肝癌合并门静脉高压症的同期联合手术治疗（附19例报告）

目的 肝癌合并门静脉高压症同期联合手术治疗的方法和疗效。方法 回顾性分析1994年8月至2002年2月施行肝癌和门静脉高压症同期联合手术治疗19例。结果 除1例于术后4周因并发肝肾综合征及上消化道出血死于多器官功能衰竭（手术死亡率5．26％）外，其余18例皆康复出院，术后并发症发生率为4．1％（8／19）。随访中死亡11例，死亡原因：肝癌复发3例，肝功衰竭5例，上消化道出血3例。术后1，2，3年生存率分别为79．8％，28．6％，0％。结论 只要合格掌握手术适应证和术式，对肝癌合并门静脉高压症施行同期联合手术治疗是安全的，可望延长病人的生存期。     

肝癌并门静脉高压症的一期外科治疗(附17例报告)

目的：探讨肝癌合并门静脉高压症一期外科治疗的指征与方法。方法：回顾分析1992－1998年经手术治疗的17例肝癌并门静脉高压症病人，在切除肝癌病灶的同时行脾切除加门奇断流术9例；脾切除术8例，其中2例于术前2周先行食管曲张静脉套扎2－3次。结果：术后7d死亡1例，严重心肺并发症及多量腹水各1例，术后1，2，3年生率分别为94％，53％，44％。死亡原因依次是肝癌复发，肝功能衰竭，上消化道出血。结论：肝癌合并门静脉高压症一期手术治疗是安全可行的，适应于肝功能正常的小肝癌并门静脉高压症病人。     

肝癌伴门静脉高压症的外科处理28例报告

目的：评价不同手术方法治疗肝癌合并门静脉高压症的效果。方法：回顾性分析1992年1月至2000年6月肝癌和门静脉高压症同期手术28例。结果：全组无手术死亡。术后并发症发生率为39％（11／28）。术后1，3，5年生存率为91％，61％，48％。术后上消化道出血9例，随访中死亡13例，死亡原因：肝癌复发6例，肝功能衰竭2例，上消化道出血5例，其中1例于术后1个月内死亡。结论：合理选择术式可延长生存期，减少术后并发症。贲门周围血管离断术对防止术后再出血效果较好。肝癌体积较大时，宜简化手术操作。肝癌伴门静脉高压症时应慎用化学药物栓塞。     

原发性肝癌合并门静脉高压的外科处理(附26例报告)

目的：评价不同手术方法治疗肝癌合并门静脉高压的效果。方法：回顾性分析肝癌合并门静脉高压同期手术治疗26例患者的临床资料。结果：全组无手术死亡。术后并发症发生率为50%（13/26）。术后1、3、5年存活率为84.6%（22/26）、57.7%（15/26）、34.6%（9/26）。术后随访上消化道出血10例,死亡15例,死亡原因：肝癌复发7例,肝功能衰竭2例,上消化道出血6例。结论：加强围手术期处理、合理选择个体化术式、联合手术对肝癌合并门静脉高压患者是安全、可行的,可以延长此类患者生存期,减少术后并发症。     

胃切除术后早期胃镜检查及内镜下止血安全有效性探讨

目的探讨胃切除术后早期胃镜检查及内镜下止血的安全性和有效性。方法回顾分析华中科技大学同济医学院附属协和医院2006~2016年间胃手术后早期行内镜下检查吻合口286例病人资料以及术后吻合口出血29例病人的处理方法和结果。结果胃手术后早期行内镜检查吻合口的286例病人中,3例无法到达吻合口,其余均行常规检查,所有病人住院期间无再发出血、穿孔等情况。收治的29例上消化道出血的病人中,7例病人出血后先行保守治疗,经保守治疗无效后再行内镜下止血;22例病人并发出血后直接行内镜下止血。最终28例病人经过内镜下治疗成功止血,均无再发出血;1例病人止血失败行介入栓塞止血。结论胃手术后早期行内镜检查不增加吻合口出血、穿孔等风险。术后上消化道出血早期行内镜下止血是安全、有效的,能明显提高止血成功率,降低再手术率,缩短病人住院时间。     

急诊内镜治疗上消化道动脉性出血

目的评价上消化道动脉性出血的内镜治疗效果。方法回顾性总结1998年以来收治的31例上消化道动脉性出血的临床资料，所有病人均实行急诊内镜下1：10000肾上腺素盐水注射治疗。结果本组内镜止血有效29例(93．5％)，其中2例治疗过程中再次出现搏动性出血，经继续内镜下治疗止血成功；3例止血后再出血，经再次胃镜下注射后止血。止血失败2例(6．5％)，经Billroth Ⅰ式胃大部切除后治愈。10例治疗过程中出现胸痛或腹痛，9例自行缓解，1例给予镇痛剂后缓解，无其他并发症。结论内镜下注射肾上腺素治疗上消化道动脉性出血方法简单、疗效可靠、安全性高，可成为目前首选的治疗方法。     

肝癌合并门静脉高压症的外科治疗分析

肝硬化与肝癌和门静脉高压的发生和发展有着密切的关系。对肝癌合并门静脉高压的病人如在切除肝癌的同时处理门静脉高压,因扩大创伤,延长手术时间,易加重肝功能损害而增加手术的风险。而单纯切除肝癌,术后可能因并发食管胃底静脉曲张破裂出血,并由此而死亡。本文回顾分析13例肝癌合并门静脉高压症一期手术的病人,探讨其手术指征及方法。1资料与方法1.1一般资料:1989年至2000年,对13例肝癌合并门静脉高压症病人行一期手术治疗。男11例,女2例;年龄37～61岁,平均47.3岁。10例AFP阳性,11例提示有乙肝病毒感染。食管胃底静脉曲张重度7例,中度6…     

食管平滑肌瘤的诊断与治疗

目的 总结10年来食管平滑肌瘤诊断与治疗的经验。方法 分析1993年至2002年间52例食管平滑肌瘤患者的临床资料。结果 本组54％的患者以进食困难为首发症状。诊断准确率：上消化道钡剂低张双对比造影检查为64％，CT为44％，胃镜为27％，超声内镜为90％。本组患者经胸腔镜手术6例，内镜下切除术9例，行食管平滑肌瘤摘除术32例，食管部分切除、食管胃吻合术5例。仅1例术后出血，经再次手术止血；其余未发生严重的术后并发症。结论 超声内镜是诊断食管平滑肌瘤的有效手段，对于适合的病例要积极考虑胸腔镜手术及内镜摘除以减轻创伤。     

肝癌合并门静脉高压症的同期联合手术治疗(附19例报告)

目的　肝癌合并门静脉高压症同期联合手术治疗的方法和疗效。方法　回顾性分析1994年 8月至 2 0 0 2年 2月施行肝癌和门静脉高压症同期联合手术治疗 19例。结果　除 1例于术后 4周因并发肝肾综合征及上消化道出血死于多器官功能衰竭 (手术死亡率 5 .2 6 % )外 ,其余 18例皆康复出院 ,术后并发症发生率为 4 .1% (8 19)。随访中死亡 11例 ,死亡原因 :肝癌复发 3例 ,肝功衰竭 5例 ,上消化道出血 3例。术后 1、2、3年生存率分别为 79.8%、2 8.6 %、0 %。结论　只要合理掌握手术适应证和术式 ,对肝癌合并门静脉高压症施行同期联合手术治疗是安全的 ,可望延长病人的生存期     

食管多原发癌及食管贲门双原发癌的早期诊断与治疗

目的 探讨食管多原发癌及食管贲门双原发癌的早期诊断及治疗方法。方法 对应用X线钡餐检查及内镜下碘染色确诊，并经手术切除病理证实的71例食管多原发癌和食管贲门双原发癌进行分析。结果 X线钡餐术前确诊14例(19．72％)，内镜及内镜下碘染色术前确诊69例(97．2％)。发现早期病灶54个，早期病例6例。全部手术切除，无手术死亡，3年生存率40．5％。结论 对食管癌贲门癌病人应常规进行上消化道钡餐检查，并应用内镜下碘染色活检方法提高诊断率，发现早期病例，同时进行积极的外科治疗，可望提高治疗效果。     

25年来经胃镜检出胃癌的临床与病理特点

目的 探讨早期胃癌的临床及病理特点为微创治疗提供基础。方法 回顾分析：1975年1月至1999年12月来我院进行胃镜检查并经病理确诊为胃癌患的临床症状、内镜下表现及病理组织学特点。结果25年来胃镜胃癌的总检出率为1．95％(1178／61475),其中早期胃癌48例,占4．1％。在48例早期胃癌中胃窦部癌28例(58．3％),胃体部癌12例(25％),胃贲门部癌6例(12．5),胃底部癌2例(4．2％)。25年来每年胃癌的检出率无明显下降趋势。每年胃贲门癌无上升趋势。结论 我国常规胃镜检查的早期胃癌的诊断率仅4．1％,对有症状人群常规进行胃镜检查、提高对胃癌的识别能力以及准确活检是提高早期胃癌诊断关键。     

内镜、腹腔镜联合治疗消化道肿瘤15例报告

目的:探讨内镜与腹腔镜(双镜)联合治疗消化道肿瘤的应用价值.方法:回顾分析双镜联合治疗15例消化道良恶性肿瘤患者的临床资料.结果:15例患者均施行内镜定位加腹腔镜手术,其中病变楔形切除术8例(53.33％),肠段切除术5例(33.33％),腹腔镜根治术2例(13.33％).15例中胃间质瘤3例;结肠绒毛状腺瘤5例,其中...     

胃癌大出血26例临床分析

目的 探讨胃癌大出血的临床特点及其诊治方法.方法 回顾性分析26例胃癌大出血病人的临床资料.结果 胃癌大出血的临床特点主要表现为:呕血,排柏油样大便或暗红色血便,约半数病例可出现失血性休克征象.26例均经纤维胃镜检查确诊为胃癌,其中限期手术22例,急诊手术3例,放弃手术1例.26例中,治愈出院25例,死亡1例.结论 胃...     

Esophagogastric malignancies detected in a tertiary surgical center endoscopy unit from Turkey: a descriptive study

Background:The most common symptoms of upper gastrointestinal(UGI)diseases are epigastric pain and heartburn,nausea and vomiting,regurgitation and dysphagia.Endoscopic examination is the most reliable method for assessing UGI evaluation.Methods:Malignant tumors detected in UGI endoscopies performed between Dec 31,2015 and Jan 1,2011were included in our study.Age,gender,indication for endoscopy,tumor site,tumor type,stage of disease and type of treatment data were recorded.Results:According to the analysis of five-year patient data;39(1.17%)of 3,309 cases had malignancy in the UGI endoscopy.The average age of malignancy detected cases were 63.4 years(range,33–88 years).In the malignancy positive group;35(1%)cases had gastric and 4(0.12%)cases had esophagus tumors.According to the gastric localization of tumors,12 of cases were distal,10 were proximal,7 were middle and 4 were linitis plastica.Two of the cases had previous gastric surgery and the gastric malignancy of these cases was localized at the gastrojejunostomy site.The most frequent symptoms were abdominal pain,anemia,dyspepsia,bleeding,weight loss,obstruction and dysphagia in patients with gastric cancer.Two(5.7%)of the cases had previous gastrectomies because of benign causes.Malignant tumors were detected in the remnant tissue of these cases.The percentage of over 50-year-old patients was 89.7%in UGI malignancy detected patients.Three percent of gastric cancers were stage I,18%of them were stage II,25%of them were stage III and 53%of the cases were stage IV.Seventy-five percent of esophageal cancer cases had systemic metastases.Conclusions:Malignity is rarely detected among the patients from general surgery outpatient clinic,on whom UGI endoscopy is performed.But it is not different from the literature.Most of the malignancies are at advanced stage.In older age patients,endoscopy should be recommended even there are nonspecific symptoms.In the presence of alarm symptoms,UGI endoscopy should be recommended without considering the age.     

Accuracy of identification of early gastric cancer

Two hundred and nineteen patients underwent gastrectomy for cancer in Nottingham University Hospital between January 1978 and December 1985. Twenty of these patients had early gastric cancer (EGC). Barium meal was performed in 15 patients and upper gastrointestinal endoscopy in 15. In all cases, barium meal failed to define the early nature of this disease. Only two lesions were thought to be EGC endoscopically and at laparotomy three were considered to be EGC. As neither radiologist, endoscopist nor surgeon can reliably identify EGC, all patients with gastric cancer in the absence of proven metastases should undergo gastrectomy.     

Gastrointestinal metastasis from primary lung cancer

Aim: Although gastrointestinal metastasis from primary lung cancer is uncommon, the incidence may increase due to widespread application of chemotherapy and positron emission tomography scan. The aim of the present study was to determine the incidence and characteristics of patients with gastrointestinal metastasis from primary lung cancer. Methods: All patients with curative pulmonary resection for primary lung cancer from January 1994 to December 2006 were reviewed. A total of 10 patients (0.3%) who had gastrointestinal metastases from primary lung cancer were included. Results: Eight patients had small bowel metastases and two had gastric metastases. All eight patients who had small bowel metastases underwent emergency laparotomy. Two gastric metastases were diagnosed via endoscopy. None of them survived more than 3 months after diagnosis. Conclusion: Gastrointestinal metastasis from primary lung cancer is uncommon and its prognosis is poor. Extensive bowel resection and reconstruction are not recommended.     

Two cases of variceal haemorrhage during living-donor liver transplantation

Some patients with cirrhosis experience rupture of venous varices before operation, and liver transplantation is a therapy of last resort for these patients. However, we have experienced two cases of intraoperative rupture in whom no abnormalities of the venous varices were seen on endoscopy before operation. One patient with ruptured gastrointestinal varices was treated by direct surgical ligation and the other with ruptured oesophageal gastric varices, spontaneously recovered with a Sengstaken-Blakemore tube. These cases suggest that acute variceal haemorrhage should always be considered as a possibility during living-donor liver transplantation in patients with a history of upper gastrointestinal bleeding. Careful observation of the nasogastic tube is important during clamping of the hepatic portal vein.     

CDH1 truncating mutations in the E-cadherin gene: an indication for total gastrectomy to treat hereditary diffuse gastric cancer

BACKGROUND: Approximately 1% to 3% of all gastric cancers are associated with families exhibiting an autosomal dominant pattern of susceptibility. E-cadherin (CDH1) truncating mutations have been shown to be present in approximately 30% of families with hereditary diffuse gastric cancer (HDGC) and are associated with a significantly increased risk of gastric cancer and lobular breast cancer. METHODS: Individuals from a large kindred with HDGC who were identified to have a CDH1 mutation prospectively underwent comprehensive screening with stool occult blood testing, standard upper gastrointestinal endoscopy with random gastric biopsies, high-magnification endoscopy with random gastric biopsies, endoscopic ultrasonography, CT, and PET scans to evaluate the stomach for occult cancer. Subsequently, they each underwent total gastrectomy with D-2 node dissection and Roux-en-Y esophagojejunostomy. The stomach and resected lymph nodes were evaluated pathologically. RESULTS: Six patients were identified as CDH1 carriers from a single family. There were 2 men and 4 women. The mean age was 54 years (range, 51-57 years). No patient had any signs or symptoms of gastric cancer. Exhaustive preoperative stomach evaluation was normal in each case, and the stomach and adjacent lymph nodes appeared normal at surgery. However, each patient (6 of 6, 100%) was found to have multiple foci of T1 invasive diffuse gastric adenocarcinoma (pure signet-ring cell type). No patient had lymph node or distant metastases. Each was staged as T1N0M0. Each patient recovered uneventfully without morbidity or mortality. CONCLUSIONS: CDH1 mutations in individuals from families with HDGC are associated with gastric cancer in a highly penetrant fashion. CDH1 mutations are an indication for total gastrectomy in these patients. This mutation will identify patients with cancer before other detectable symptoms or signs of the disease.     

Laser endoscopic treatment for upper gastrointestinal cancers.

We report the effective clinical use of endoscopic laser in Japan using the results of a nationwide survey and our own experience with more than 100 cases. The Nd:YAG laser and argon dye laser with hematoporphyrin derivative (photodynamic therapy) were most commonly used in digestive endoscopy and were investigated as new modalities of cancer therapy. Photodynamic therapy was fairly effective, especially in superficial esophageal cancer and the ill-defined lesions of early gastric cancer. Endoscopic laser treatment was carried out on 80 patients with 86 lesions of early gastric cancer at our hospital, and the following tumor types were proven highly curable by this means: focal cancer, IIa and so-called "gastritis-like" tumors less than 2 cm in size. The Nd:YAG laser provides a new approach to palliative treatment, such as recanalization of neoplastic obstruction in the advanced stage of gastrointestinal cancers.     

原发性胃肠道恶性淋巴瘤的诊治

目的:探讨原发性胃肠道恶性淋巴瘤(PGIML)的诊治方法。方法:回顾性分析1995年1月—2010年12月收治的34例原发性胃肠道恶性淋巴瘤患者临床资料。结果:全组男23例,女11例,年龄22～74(平均51.8)岁。均经病理证实为恶性淋巴瘤,原发病灶位于胃24例,肠道10例。24例胃恶性淋巴瘤患者的首发症状为上腹部隐痛不适,8例合并呕血黑便,3例伴有发热;10例肠道淋巴瘤均以腹痛、腹部包块为首发症状,4例伴有黑便,2例有肠梗阻表现,肠穿孔1例。本组24例胃恶性淋巴瘤中,仅5例经术前胃镜病理活检证实;10例肠道恶性淋巴瘤中,仅1例经结肠镜活检确诊,术前确诊率仅17.64%(6/34)。误诊时间2～8(平均4.5)个月。患者均接受手术治疗,其中行根治性肿瘤切除术32例(根治性全胃切除术8例,根治性远端胃大部切除术14例,小肠部分切除术3例,右半结肠切除术6例,根治性直肠切除术1例),姑息性远端胃大部切除术2例。术后31例患者进行了化疗。34例患者免疫组化分型属B淋巴细胞型27例,T淋巴细胞型4例,未分类型3例。全组均获随访,随访时间5～62个月,1,3,5年生存率分别为82.35%,64.71,47.05%。结论:原发性胃肠道恶性淋巴瘤术前确诊率低,胃肠镜及病理活检是术前确诊的主要方法,以手术化疗联合的综合治疗效果良好。