiltrative growth and DNA aneuploidy had a high potential for peritoneal metastasis. This combination is associated with the most pessimistic prognosis for patients with gastric cancer with esophageal invasion. © 1995 Wiley-Liss, Inc.     

残胃癌的临床病理特征及预后分析

目的探讨残胃癌的临床病理特征及预后相关因素。方法回顾性分析45例残胃癌患者的临床病理资料,并进行随访。结果45例残胃癌患者的男女比例为44：1。初次手术距残胃癌的诊断时间为5～42年,平均23年。残胃病变位于吻合口28例,位于贲门9例,其余部位8例。未分化癌1例,低分化腺癌36例,中分化腺癌7例,高分化腺癌1例。根治性切除患者的1、3、5年生存率分别为100．0％、78．8％和47．2％,非根治性切除患者的1、3、5年生存率分别为62．5％、25．0％和0,两组患者生存率差异有统计学意义（P〈0．05）。10例病变未切除患者均于2年内死亡,平均生存时间为12个月。各病理分期患者间生存率差异有统计学意义（P〈0．05）。结论残胃癌多于Billroth Ⅱ式胃大部切除术后10年以上发生,男性多于女性,病变主要位于吻合口附近。进展期残胃癌病理类型以低分化腺癌常见。残胃癌的预后与病理分期、能否行根治性切除密切相关。     

Surgical therapeutic planning for non-small cell lung cancer

The survival rates of 380 resected cases of lung cancer in our hospital were analyzed according to curability and histological cell type. The overall 5-year survival rate for stage I a cases was 64.5%, that for stage I b 52.3%, and that for stage II 26.7%. However, there were distinct differences in survival rates between stages I a-II with mediastinal lymph node dissection and those without mediastinal lymph node dissection. Of these 380 tumors, many were advanced (for instance, stage III tumors comprised 180 cases). T3 tumors had better prognosis (40.7% showing 5-year survival) than N2 tumors (26.7% showing 5-year survival). Among stage III tumors, squamous cell carcinoma (T3: 41%, N2: 36.7% showing 5-year survival) had a better prognosis than adenocarcinoma (T3: 16.1%, N2: 21.4%). T3N2 tumors, however, had such a poor prognosis that the value of surgery in these cases seemed questionable. Adjuvant therapy should therefore be evaluated accurately in future to improve prognosis. It was stressed that a randomized controlled study would be needed to evaluate the effectiveness of adjuvant therapy.     

我国进展期胃癌围手术期行预防性腹腔热灌注化疗的研究进展

胃癌是我国最常见的恶性肿瘤之一, 术后5年生存率仅为10%~49%, 术后腹膜复发是影响其生存率的主要原因。腹腔热灌注化疗经过20多年的研究和发展, 已得到了充分的认识和较好的临床应用效果。预防性应用腹腔热灌注化疗有助于减少术后复发率, 提高胃癌的5年生存率, 改善生存质量, 提升胃癌的总体疗效。本文对近年来我国对进展期胃癌AGC行预防性腹腔热灌注化疗(hyperthermic intraperitonral chemotherapy, HIPEC)的临床开展情况作一综述。      

The prognostic determinants of gastric cancer treatment outcome in Omani Arab patients

BACKGROUND: Gastric cancer is the most common cancer in Oman and a leading cause of cancer death. The variation in survival rates between countries and ethnic groups has been attributed to early detection policies, differences in clinicopathological features, treatment approaches, and biological characteristics. There were no previous reports on gastric cancer from Oman and very few studies on Asian Arabs. AIM: To evaluate the impact of clinicopathological and treatment variables on the survival prospects of Omani Arab patients diagnosed with gastric cancer. METHODS: The medical records of 339 Omani Arab patients diagnosed with invasive gastric adenocarcinoma during the period 1993-2004 were retrospectively reviewed. The relative importance of clinicopathological features and surgical and medical treatments were assessed using univariate and multivariate analyses. RESULTS: Most patients had distal ulcerating-type gastric cancer and presented at advanced stages. The median survival time for the entire cohort was 12 months (95% CI 9.7-14.4) with a 5-year overall survival rate of 16.7%. On univariate analysis of 237 patients who underwent surgical resection, the following positive prognostic factors emerged as significant: early overall TNM stage, early T stage, negative lymph nodes, tumor size <5 cm, ulcerating macroscopic appearance, and curative surgical attempt. The independent prognostic factors on multivariate analysis were T stage and lymph node involvement. CONCLUSION: The overall T and N stages are the most important determining factor for survival in Omani Arab patients. More efforts need to be made for the early detection of gastric cancer in developing countries such as Oman, while continuing to employ the standard surgical and medical treatments.     

吻合口瘘治愈后对预后的影响

本文介绍了１６例食管，贲门癌切除后并吻合口瘘均有胸腔感染和发烧，经治愈后其５年存活率为５０％，明显高于同期同类病人。文章介绍了临床观察资料，并就感染烧对预后的影响作了初步探讨。     

Lymphovascular invasion as a tool to further subclassify T1b esophageal adenocarcinoma

BACKGROUND: Lymphovascular invasion (LVI) and/or lymph node metastases (LNM) adversely influence the overall survival (OS) of patients with T1 esophageal adenocarcinoma. Although endoscopic therapy may be adequate for patients with T1a cancer, patients with T1b cancer require esophagectomy/lymphadenectomy. The authors hypothesized that LVI status would subclassify T1b cancers and facilitate new therapeutic strategies. METHODS: Ninety-nine consecutive patients with T1 adenocarcinoma were analyzed after they underwent esophagectomy/lymphadenectomy. LNM was assessed in all patients, and LVI was assessed in 89 patients. OS was correlated with pathologic cancer stage in association with LVI and LNM. RESULTS: The 5-year OS rate for patients with T1a tumors (88%) was superior to that for patients with T1b tumors (62%; P = .001). The 5-year OS rate for patients who had cancers without LVI (85%) was superior to the rate for patients who had cancers with LVI (36%; P = .0001). It is noteworthy that, for cancers without LVI, the 5-year OS rate for patients with T1b tumors (77%) was similar to the rate for patients with T1a tumors (90%; P = .08), but it was superior to the rate for patients with T1b tumors that had LVI (27%; P = .006). The presence of LVI and/or LNM resulted in worse 5-year OS (< or =37%) compared with the lack of LVI and/or LNM (88%; P < .001). The rate of LNM for patients who had T1b tumors without LVI still was 19%, and the relapse rate was 16%. CONCLUSIONS: The current results demonstrated that LVI distinguishes the biologic behavior of early esophageal cancer, and patients who have T1b cancer without LVI have a clinical biology similar to that of patients with T1a cancer. If LNM before surgery can be diagnosed with high sensitivity by better endoscopic techniques and/or molecular biomarkers, then a new therapeutic paradigm for T1b cancers could emerge. Further research is needed on patients with T1b esophageal adenocarcinoma.     

Incidence,Survival and Prevalence of Esophageal and Gastric Cancer in Linzhou City from 2003 to 2009

This study describes recent trends in incidence, survival and prevalence of subgroups of esophageal and gastriccancer in Linzhou city between 2003 and 2009. Data of esophageal and gastric cancer for the period of interestwere extracted from the Linzhou Cancer Registry. Using information on tumor morphology or anatomical site,data were divided into six groups; esophageal squamous cell carcinoma, esophageal adenocarcinoma, otherand unspecified types of esophageal cancer, and cardia, non-cardia, and unspecified anatomical site of stomachcancer. Incidence, survival and prevalence rates for each of the six cancer groups were calculated. The majorityof esophageal cancers were squamous cell carcinomas (82%). Cardiac cancer was the major gastric cancer group(64%). The incidence of esophageal squamous cell carcinoma and gastric cardiac cancer increased between 2003and 2009. Both esophageal and gastric cancer had a higher incidence in males compared with females. Overallsurvival was poor in all sub-groups with 1 year survival ranging from 45.9 to 65.6% and 5 year survival rangingfrom 14.7 to 30.5%. Prevalence of esophageal squamous cell carcinoma and gastric cardiac cancer was high(accounting for 80% overall). An increased focus on prevention and early diagnosis, especially in esophagealsquamous cell carcinoma and gastric cardiac cancer, is required.     

Quality of Life for Patients with Esophageal/Gastric Cardia Precursor Lesions or Cancer: A One-year Prospective Study

Background: The current study examined health-related quality of life (QoL) for patients with esophageal/gastric cardia precursor lesions or cancer before and after treatment to facilitate improved prevention andtreatment. Materials and Methods: Patients with different stages of esophageal/gastric cardia lesions completedtwo QoL questionnaires, EORTC QLQ-C30 and supplemental QLQ-OES 18, before primary treatment, and at 1,6 and 12 months after treatment. Results: Fifty-nine patients with precursor lesions, 57 with early stage cancer,and 43 with advanced cancer responded to our survey. Patients with precursor lesions or early stage cancerreported better QoL overall than those with advanced cancer before treatment (p<0.01). Global QoL scores beforetreatment and at 1 month after treatment were 71±9 versus 69±9 (p>0.01), 71±8 versus 61±11 (p<0.01), 67 ± 11versus 62 ± 9 (p<0.01) for three stages of lesions. At 6 months after treatment, some QoL measures recoveredgradually in precursor lesion and early cancer patients, while some continuously deteriorated in advancedcancer patients. At 12 months, all QoL scores were comparable to baseline for patients with precursor lesions(p>0.01), while global QoL, social, pain, and insomnia scores for early stage and advanced cancer were inferior tocorresponding baseline levels (difference between means>5, p<0.01). At this time point, compared with patientswith early stage cancer, those with advanced cancer showed worse QoL with all function and most symptommeasures (p<0.01). Conclusions: Patients with precursor lesions or early stage esophageal/gastric cardia cancershow better QoL than those with advanced cancer. This indicates that screening, early diagnosis and treatmentmay improve the QoL for esophageal/gastric cardia cancer patients. Target intervention and counseling shouldbe given by health care providers during treatment and follow-up to facilitate QoL improvement.