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.     

Association of esophageal carcinoma with achalasia--report on 7 cases]

Among 11,821 cases of esophageal carcinoma treated in a 32 year period, 7 were found to be associated with achalasia (0.059%). Five cases were proved by biopsy or cytology and 2 were diagnosed by esophagograms. There were 4 men and 3 women. The age ranged from 30-54 years with a median of 38. The age was younger than that of esophageal carcinoma unassociated with achalasia. Duration of achalasia was from 7 to 20 years. Three patients died within 1 year and 1 died 17 months after diagnosis. Three were lost to follow-up. The presenting symptoms were aggravating dysphagia in 4; and hoarseness, dyspnea and bloody regurgitation in the other two. Patients with achalasia should be treated energetically in the early stage. Double contrast esophagography and esophagoscopy should be done carefully during the followup. Preparation of the esophagus is most important when performing the X-ray examination of the esophagus.     

贲门失弛缓症并发食管癌临床及X线分析

目的：提高贲门失弛缓症并发食管瘤的早期临床X线诊断。材料与方法：21例贲门失弛缓症并发食管癌均经病理证实，作者回顾分析了其临床及X线表现。结果：21例贲门失弛缓症并发食管癌，占我院同期收治食管癌的0．078％，占失治贲门失弛症的1．59％。失弛症病史为8～28年。4例曾作手术治疗。X线检查失弛症重度14例，中度7例。癌位于胸食管上段5例，中下段16例，病变平均长度9cm。结论：贲门失弛缓症有可能因长期食物潴留引起食管炎症，促使食管鳞状上皮变性和癌变。早期手术治疗可缓解症状，但仍有术后并发癌变的病例。对病史长、年龄较大患者，应做详细的食管双对比造影，多轴摄片以及食管镜检查，以提高病变的早期检出率。     

Histopathological diagnosis of biopsy samples from early esophageal carcinoma

Carcinoma of the esophagus is frequently diagnosed in advanced clinical stages. When an esophagic carcinoma has infiltrated the submucosa or the muscular or serosa, metastases are a common finding. Thus, early diagnosis and opportune treatment are vital for patients with this type of neoplasm. Timely diagnosis can be done through endoscopic or X-ray studies and confirmed through a histopathological study by directed biopsy. We presently report the case of a 65 year old man with precedents of achalasia who underwent an endoscopic study using the Lugol staining technique for suspected malignant lesion classified as 0-IIc. After two biopsies it was diagnosed as early carcinoma of the esophagus and was subjected to mucosectomy. Histopathological findings are reviewed at architectural and cellular level and are essential to establish the diagnosis of early neoplastic lesions of the esophagus epithelium. These cellular changes are corroborated by immunohistochemical studies with nuclear expression of p53. The relevant literature was reviewed and experiences by Japanese and North American pathologists compared with emphasis on the need for multidisciplinary management to make an early diagnosis by endoscopic studies, Lugol staining, X-rays, biopsy and conservative treatment based on mucosectomy.     

Achalasia of the esophagus associated with Hodgkin disease.

Esophageal achalasia has not been reported in the literature as a complication of Hodgkin disease. Involvement of the esophagus is rare but when present, consists mostly of bleeding, ulceration or diverticuli. A case is reported in a fifty-one year old female with achalasia of the distal third of the esophagus associated with Hodgkin disease, Stage II B.     

P21^WAF-1和cyclinD1蛋白在食管鳞癌组织中表达的研究

目的研究P21^WAF-1和cyclinD1在食管鳞状细胞癌组织中的表达及与临床病理的相关性。方法用免疫组化方法检测80例食管鳞癌标本和80例正常食管组织中P21和cyclinD1蛋白的表达水平。结果P21蛋白和cyclinD1蛋白在食管鳞癌组织中的表达均明显增加,与癌细胞的分化程度、肿瘤的TNM分期密切相关。P21在正常食管黏膜生发层细胞中也有少量的表达。结论1921与cyclinD1参于调节细胞的生长周期,P21可以作为临床预测食管鳞癌预后的潜在的指标。     

19例早期食管癌贲门癌的诊治体会

作者报告了手术切除的早期食管癌贲门癌19例,占同期食管癌贲门癌手术的3.2％。全组男9例,女10例,年龄36～64岁,其中食管上段癌3例,中段癌13例,下段癌1例,贲门癌2例。临床症状:进食梗喷者13例,胸骨后疼痛7例,呕血1例。19例病人均作了X线钡餐检查,13例行胃镜检查,11例行食管拉网。全组病例左侧开胸手术根治,5例术中不能探及肿块都切开食管及贲门腔内观察或纱布涂擦破片检查发现癌灶。对早期食管癌贲门癌的病理肉眼分型,癌肿分类及浸润深度进行了描述。作者对影响早期食管癌贲门癌检出率的因素、早期癌的临床症状与病变的关系、提高早期癌检出率的途径及早期食管癌贲门癌的手术治疗问题进行了讨论。     

基质金属蛋白酶MMP-2和MMP-9在食管癌组织中的表达意义

目的 :探讨基质金属蛋白酶MMP 2和MMP 9在食管癌组织中的表达及其与食管癌浸润转移的关系。方法 :用免疫组化S P法检测 5 9例食管癌组织中MMP 2和MMP 9的表达。结果 :MMP 2和MMP 9阳性表达率在食管腺癌分别为 84 6 1%、76 92 % ,明显高于食管鳞癌 5 0 0 0 %、4 3 4 8% (P <0 0 5 ) ;淋巴结转移组分别为 93 33%、86 6 7% ,明显高于无淋巴结转移组 4 1 38%、37 93% (P <0 0 1)。结论 :MMP 2和MMP 9可能在食管癌侵袭及转移过程中发挥重要作用。     

食管癌间质嗜酸性白细胞作用观察

在HE及瑞姬染色下，对90例食管癌间质中的嗜酸性白细胞（Eosinophil，EOS）进行计数，观察EOS与分化度、淋巴结转移及浸润深度的关系．结果表明：EOS的多少与肿瘤的浸润深度及淋巴结转移关系密切，与肿瘤的分化程度的关系无统计学意义。结果还显示：肿瘤组织中的EOS数明显高于同一病例的正常食营组织中的EOS数。作者认为，食管癌间质中的EOS在食管癌的发展及预后方面起了一定作用，提出：食管癌间质中EOS计数有可能作为食管癌预后的一项指标。     

Epidemiologic investigation of carcinoma of the esophagus and gastric cardia carcinoma in Nanao County, Guangdong province

Nanao county, Guangdong province is a high incidence area of carcinoma of esophagus and gastric cardia carcinoma. By retrospective investigation of data in the past 14 years (1970 to 1983), the annual average crude mortality of carcinoma of esophagus and gastric cardia carcinoma was found to be 88.65/100,000, the age adjusted mortality of Chinese population was 82.91/100,000 and that of the world population was 113.09/100,000. The mortality of the male was 100.65/100,000 and of the female was 67.24/100,000 with the ratio of 1.38:1. As regards the relationship between the age and mortality, the highest rate occurs from 50 to 74. A higher mortality was also observed in the population engaged in salt production and fishing. The mortality was higher in the lower elevation areas than in the elevated regions.     

hMLH1蛋白在食管鳞状细胞癌和不典型增生组织中的表达

目的：探讨同一食管癌患者食管的鳞状细胞癌组织、不典型增生组织、正常鳞状上皮组织中错配修复基因1（human mutl homolog 1，hMLH1）的蛋白表达情况，深入研究它与食管鳞状细胞癌发生发展的关系。方法：取92例食管鳞状细胞癌患者的病变组织，其病理切片中鳞状细胞癌组织、不典型增生组织和正常鳞状上皮组织均存在，采用免疫组织化学的方法，检测hMLH1蛋白在3种不同组织中的表达，并分析其与性别、年龄、分化程度、浸润深度、肿瘤分期、淋巴结转移等临床病理参数之间的关系。结果：hMLH1蛋白在食管鳞状细胞癌组织、不典型增生组织、正常鳞状上皮组织细胞核中的阳性表达率分别为36．96％、56．52％、84．78％，鳞状细胞癌组织和不典型增生组织均显著低于正常食管鳞状上皮组织（P〈0．01）。鳞状细胞癌组织中hMLH1蛋白表达阴性者，年龄较阳性者大（P〈0．05）；hMLH1蛋白表达与肿瘤分期、淋巴结转移等有明显相关性（P〈0．05）。结论：hMLH1基因缺失可能在早期就参与了食管鳞状细胞癌的发生过程，hMLH1蛋白可能抑制或延缓食管鳞状细胞癌的发生和发展。     

60例高龄食管癌放射治疗分析

目的研究高龄食管癌患者放射治疗的特点。方法在积极对症,支持治疗的同时,对60例年龄在85-92岁之间的高龄食管癌患者以小照射野、低剂量进行常规放射治疗或适形精确放疗,放疗过程中经常进行食管造影、心肺功能检查。结果59例高龄食管癌患者安全地完成了放射治疗,未出现严重并发症,生存质量明显提高,生存时间明显延长,其中适形精确放疗效果更好,副作用更少。1例溃疡型食管癌患者疗程结束时出现食管穿孔,经食管支架植入后现已存活2年。结论高龄食管癌患者发现晚,病情严重,心、肺功能及全身状况差,放射治疗风险大,但在积极对症、支持治疗的同时,进行放射治疗是有意义的,不能追求大而全,包及所有肿瘤病灶的照射野,不能追求高剂量、高疗效,应经常进行检查,及时处理可能出现的并发症。     

食管憩室伴发食管及贲门癌26例临床分析

目的探讨食管憩室与癌肿的关系,总结其治疗经验.方法回顾性分析我院胸外科26例食管憩室伴发食管及贲门癌手术治疗资料.结果24例食管憩室均位于癌肿之上,仅见2例憩室癌变;本组X线钡餐检查癌肿漏诊率为26.9%,术前内镜检查癌肿确诊率100%;25例均行癌肿与憩室一并切除术,1例贲门癌伴发食管中段憩室,癌肿切除后单纯行憩室切除及壁修补术,全组无手术并发症发生.结论食管憩室合并疾患较多,对于食管憩室患者尤其病程长者应行食管镜检,避免癌肿等疾患漏诊;治疗应食管憩室与癌肿一并切除.     

Expression of basic fibroblast growth factor is associated with a good outcome in patients with squamous cell carcinoma of the esophagus

Angiogenesis is an essential step in tumor growth and metastasis, but rather than being controlled by means of a simple mechanism, the control of tumor angiogenesis may be mediated by several angiogenic factors. We investigated the expression of basic fibroblast growth factor (b-FGF) and platelet-derived endothelial cell growth factor (PD-ECGF) in squamous cell carcinoma of the esophagus in order to clarify the mechanism of angiogenesis. Expression of b-FGF and PD-ECGF was immunohistochemically investigated in tissue specimens from the tumors of 79 patients with squamous cell carcinoma of the esophagus who underwent curative esophagectomy without preoperative chemotherapy or radiation therapy, and the relationship between expression of b-FGF/PD-ECGF, microvessel density (MVD), and clinicopathological background factors was assessed. Tumor cells that expressed b-FGF were found in 41 patients (51.9%), and tumor cells that expressed PD-ECGF were found in 57 patients (72.2%). Although the mean vascular density (47.9/mm(2)) of b-FGF-positive tumors was significantly lower than that (67.2/mm(2)) of b-FGF-negative tumors (p=0.014), the difference between the 56.0/mm2 in PD-ECGF-positive tumors and 60.3/mm2 in PD-ECGF-negative tumors was not significant. Although the survival rate of patients with b-FGF-positive tumors was significantly higher than those with b-FGF-negative tumors (p=0.033), there was no significant difference between the survival rates of patients with PD-ECGF-positive and -negative tumors (p=0.580). Expression of b-FGF may be associated with promotion of angiogenesis and a good prognostic factor in squamous cell carcinoma of the esophagus.     

Primary adenocarcinoma of the esophagus: A review of 12 cases

To evaluate its true incidence and related clinical characteristics, the definition of primary adenocarcinoma of the esophagus is reemphasized. The tumor constitutes 2% of all esophageal malignancies. Its symptomatology, biologic behavior, and ultimate prognosis appear to be no different from the ordinary squamous cell carcinoma. Our analyses also support the implication of causal relationship between a columnar-lined lower esophagus (Barrett's epithelium) and the neoplasm.     

环咽肌切断术在鼻咽癌及颅脑肿瘤治疗后环咽肌失弛缓症中的应用

背景与目的：目前治疗环咽肌失弛缓症的方法较多,但有些治疗方法患者的依从性较差,有些治疗方法需长期腹部带管,同时容易出现造瘘口周围感染。本文探讨环咽肌切断术在鼻咽癌及颅脑肿瘤治疗后环咽肌失弛缓症中应用的有效性及可行性。材料与方法：2005年6月至2010年1月诊断为环咽肌失弛缓症患者8例,其中鼻咽癌放疗后6例,颅脑肿瘤术后2例。结果：8例患者均接受环咽肌切断术,术后患者可进食固体或软食,进食时间缩短,体重增加。结论：环咽肌切断术是治疗鼻咽癌及颅脑肿瘤治疗后环咽肌失弛缓症的有效手段,可明显改善患者吞咽困难症状,提高生存质量。     

ECRG4 基因甲基化在食管癌中的检测及临床意义

目的：探讨人食管癌相关基因4（ECRG4）在食管癌中基因启动子甲基化状态及临床意义。方法：应用甲基化特异性PCR检测ECRG4基因启动子在55例食管癌原发组织及癌旁组织中的甲基化状态并结合临床病理资料进行分析。结果：在食管癌组织中ECRG4甲基化阳性率（67．3％，37／55）显著高于癌旁对照组织（5．5％，3／55）（P〈0．01）。ECRG4甲基化与肿瘤病变长度与患者饮酒史密切相关（P〈0．05）。结论：ECRG4甲基化可能是参与食管癌发展的重要分子事件。     

Primary adenoid cystic carcinoma of the esophagus: report of a case.

A case of primary adenoid cystic carcinoma of the esophagus is reported. A 51-year-old male patient had a tumor in the lower third of the esophagus which was incidentally found during an examination for cholelithiasis, and resected successfully. The tumor exhibited a polypoid appearance covered by normal esophageal epithelium, localized entirely in the submucosal layer, and morphologically identical to adenoid cystic carcinoma in the salivary glands. The patient is still alive and well three and one-half years after surgery. This seems to be a typical case of adenoid cystic carcinoma of the esophagus arising from the submucosal esophageal gland.     

A Case of Esophageal Carcinoma and Collision Tumor of the Stomach

A case of double primary cancer of the esophagus and stomachwith metastasis of the esophageal cancer to the stomach is reported.The entire stomach and the lower part of the esophagus weresurgically resected and intrathoracic esophagojejunostomy wasperformed. Macroscopically, two tumors were found to be present,both in the lower esophagus and the stomach. There were twoprimary cancers, one a squamous cell carcinoma of the esophagusand the other a collision tumor of the stomach which consistedof well-differentiated adenocarcinoma and signet ring cell carcinoma.Furthermore, this collision tumor was present together witha metastatic lesion from the esophageal carcinoma.     

食管癌DNA倍体及增殖活性与病理特征的关系

 目的 探讨食管癌组织DNA含量（DI）、合成期细胞比例（SPF）、增殖指数（PI）与临床病理特征间的关系。方法 应用流式细胞仪测定98例新鲜食管癌组织细胞的DI、SPF、PI值，研究其和食管癌临床病理的关系。结果 （1）异倍体率、DI、SPF、PI等指标在以患者性别、肿瘤大体类型、分化程度、TNM分期等病理特征为分组对象的各组间没有发现差异有统计学意义；（2）食管组织淋巴结阳性组的SPF明显大于淋巴结阴性组（P＝0.03）。结论 （1）食管组织一旦癌变后其细胞DNA的改变和临床分期等病理指标没有明显关系；（2）食管癌淋巴结转移和食管癌组织合成期细胞比例（SPF）有关。