胸腔镜切除术与传统式手术对食管癌术后肺部功能和炎症细胞因子的影响

目的 对比分析胸腔镜切除术与传统式手术对食管癌术后肺部功能、炎症细胞因子的影响.方法 选择经术前胃镜病理活检确诊的食管癌患者58例,25例行胸腔镜食管癌切除术,作为胸腔镜组,33例行传统常规开胸食管癌切除术,作为传统组.比较分析两组患者的手术情况、并发症发生情况.同时,对两组患者的术前及术后1个月肺功能(包括VC、FVC、FEV1、MVV),术前1~2 d及术后1周炎症因子(IL-6、IL-8、IL-10、TNF-α)进行测定,观察两组患者的肺功能以及炎症因子的变化.结果 两组的淋巴结清扫数目比较差异无统计学意义(P>0.05);而胸腔镜组的手术时间、出血量及住院时间显著优于传统组(P<0.05);胸腔镜组患者术后的吻合口瘘、吻合口出血、胸腔感染发生率均低于传统组,但无统计学意义(P>0.05);术后1个月,两组患者的肺部功能各项指标水平较术前均明显降低,而胸腔镜组患者的各项指标水平均显著高于传统组患者(P<0.05);术后1周,两组患者的各项指标较术前均有所升高,且胸腔镜组患者的IL-8、IL-10以及TNF-α水平均显著低于传统组患者(P<0.05).结论 相较于传统式手术,胸腔镜食管癌切除术能够一定程度维持患者的正常肺部功能,同时可有效抑制炎症细胞因子的释放.     

微创胸腹腔镜联合食管癌根治术的治疗效果

目的 观察微创胸腹腔镜联合食管癌根治术的治疗效果.方法 将96例行食管癌根治术的患者根据手术方法分为观察组(n=70)和对照组(n=26),观察组实施胸腹腔镜联合食管癌根治术,对照组应用传统小切口食管癌根治术.比较两组患者的手术一般情况、氧分压、并发症及预后情况.结果 观察组患者手术时间、术中出血量、淋巴结清扫数目、术后住院时间均明显低于对照组(P﹤0.01).术后6、72 h,观察组患者的氧分压均明显高于对照组,差异均有统计学意义(P﹤0.01).观察组患者并发症总发生率为28.57％(20/70),明显低于对照组的61.54％(16/26),差异有统计学意义(χ2=21.489,P=0.000).观察组患者术后淋巴结转移率、复发率、二次手术发生率均明显低于对照组,术后生活质量评分、6个月内生存率均明显高于对照组,差异均有统计学意义(P﹤0.01).结论 微创胸腹腔镜联合食管癌根治术相比传统小切口食管癌根治术具有独特的优势,其安全可靠、微创、恢复快,值得在临床上推广使用.     

胸腔镜辅助三切口食管癌切除术与开放手术的疗效及安全性对比研究

目的 比较分析胸腔镜辅助三切口食管癌切除术与开放手术的疗效及安全性.方法 以行手术治疗的食管癌患者93例作为研究对象,根据手术方式的不同将其分为观察组43例及对照组50例,观察组行胸腔镜辅助三切口手术,对照组行开放三切口手术.对两组患者围手术期指标、术后并发症、术后生存率进行观察与比较.结果 观察组患者术中出血量及术后住院时间明显优于对照组,差异有统计学意义(P＜0.05).在手术时间、淋巴结清扫个数及医疗费用方面,两组差异不显著(P＞0.05).观察组并发症发生率为30.23％,对照组为52.00％,观察组明显低于对照组(P＜0.05).观察组患者与对照组患者1年、3年及5年生存率均接近,差异无统计学意义(P＞0.05).结论 胸腔镜辅助三切口食管癌切除术具有良好的疗效及安全性,值得临床推广应用.     

胸腹腔镜联合食管癌根治术治疗食管鳞状细胞癌的安全性及可行性

目的探讨胸腹腔镜联合食管癌根治术治疗食管鳞状细胞癌(鳞癌)的安全性和可行性。方法选择2013年12月至2015年12月齐河县人民医院收治的82例食管鳞癌患者为研究对象,将采用胸腹腔镜联合食管癌根治术治疗的42例患者设为观察组,采用三切口开放手术治疗的40例患者设为对照组。记录两组患者手术时间、出血量、住院时间及淋巴结清扫等情况,随访18个月,记录两组患者并发症发生情况、随访期生存率、复发及转移情况等。结果观察组手术时间比对照组长,术中出血量、术后24 h引流量、住院时间、胸管留置时间少于对照组,差异有统计学意义(均P0.05),淋巴结清扫数差异无统计学意义(P0.05);观察组食管旁、隆突下、气管旁、下肺静脉旁淋巴结清扫数量与对照组相比,差异无统计学意义(P0.05)。观察组肺部感染、胃排空障碍发生率低于对照组,差异有统计学意义(P0.05),两组肺不张、气胸、心律失常、喉返神经损伤、吻合口狭窄、吻合口瘘发生率比较,差异无统计学意义(P0.05);两组复发率、转移率、病死率、两年生存率比较差异无统计学意义(P0.05)。结论治疗食管鳞癌采用胸腹腔镜联合食管癌根治术具有微创优势,能减少术后肺部及胃肠并发症,治疗安全有效。     

内镜下黏膜切除术联合氩等离子体凝固术治疗老年早期食管癌及癌前病变患者的临床疗效

目的 探讨内镜下黏膜切除术(EMR)联合氩等离子体凝固术(APC)治疗老年早期食管癌及癌前病变患者的临床疗效.方法 根据手术方法的不同将80例老年早期食管癌及癌前病变患者分为观察组(n=41)和对照组(n=39).观察组患者采用EMR联合APC治疗,对照组患者采用EMR治疗.比较两组患者的围手术期指标、术前和术后的焦虑自评量表(SAS)和抑郁自评量表(SDS)评分以及术后并发症发生情况.术后6个月进行随访,比较两组患者的病理诊断结果.结果 观察组患者的剥离面积和单位时间切除率均明显大于对照组,手术时间和住院时间均明显短于对照组,差异均有统计学意义(P﹤0.01).术后观察组患者的SAS和SDS评分均低于对照组,差异均有统计学意义(P﹤0.05).观察组患者的术后并发症总发生率为7.32％,低于对照组的23.08％,差异有统计学意义(P﹤0.05).术后6个月,观察组患者的病理结果优于对照组,差异有统计学意义(P﹤0.05).结论 EMR联合APC应用于老年早期食管癌及癌前病变患者能够缩短患者的住院时间,改善患者的负性情绪,降低术后并发症发生率,促进患者术后恢复.     

胸腹腔镜Ivor-Lewis手术治疗食管中下段癌的疗效及对患者肺功能和免疫功能的影响

目的:探讨胸腹腔镜Ivor-Lewis手术治疗食管中下段癌的疗效,并分析对患者肺功能及免疫功能的影响。方法:选取我院收治的食管中下段癌患者82例,根据手术方式不同分为观察组（n=42）和对照组（n=40）。观察组行胸腹腔镜Ivor-Lewis食管癌切除术,对照组行传统开放Ivor-Lewis食管癌切除术。观察两组患者围手术期指标及术后并发症,分别于术前、术后1月检测患者的肺功能,于术前1天、术后7天检测患者的免疫功能。结果:观察组与对照组的手术时间无统计学差异（P>0.05）。观察组术中出血、留置胸引管时间、住院时间少于对照组,差异有统计学意义（P<0.05）。观察组与对照组喉返神经损伤、吻合口瘘发生率无统计学差异（P>0.05）,观察组肺部感染、心律失常低于对照组,差异有统计学意义（P<0.05）。观察组术后1月肺功能各项指标均高于对照组,差异有统计学意义（P<0.05）。观察组术后CD3+、CD4+、CD4+/CD8+均高于对照组,CD8+低于对照组,差异有统计学意义（P<0.05）。结论:胸腹腔镜Ivor-Lewis手术治疗食管中下段癌能减少手术创伤,降低术后并发症,减轻对患者肺功能、免疫功能的影响,有利于患者快速康复,值得临床推广应用。     

完全胸腔镜手术治疗早期肺癌的临床效果

目的 探讨完全电视胸腔镜手术(cVATS)治疗早期肺癌的临床效果.方法 选取早期非小细胞肺癌行肺叶切除术患者79例,按照手术方式分为观察组59例,采用完全电视胸腔镜肺叶切除术;对照组20例,采用开胸肺叶切除术组.统计2组患者手术时间、术中出血量、切口长度、淋巴结清扫数目、术后24和48 h引流量、术后留置引流管时间、术后卧床时间和术后住院天数.比较2组患者术前24 h、术后24 h及第7天的C反应蛋白(CRP)等体液免疫指标.同时记录术后并发症和疼痛及止疼药物使用情况.结果 相比于对照组,观察组术中出血量、切口长度、术后置管时间、术后住院天数、术后疼痛评分和止痛药物使用时间显著低于对照组,差异有统计学意义(P<0.05);2组感染率比较,观察组显著低于对照组(P<0.05).术后24 h,2组患者CRP水平均显著升高,且观察组低于对照组(P<0.05);术后第7天,2组患者CRP水平又下降,且观察组低于对照组(P<0.05).结论 与传统开胸手术相比,完全电视胸腔镜肺叶切除术具有降低创伤和出血量,减少术后患者疼痛和并发症的优点,利于患者术后康复,值得临床推荐.     

中晚期食管癌胸腔镜根治术的疗效观察

目的探讨中晚期食管癌行胸腔镜食管癌根治术治疗的临床疗效。方法选取2012年1月至2014年12月间南京医科大学附属淮安一院收治的178例中晚期食管癌患者,按其手术方式分为胸腔镜食管癌根治组(100例),三切口食管癌根治开放组(78例)。记录患者术中情况、术后拔管时间、住院费用、并发症发生情况及复发率和死亡率。结果两组患者均顺利完成手术,胸腔镜组无中转开胸病例,围术期两组均无死亡病例。胸腔镜组平均术中出血量(158.5±26.5)ml、引流时间(4.5±1.5)d、引流量(470.0±250.0)ml、平均住院时间(12.5±2.5)d和并发症发生率为20.0%,均优于开放组的(176.5±28.5)ml、(7.5±2.5)d、(900.0±360.0)ml、(16.5±3.5)d和29.5%,两组比较差异均有统计学意义(均P<0.05)。胸腔镜组淋巴结清扫数量(22.8±6.8)枚、阳性淋巴结率(9.5±1.5)%、手术时间(158.5±26.5)min和住院费用(5.5±0.3)万元,与开放组的(23.7±7.0)枚、(9.6±1.5)%、(176.5±28.5)min和(5.3±0.2)万元比较,差异均无统计学意义(均P>0.05)。胸腔镜组患者复发或转移9例(9.0%),开放组为10例(12.8%),组间比较差异无统计学意义(P>0.05)。胸腔镜组患者死亡3例(3.0%),开放组患者死亡4例(5.1%),组间比较差异无统计学意义(P>0.05)。胸腔镜组总生存率为97.0%,开放组为94.9%,组间比较差异无统计学意义(P>0.05)。结论胸腔镜下治疗中晚期食管癌临床疗效理想,术后恢复快,术后并发症发生率低,适于临床上使用。     

内镜下切开术治疗难治性食管癌术后吻合口狭窄的疗效

目的 探究食管支架置入术(ESP)和内镜下切开术(EIM)在难治性食管癌术后吻合口狭窄治疗中的应用效果.方法 将70例难治性食管癌术后吻合口狭窄患者按照手术方式不同分为ESP组(n=41)与EIM组(n=29).对比两组患者临床疗效、吞咽困难评分及并发症发生情况.结果 两组患者总有效率比较,差异无统计学意义(P>0.05).术前,两组患者Stooler评分比较,差异无统计学意义(P>0.05);术后1个月,两组患者Stooler评分均较术前降低(P<0.05),且EIM组患者Stooler评分明显低于ESP组(P<0.01).ESP组患者术后并发症总发生率高于EIM组(P<0.05).结论 EIM和ESP治疗难治性食管癌吻合口狭窄的临床疗效相当,EIM短期内对患者吞咽困难症状改善作用明显,且具有术后并发症少等优点.     

电视胸腔镜下行小切口肺癌手术治疗疗效安全性及复发情况

目的探讨电视胸腔镜辅助小切口肺癌手术的临床疗效、安全性及复发情况。方法选取2013年1月至2013年12月间接受手术治疗的86例肺癌患者,采用随机数字表法分为试验组和对照组,每组43例。试验组患者于电视胸腔镜下行小切口手术治疗,对照组患者行传统开胸手术治疗,所有患者均随访12个月。对比分析两组患者的疗效、安全性及复发情况。结果两组患者的淋巴扫除情况差异无统计学意义(P>0.05);试验组患者的术中出血量、切口长度、带管时间、术后住院天数和术后引流量与对照组比较,差异均有统计学意义(均P<0.05);86例患者随访时间均达12个月,无失访病例,但试验组患者术后并发症及复发的发生率均低于对照组,差异均有统计学意义(均P<0.05)。结论电视胸腔镜下行小切口肺癌手术的创伤较小、安全性较高,能够有效改善治疗效果,减少肿瘤复发率,值得在临床上推广使用。     

Barrett's esophageal cancer

Barrett's esophageal cancer is defined as carcinoma developing in Barrett's esophagus. The esophagogastric junction is located at the distal end of a network of fine longitudinal vessels, and the columnar epithelium existing above it is Barrett's mucosa. Barrett's mucosa, especially specialized columnar epithelium is considered as precancerous lesion, and malignant potential is examined in various ways. For the surveillance of malignant lesions from Barrett's esophagus, periodic endoscopic examination is necessary with chromoendoscopy or magnifying endoscopy. Treatment strategies are EMR and other endoscopic treatment for mucosal cancer, and surgical treatment for submucosal and advanced cancer. Several surgical modalities are employed depending on the stage of cancerous progression, the location of the cancer in Barrett's esophagus, and the length of Barrett's esophagus. There remain many unexplained problems in Barrett's esophagus and Barrett's cancer.     

Usefulness of esophageal prosthesis in inoperable esophageal cancer

Radiotherapy of inoperable esophageal cancer provided palliation for dysphagia in only 40% of the patients treated over the past 5 years at our hospital. The remaining patients were unable to eat a regular diet even after radiotherapy and to provide them with nourishment, a gastrostomy and/or IVH were required. We feel that the release of the patient from a medical environment will lead to a better quality of remaining life. From our experience with a prosthesis tube for palliation of a malignant esophageal stricture, 4 patients showed excellent results with this way of improving their oral intake.     

Nutrition and esophageal cancer

Epidemiologic evidence on the relation between nutrition and esophageal cancer is reviewed. Results from ecologic, case-control, cohort, and intervention studies are included. Most of the findings pertain more to squamous cell carcinoma than adenocarcinoma of the esophagus. The protective effect of fruit and vegetable consumption is supported by a large body of evidence, especially from case-control studies. The effects of food groups and nutrients other than fruits and vegetables also have been examined, but the overall evidence is less convincing. Recent intervention studies in high incidence areas in China indicate that micronutrient supplements may have a modest effect in reducing risk, but the generalizability of this result is uncertain. Hot drinks are likelyto increase the risk of esophageal cancer. On the other hand, the role of tea drinking, especially the use of green tea, remains to be defined better.     

Epidemiology of esophageal cancer

The incidence of cancer of the oesophagus is high in India but not as high as the rates reported from the Caspian Littoral of Iran. Incidence data available for three places in India--Bombay, Madras, and Bangalore--show regional variations. In Bombay, the rates for males are high compared to Madras and Bangalore. A case control study of 503 oesophageal cancer cases in males and 634 controls registered at the Tata Memorial Hospital during the period 1980-84 was carried out to determine the association of oesophageal cancer with two types of dietary practices, viz., vegetarian and non-vegetarian, in addition to tobacco and alcohol habits. In the presence of an alcohol habit, the relative risk for tobacco chewing and smoking was observed to be high in the non-vegetarian group compared to the vegetarian group. A vegetarian diet was protective. Further studies are suggested to confirm this finding.     

Chemoradiotherapy of esophageal cancer

Esophageal cancer is a disease with a poor prognosis and high biological aggressiveness. The disease used to be considered a mainly local problem, and palliative care with relief of dysphagia was the goal for most of those concerned with the disease. When surgical techniques were improved and parallel progress was made in intensive care and postoperative care, some patients could be cured of the disease. The development of pre- or postoperative radiotherapy also improved local control. Partly because of the interest that began to be focused on improving survival for this diagnostic group, chemotherapy combined with radiotherapy has been incorporated into the therapeutic arsenal. The aim of this review is to shed light on current treatment principles for esophageal cancer. However, treatment results from studies utilizing combination chemotherapy given concurrently with radiotherapy support the conclusion that well-designed randomized trials with long-term follow-ups should be performed.     

Chemoradiotherapy for esophageal cancer

Since mucosal (T1a) esophageal cancer is well controlled by endoscopic treatment, chemoradiotherapy (CRTx) is not indicated. However, for a submucosal (T1b, N0) esophageal cancer, CRTx may be the first line of treatment, since it can provide a good response rate, with an excellent survival rate comparable to that after esophagectomy. Definitive CRTx is also in the first line of treatment for a T4 esophageal cancer, because there was no difference in the survival rate between CRTx with surgery and CRTx without surgery in our trial. Esophagectomy is indicated only for non-responders or recurrence-salvage surgery. For patients with a potentially-resectable (T2-T3) esophageal cancer, esophagectomy offered a longer survival rate than CRTx did, in our series. However, there remains controversy over the efficacy of CRTx for a T2-T3 esophageal cancer. It has been reported by the National Cancer Center Hospital East Group that definitive CRTx provided the same survival rate as esophagectomy. A prospective trial comparing the survival rate after esophagectomy and that after CRTx for a T2-T3 esophageal cancer is needed.     

Chemotherapy for esophageal cancer

Esophageal cancer is supposed to be more sensitive to chemotherapy compared to other gastrointestinal cancers. Since cisplatin (CDDP) was developed, it has become a key drug for combined chemotherapy. At present, the combination of CDDP and 5-fluorouracil (5-FU) is the standard regimen for the treatment of esophageal carcinoma. Nedaplatin (CDGP) and paclitaxel (TXL) have shown favorable results either as a single agent or in combination with CDDP. Comparisons of drug efficacy between these new regimens and CDDP/5-FU in more cases has yet to be carried out. However, since esophageal cancer can hardly be cured by definitive chemotherapy alone, chemotherapy plays an important role in the multimodality therapy for esophageal cancer. The results of definitive chemoradiotherapy for advanced esophageal cancer has recently improved. The efficacy of preoperative (neoadjuvant) chemoradiotherapy in terms of survival benefit still remains controversial according to a meta-analysis of large-scale, randomized controlled trials (RCTs) when compared with surgery alone. A RCT completed by the Japan Clinical Oncology Group (JCOG) demonstrated the prognostic benefit of postoperative adjuvant chemotherapy for disease-free survival in comparison to surgery alone. Another RCT by JCOG has been conducted to clarify whether preoperative or postoperative chemotherapy may have a prognostic benefit in patients who undergo an esophagectomy.