放射导向手术对非小细胞肺癌胸内转移淋巴结检测的临床价值

目的：采用放射导向手术检测经^99mTc—MIBI标记的非小细胞肺癌病人30例,探讨对非小细胞肺癌胸内转移淋巴结检测的临床价值。方法：用放射导向手术探测肺内和纵隔淋巴结及切除的标本,术后对常规病理为阴性的淋巴结,即假阳性进行连续切片,HE染色,显微镜下观察。然后计算及统计学处理。结果：用放射导向手术探测淋巴结的灵敏度为100％,特异度96．9％,准确率97．42％。结论：放射导向手术比其他检测方法有更高的准确率和更低的漏诊率,能检测出微小的转移淋巴结,指导手术廓清的进行。     

直肠系膜淋巴结分布特点及其临床意义

目的：通过研究尸体及活体术后标本观察直肠系膜淋巴结的数目及分布，探讨直肠癌全直肠系膜切除术后患者的复发和转移之间的关系。方法：30例福尔马林固定的尸体和102例活体术后标本解剖，自直肠上动脉开始沿其最小的分支至肛门直肠环水平进行解剖并登记。结果：30例尸体标本直肠系膜共发现淋巴结248枚，平均8．3枚(标准差4．41)，淋巴结大小为1．8～10mm。102例行直肠癌全直肠系膜切除术的病例共发现淋巴结916枚淋巴结，平均8．98枚。所有淋巴结均送病理，其中有77枚(8．41％)有癌转移。结论：通过尸体与活体标本淋巴结的解剖，大部分淋巴结分布在直肠系膜周围靠近腹膜返折处。淋巴结数目变化范围可指导直肠癌全直肠系膜切除术后标本的病理解剖及指导术后病人的治疗。     

食管癌贲门癌根治术中进行肺活检的临床实验研究

为探讨食管癌、贲门癌病人手术时是否已经出现了肺组织转移,我院胸外科自1998年1月至2001年10月随机抽取100例食管癌、贲门癌病人进行根治手术并在术中进行肺组织活检,结果表明有3例病人手术时已经出现了肺组织转移,为提高病人的术后长期生存率,我们强调食管癌、贸门癌病人手术中进行肺组织活检的必要性及术后综合治疗的重要性。     

食管癌贲门癌根治术中进行肺活检的临床实验研究

为探讨食管癌、贲门癌病人手术时是否已经出现了肺组织转移,我院胸外科自1998年1月至2001年10月随机抽取100例食管癌、贲门癌病人进行根治手术并在术中进行肺组织活检,结果表明有3例病人手术时已经出现了肺组织转移,为提高病人的术后长期生存率,我们强调食管癌、贸门癌病人手术中进行肺组织活检的必要性及术后综合治疗的重要性.     

食管癌淋巴结转移的组织病理学和流式细胞术检测的对比分析

目的：探讨食管癌癌周淋巴结转移不同检测方法的临床意义。方法：采用流式细胞术对64例食管癌癌周淋巴结转移进行了检测,并和组织病理学检测结果进行了比较,还对不同方法检测的临床意义进行了分析。结果：采用FCM法检测癌周淋巴结转移（＋）检出率显著高于组织病理学检测法,分别为87.5%和57.8%（P〈0.05）,食管癌中心灶与癌周LNM灶DI值均显著高于对照组（P〈0.05）,但两者之间则无显著性差异（P〉0.05）。随癌周淋巴结LNM（-）→半数LNM（＋）→全部LNM（＋）病例,两种方法检测LNM灶的DI、SPF和PI值均逐渐增高;随着癌周LNM（＋）检出率增加,无论采用组织病理学检测,还是FCM检测,患者临床分期数、病理分级数、肿瘤直径均逐渐增大,患者生存期逐渐降低。结论：采用FCM法检测食管癌周淋巴结转移情况,不仅可以提高LNM（＋）检出率,而且其检测结果和癌细胞生物学特性和患者临床生物学行为的关系均比采用组织病理学方法更为密切。如果采用两种方法联合检测,更能进一步提高癌周淋巴结（＋）检出率。     

术前外周血中性粒细胞与淋巴细胞比值在预测食管癌根治术后淋巴结转移中的临床价值

目的探讨术前外周血中性粒细胞与淋巴细胞比值(NLR)在预测食管癌根治术后淋巴结转移中的临床价值。方法回顾性分析我院2015年2月到2017年3月行食管癌根治术的110例食管癌患者的临床资料。以110例食管癌患者NLR≥4为临界点,将110例食管癌患者分为高NLR组(即NLR≥4)45例和低NLR组(即NLR4)65例,比较2组患者临床特征、淋巴结转移率,并采用logistic回归分析食管癌根治术后淋巴结转移的影响因素。结果本组110例患者共有87例患者出现淋巴结转移,其中高NLR组45例中有43例(95.56%)出现淋巴结转移,低NLR组65例中有44例(67.69%)出现淋巴结转移。高NLR组的淋巴结转移数及肿瘤浸润深度、远处转移均多于低NLR组(P0.05),表明术前NLR水平和食管癌根治术后患者淋巴结转移有关。高NLR组的淋巴结转移人数比例、淋巴结转移度均高于低NLR组(P0.05)。肿瘤T分期[OR=1.898,95%CI(1.151~3.130)]、NLR≥4[OR=1.919,95%CI(1.076~3.422)]是食管癌患者淋巴结转移的发生的独立危险因素(P0.05)。结论术前NLR较高的食管癌患者其淋巴结转移的风险性越大、肿瘤浸润越深、远处转移可能性越大,提示应扩大术中淋巴结清扫的范围。     

食管癌细胞中c-erbB-2与P-gP表达的相关性

目的　探讨食管癌细胞c erbB 2与多药耐药性相关性及其临床意义。方法　用免疫组化方法检测癌细胞c erbB 2和用流式细胞术检测了 4 6例食管癌手术标本中癌细胞P 糖蛋白 (P gp)表达水平 ,并进行相关性分析。 结果　食管癌中c erbB 2表达阳性 12 / 4 6例 (2 6 1% ) ;P gp表达阳性 2 8/ 4 6例 (6 0 9% )。食管癌淋巴结转移情况与c erbB 2和P gp表达比较发现 ,在c erbB 2阳性时淋巴结有转移 (31 0 9%± 5 33% )与无转移 (8 0 4 %± 3 0 3% )组的P gp表达比较差异有显著性(P =0 0 0 73) ,而在c erbB 2阴性时淋巴结转移情况与P gp表达无相关性。食管癌临床分期与c erbB 2和P gp表达比较发现 ,在c erbB 2阳性时 ,Ⅲ～Ⅳ期 (33 6 8%± 5 5 1% )与Ⅱ期 (9 30 %± 2 78% )组P gp表达比较 ,差异有显著性 (P =0 0 0 2 7) ,而在c erbB 2阴性时临床分期与P gp表达无相关性。食管癌肿瘤大小、肿瘤分化程度与c erbB 2和P gp表达均无相关性。结论　在c erbB 2表达阳性时食管癌中有淋巴结转移、临床Ⅲ～Ⅳ期患者与P gp表达升高有相关性 ,提示双阳性时肿瘤患者预后较差。但在c erbB 2表达阴性时食管癌有淋巴结转移、临床分期与P gp表达无相关性     

食管癌中COX-2表达与其临床病理特征及预后的关系

目的：检测COX-2在食管癌中的表达，探讨其与食管癌临床病理特征及术后患者预后的关系。方法：应用SABC免疫组化染色法检测89例手术切除的食管癌组织和20例正常食管粘膜组织COX-2蛋白的表达，分析COX-2在食管癌组织的表达与患者性别、年龄、肿瘤部位、病变长度、浸润深度、区域淋巴结转移、远处转移、鳞癌分化程度的关系。并对其中81例有随访资料者，分析COX-2表达与预后的关系。结果：食管癌组COX-2呈阳性表达率为94.38%（84/89），且着色较深，正常食管组COX-2呈阳性表达率为60%（12/20），着色浅。食管癌中，随着肿瘤浸润深度的增加、鳞癌细胞分化程度的减低，COX-2的表达逐步增强（P＜0.05）。COX-2的表达与其它临床病理特征，包括性别、年龄、肿瘤生长部位、肿瘤大小、有无区域淋巴结转移、有无远处转移无相关（P＞0.05）。COX-2低表达组与高表达组的生存时间有显著差异，前者生存时间较后者为长（P＜0.01）。结论：COX-2在食管癌中的表达高于正常食管粘膜。肿瘤浸润越深、鳞癌分化程度越低，COX-2的表达越强；COX-2的表达与食管癌患者的年龄、性别、肿瘤生长部位、肿瘤长度、有无区域淋巴结转移、有无远处转移均无关。COX-2的表达与食管癌术后患者的预后相关，COX-2呈低表达者的生存时间比COX-2高表达者长。     

放射导向手术(RGS)的发展及临床应用

本文介绍了放射导向手术(RGS)的基本原理及发展情况,概括了体内γ探针在放射免疫导向手术(RIGS)和淋巴结(SLN)成像技术中的应用,说明了体内γ探针与核药物相结合应用于临床能推动外科技术的发展,改善手术的效果,提高病人的成活率.     

CK19表达及其在喉鳞癌淋巴结微转移诊断中的应用

目的:研究用免疫组化方法检测CK19及其在喉鳞癌淋巴结微转移诊断中应用与临床病理意义。方法:对40例喉鳞癌患者及清扫淋巴结163个(常规临床检查颈部淋巴结阴性pN₀)进行常规病理检查(HE染色)和抗角蛋白19抗体的免疫组化检测。结果:40例喉鳞癌组织中CK19均表达阳性,40例颈淋巴结常规病理检查(HE染色)发现5例有转移者(共23枚淋巴结),CK19检测也为阳性。19个淋巴结常规病理检查未发现转移者,CK19也表达阳性。随着肿瘤T分期的增加,淋巴结CK19表达阳性率亦增加。CK19表达阳性者预后较阴性者差。结论:CK19免疫组化法是检测喉鳞癌淋巴结微转移的敏感而便捷的方法,而检测喉鳞癌微转移有助于判断肿瘤进展程度与预后,特别对筛选组织学检查淋巴结阴性但存在微转移的病人有实用价值。     

同一个体食管和贲门双源癌前病变组织中Rb的表达

目的 探讨同一个体食管鳞状上皮不典型增生(esophageal epithelial dysplasia,EDYS)和贲门腺上皮不典型增生(gastric cardia dysplasia,GDYS)组织中Rb蛋白表达的变化特征及其意义.方法 采用免疫组化ABC法和组织病理学方法,分析河南食管癌高发区30例同一个体同时发生EDYS和GDYS组织中Rb蛋白的表达情况.结果 Rb在EDYS组织中阳性率为70%(21/30),GDYS组织阳性率为80%(24/30),两者阳性率差异无统计学意义(χ~2=0.800,P>0.05);同一个体EDYS和GDYS组织Rb表达有明显一致性(Kappa=0.561,P<0.01),25例(83%,25/30)同时出现EDYS和GDYS组织Rb表达的一致性改变,一致阳性率为67%(20/30),一致阴性率为17%(5/30);EDYS和GDYS组织中Rb的表达相关(P<0.01).结论 Rb在同一个体EDYS和GDYS组织中存在较高的表达一致性改变,进一步提示食管鳞癌和贲门腺癌可能具有相似的发病因素和分子机制.     

Effect of salbutamol on gastroesophageal reflux in healthy volunteers and patients with asthma

The aim of this work was to establish whether beta-adrenergic agonists promote or increase gastroesophageal reflux in patients with asthma. Ten healthy individuals and eight patients with asthma were studied on 2 different days. One day they received a placebo, and the other day they received 4 mg of salbutamol by mouth. Complete measurements of esophageal manometry were performed before and every 30 minutes for 210 minutes after the administration of the drugs. Esophageal pH was measured continuously for the duration of the experiment. The results demonstrate that (1) salbutamol had no effect on the lower esophageal sphincter pressure gradient, the peak esophageal contraction pressure, or the number and duration of reflux episodes in patients with asthma and normal individuals, and (2) patients with asthma have a resting lower esophageal sphincter pressure higher than healthy subjects. We conclude that the administration of salbutamol does not affect esophageal function.     

Esophageal candidiasis as complication of inhaled steroid therapy]

Gastrointestinal endoscopy was performed in two bronchial asthma patients using inhaled corticosteroid who complained of odynophagia. The endoscopic finding was high grade with white moss (Grade III) in both patients. Esophageal candidiasis is often recognized in bronchial asthmatic patients receiving long-term fluticasone propionate (FP) dry powder (Diskhaler) inhalation. We therefore examined the complicated context of esophageal candidiasis in patients with long-term FP inhalation. Out of 20 bronchial asthmatic patients who had been using FP inhalation long-term, seven showed signs of esophageal candidiasis. Three patients had mild grade (Grade I), one middle grade (Grade II) and three high grade (Grade III) candidiasis, with a frequency of 35%. This rate is higher than the usual spontaneous occurrence rate of esophageal candidiasis, and it is suggested that inhalation of corticosteroid medication can penetrate into the esophagus after deep inhalation. We tested this hypothesis in two studies. 1) To measure the esophageal concentration of FP, four healthy adults inhaled 200 microg FP once. Right after inhalation, FP concentration in the esophageal washing fluid was 3.3 microg. On another day, 30 minutes after the same dose of inhaled FP, one FP concentration in the esophageal washing fluid was 0.67 microg (immediately laydown), and another was 0.11 microg (remained standing). This indicates that even though FP dissipates quickly, it remains in the esophagus 30 minutes after inhalation. 2) We observed the process in one patient with high grade (Grade III) esophageal candidiasis. The time of inhalation was changed from just after getting up and just before going to bed to before breakfast and before dinner. Under this regimen, the signs of esophageal candidiasis improved from high to middle grade. Conclusion: If asthmatic patients do not go to sleep immediately after FP inhalation, the remaining FP in the esophagus decreases rapidly, thereby decreasing the risk of esophageal candidiasis. In addition, by changing the FP inhalation times to before breakfast and dinner, the remaining FP in the esophagus is washed away and does not remain in the esophagus. Therefore, this study, which avoided inhalation before going to bed, provides useful information for the prevention and improvement of esophageal candidiasis.     

MAGE—1基因在人食管癌中的表达及基因克隆

目的 研究MAGE-1基因在人食管癌中的表达,分析MAGE-1抗原能否作为食管癌的治疗性候选疫苗。方法 采用RT-PCR方法检测了MAGE-1基因在30例食管癌组织和相应癌旁正常组织中的表达;并从食管癌组织中扩增了MAGE-1cDNA全长序列,经酶切后与pET-30a( )质粒载体连接,经初步酶切鉴定后,进行DNA序列分析。获得克隆基因的核苷酸序列。结果 MAGE-1基因在食管癌组织中的表达率为43%（13/30）,在30例相应癌旁正常组织中未见表达;成功地克隆了MAGE-1cDNA全长序列。结论 由于MAGE-1基因在食管癌中高频率表达以及MACE-1抗原具有HLA-I类分子限制性CTL识别表位,因此,MAGE-1抗原可以作为食管癌免疫治疗的候选疫苗。     

Validity of clinical symptoms in benign esophageal disease, assessed by questionnaire

A questionnaire designed to test the value of questions identifying benign esophageal disease was sent to patients representing four well-defined entities: angina pectoris (n = 30), benign esophageal disease (n = 25), gastroduodenal ulcer or former gallstones (n = 27) and normal subjects (n = 38). By means of logistic regression, three key-questions were selected. A combination of an affirmative answer to "difficulty in swallowing solid food" and to "pain in the chest" or "heartburn at night" or both did not occur in the group of normal subjects, while occurring in 68% of the patients with esophageal diseases. The combination occurred in only 10% of the patients with angina pectoris and 15% of those suffering from gastroduodenal ulcer or gallstones. The predictive accuracy of the combination of the three questions is estimated for various hypothetic prevalences of esophageal disease. These questions appear to identify approximately two-thirds of individuals with esophageal disease with acceptable false-positive rates and can therefore be used in epidemiological studies.     

MAGE-3基因的表达检测和重组MAGE抗原的制备及其应用

目的 克隆MAGE－3基因并检测其在人食管癌组织中的表达情况；重组表达MAGE－1和MAGE－3抗原，用于食管癌的治疗性蛋白疫苗的免疫原性研究。方法 RT－PCR法检测了MAGE－3在人食管癌组织中的表达情况。采用DNA重组技术将MAGE－1和MAGE－3全长cDNA克隆至pET30a( )载体上，转化大肠杆菌BL21（DE3），IPTG诱导表达，经SDS－PAGE和western blot鉴定后，制备其可溶性蛋白，研究其对人T细胞增殖能力的影响。结果 MAGE－3基因在食管癌组织中的表达率为50％（15／30）；在30例相应癌旁正常组织中未见表达。成功获得了MAGE－1和MAGE-3可溶性蛋白；人T细胞能够对自身抗原递呈细胞加工处理的MAGE－1和MAGE－3蛋白产生应答。结论 MAGE－1和MAGE－3蛋白可能是用于食管癌免疫治疗的免疫原性较强的靶抗原。     

TRF2在食管鳞癌中的表达及意义

目的：探讨端粒重复序列结合因子2（Telomeric repeat binding factor2,TRF2）在食管病变中的表达及其临床意义。方法：采用免疫组化ABC法检测60例食管鳞状细胞癌、30例食管上皮内瘤变和20例食管正常组织中TRF2的表达,并探讨与食管癌临床病理特征之间的关系。结果：在正常上皮组织、上皮内瘤变和食管鳞癌组织中,TRF2的阳性表达率分别为35%、56.7%和96.7%。食管鳞癌组织中,TRF2的表达与淋巴结转移和病理分级呈轻度正相关（P〈0.01）。结论：TRF2在食管癌组织中表达异常增高,提示TRF2与食管癌的发生、发展有密切的关系,检测TRF2的表达可能成为判断食管鳞癌生物学行为的重要指标。     

A Single Center Experience of Self-Bougienage on Stricture Recurrence after Surgery for Corrosive Esophageal Strictures in Children

Purpose

This study was undertaken to evaluate the long-term treatment of esophageal strictures in children with corrosive esophagitis and to determine the effect of self-bougienage on recurrent strictures.

Materials and Methods

We reviewed the medical records of nine children that were treated for corrosive esophageal strictures from May 2000 to May 2008. Six males and three females were included and their average age was 30 months. Six patients had ingested acids, two patents had ingested alkali, and one ingested an unknown agent.

Results

The interval between caustic ingestion and esophageal stricture ranged from one to eight weeks. The average length of the esophageal strictures was 3.8 cm (range, 1 to 9.2 cm). Four patients had a long segment stricture (longer than 5 cm) and one patient had multiple strictures. The most common site of involvement was the upper third followed by the mid third of the esophagus. Eight patients received repeated dilatation using a balloon catheter or bougie dilator. Among the eight patients, two patients had complete resolution of symptoms and six patients required surgery. Among five patients that developed restenosis of the esophageal anastomosis site, three patients had improved symptoms after self-bougienage and two patients had improved symptoms with repeated balloon dilatation or endoscopic bougienage. There were no complications in these patients.

Conclusion

Although a small number of patients were studied, self-bougienage was safe, less invasive, and effective for the management of esophageal restenosis in patients who required frequent dilation after surgery.     

超声内镜诊断与内镜下微创治疗食管平滑肌瘤

目的 评价超声内镜对食管平滑肌瘤的诊断及治疗中的价值.探讨内镜黏膜切除术(EMR)、内镜黏膜下剥离术(ESD)治疗食管平滑肌瘤的疗效和安全性.方法 对内镜检查中发现的40例食管黏膜下肿瘤行超声内镜检查,其中30例为起源于黏膜肌层的食管平滑肌瘤,4例为起源于同有肌层的食管平滑肌瘤.对30例起源于黏膜肌层的食管平滑肌瘤,根据病变大小决定行内镜下EMR或ESD治疗,完整切除病变.对4例起源于固有肌层的食管平滑肌瘤,考虑穿孔可能性大,未予内镜下治疗.结果 40例食管黏膜下肿瘤,病变直径0.4～2.5 cm(中位直径1.45 cm).24例行内镜下EMR治疗,6例病变直径超过1.5 cm行内镜下ESD治疗,ESD手术时间15～45 min(中位时间30min).2例术中出血较多.经内镜喷洒止血药物、电凝、氩离子束凝固治疗及金属钛夹钳夹止血,无术后出血,无ESD穿孔.所有EMR或ESD切除病变送检病理确诊,基底和切缘未见病变累及.术后1.5个月及6个月随访,创面愈合,无病变残留和复发.结论 超声内镜能够准确地诊断食管平滑肌瘤并指导其治疗.大多数食管平滑肌瘤的EMR治疗是简便和安全的.对于病灶较大、EMR难以完整切除的病变可行ESD治疗,也是安伞有效的,它可以完整切除食管病变,并提供完整的病理诊断资料.     

Esophageal dysfunction in diabetes mellitus: is there a relation to clinical manifestation of neuropathy?

Summary In a prospective study, we evaluated 33 diabetic patients [type I (n = 8) and type II (n = 25)]. Esophageal motor functions were examined by registering clinical symptoms and by performing esophageal manometry. We also investigated peripheral and autonomic neuropathy. In diabetics, the lower and upper esophageal sphincter pressure and amplitudes of peristaltic waves were reduced. Compared with controls (n = 30), in diabetics the esophageal peristaltic velocity was reduced significantly, and the duration of contractions were decreased as well. Multipeaked waves were uncommon in diabetics, while non-propulsive contractions were seen more often. No correlation was found between esophageal dysfunction and peripheral or autonomic neuropathy. Some 60% of diabetics reported esophageal symptoms; however, no relationship between these symptoms and the extent of dysfunction in esophageal motility was found.Abbreviations PNP peripheral sensorimotor polyneuropathy - ACN autonomic cardiac neuropathy - LES lower esophageal sphincter - UES upper esophageal sphincter - EMG electromyography - ECG electrocardiography