食管鳞癌中IGF-IR、VEGF-C的表达及临床病理意义

目的：探讨食管鳞癌IGF—IR、VEGF—C的异常表达及其临床病理学意义。方法：应用免疫组化法（Envision二步法）检测95例食管鳞癌和20例正常食管组织的IGF—IR、VEGF-C水平,并分析其表达与病理学意义。结果：IGF—IR、VEGF—C在食管鳞癌组织中的检出率分别为81．05％（77／95）和67．37％（64／95）,在食管正常组织中的阳性检出率分别为20％（4／20）和5％（1／20）,差异均有统计学意义（P〈0．01）。IGF—IR的阳性表达与食管鳞癌淋巴结转移、组织分化程度、浸润深度均有明显关系（P〈0．01）。VEGF—C的阳性表达与食管鳞癌淋巴结转移、浸润深度也有明显关系（P〈0．01）,而与分化程度无明显关系（P〉0．05）。食管鳞癌中IGF—IR与VEGF—C间存在明显等级相关性（P〈0．05）。结论：IGF—IR和VEGF—C的异常表达在食管鳞癌癌变过程中具有重要作用,IGF—IR和VEGF—C的表达可作为评估食管鳞癌恶性程度的重要生物学指标,联合检测IGF—IR和VEGF—C表达具有重要的临床应用价值。     

肋骨内固定术治疗创伤性连枷胸

Objective To compare the effects of rib internal fixation and thoracic external fixation in treatment of traumatic flail chest. Methods Eighty six cases of traumatic flail chest with multiple injuries,admitted to hospital from January 2006 to June 2009 ,were recruited into the study and divided into rib internal fixation and thoracic external fixation groups randomly. The clinical data were analyzed retrospectively. Rib internal fixations with Ti-Ni shape memory alloy embracing connector were performed in internal-fixation group(n = 45) and thoracic external fixations were performed in external-fixation group(n = 41). The outcomes were compared between the two groups. Results No patient in internal-fixation group developed chest wall deformity,while 19 patients in external-fixation group had chest wall deformity left. The mean times of hospital stay([ 15. 1 ± 1.8]d vs [22. 9 ±2. 8]d,t = - 15. 724,P ＜0. 01) ,ICU stay([5.7 ± 1.5]d vs [ 14. 4 ±2. 9]d,t =- 17.711, P ＜ 0. 01), and mechanical ventilation([ 3.9 ± 1.5 ] d vs [ 1 1.6 ± 2. 3 ] d, t = - 17. 256, P ＜ 0. 01),in internal-fixation group were significantly shorter than those in external-fixation group. The occurrence rate of respiratory complications (including pulmonary inflammation and (or) atelectasis and (or) respiratory failure)in internal-fixation group was significantly lower than those in external-fixation group(35.6% vs. 70. 7% ,x2 =10.641,P ＜ 0.01). Followed-up data of three months after discharge showed that the pulmonary function parameters, such as total lung capacity([ 89. 5 ± 3. 1 ] % vs. [ 79. 1 ± 5. 1 ] %, t = 11. 705, P ＜ 0. 01), forced vital capacity([ 80. 2 ± 2. 8 ] % vs. [ 69. 8 ± 3. 8 ] % ,t = 14. 241 ,P ＜0. 01) ,forced expiratory volume in the 1st second ([74.8 ±4.4]% vs. [71.9 ±3.6]% ,t =3.201,P ＜0.01),peak expiratory flow ([82.8 ±4.4]%vs. [79. 8 ±4. 9]% ,t =2. 885,P ＜0. 01) and forced expiratory flows at 75% of the vital capacity( [68.2 ±2. 2] % vs. [61.9 ± 2. 9 ]%, t = 11. 286; P ＜ 0. 01) were significantly higher in internal-fixation group than those in external-fixation group. Conclusion Rib internal fixation for traumatic flail chest can quickly correct chest wall deformity, stabilize thoracis and eliminate paradoxical chest wall movement. Patients accepted this treatment have a shorter therapy process during the intensive care unit and hospital stay, less pulmonary complications. They also show less long-term restrictive pulmonary functions impairment, when compared to the patients in the thoracic external fixation group. Rib internal fixation with Ti-Ni shape memory alloy embracing connector is a simple and effective therapy.     

食管鳞癌组织中IGF-1R、VEGF-C的表达变化及意义

目的观察食管鳞癌组织中的胰岛素样生长因子-1R（IGF．1R）、血管内皮生长因子C（VEGF—C）的表达变化,并探讨其意义。方法分别采用免疫组化法、免疫印迹法检测食管鳞癌和癌旁正常食管组织中的IGF-1R、VEGF—C。结果食管鳞癌组织中IGF-1R、VEGF—C阳性率分别为81．05％、67．37％,癌旁组织中分别为20％、5％,P均〈0．01;食管鳞癌组织中IGF—IR、VEGF．C蛋白条带灰度比值分别为0．58土0．03、0．43±0．05,癌旁组织中分别为0．43±0．02、0．31±0．04,P均〈0．05。IGF—IR、VEGF—C表达与食管鳞癌淋巴结转移、浸润深度有关（P均〈0．01）,二者表达呈正相关（r=0．29,P〈0．05）。结论食管鳞癌组织中IGF—IR、VEGF—C高表达,在食管鳞癌的发生发展及转移中有重要作用。     

非小细胞肺癌p16基因缺失的研究

目的：分析我国非小细胞肺癌(NSCLC)患者肿瘤组织中p16基因缺失的情况．探讨该基因在肺癌发生中的作用。方法：采用逆转录-聚合酶链反应．对31例手术切除的NSCLC标本中p16基因外显子1和外显子2的缺失进行检测。结果：31例NSCLC中．有26例发生了p16基因的缺失．缺失率达83．9%；p16基因缺失以杂合性缺失为主；p16基因缺失与NSCLC组织学类型，分化程度，有无淋巴结转移以及临床分期无关；NSCIC Ⅰ，Ⅱ期病例即有较为显著的p16基因的缺失。结论：抑癌基因p16在NSCLC发生发展中起主要作用。p16基因缺失可能是NSCLC发生的早期始动环节．检测相关标本中p16基因缺失对肺癌的早期诊断有重要意义。     

结肠代食管术联合颈胸腹三区域淋巴结清扫治疗食管癌临床疗效分析

目的探讨结肠代食管术联合颈胸腹三区域淋巴结清扫治疗食管癌的价值。方法对120例有结肠代食管术指征的食管癌患者行结肠代食管术,术中加行颈、胸、腹三区域淋巴结清扫（A组）。并与同期行常规食管癌根治术（右胸、腹两切口）的110例患者进行比较（B组）。结果A组手术切除率明显高于B组（98.3%VS 91.8%）,而切端阳性率低于B组（5.0%VS 12.7%）（P〈0.05）。A组并发症率为36.7%,高于B组的24.5%（P〈0.05）。A组共清扫淋巴结2 151枚,平均17.9枚/例,淋巴结转移9.6%;B组清扫淋巴结920枚,平均8.4枚/例,淋巴结转移率8.2%。A组1,3,5年生存率分别为86.4%、69.1%和39.1%,B组分别为83.2%、43.0%和26.2%;A组3,5年生存率均高于B组（P〈0.05）。结论结肠代食管术联合颈胸腹三区域淋巴结清扫术治疗食管癌淋巴结清除率高,可明显延长患者生存期。     

血管吻合与空肠移植在食管外科中的应用

采用空肠系膜血管吻合，施行空肠移植术修复各种类型的食管胃缺损１８例。其中２例采用甲状腺上动脉与肠系膜动脉吻合，１６例采用颈横动脉与肠系膜动脉吻合，全组１８例均采用颈外浅静脉与肠系膜静脉吻合。带蒂空肠移植７例，游离空肠移植１０例，游离空肠片移植１例。全组无手术死亡。文中就手术适应证及手术技术进行了讨论。     

食管癌术后几种罕见并发症的处理

食管癌术后几种罕见并发症的处理郭昭扬，俞力超，陈景瑛江苏省镇江医学院附属医院胸外科（２１２００１）我院胸外科从１９７６～１９９１年，手术治疗食管癌６３１例，其中发生较为罕见的并发症６例，均施行了第二次手术。全部治愈，现将其经验教训报告如下：临床资料本...     

外周血MUC1基因表达与食管癌微转移的关系

食管癌是最常见的恶性肿瘤之一,我国食管癌发病率居世界之首,每年新增发病15万人之多.尽管采用以手术为主的综合治疗,效果仍不尽人意.     

胸段食管癌颈部及上纵膈淋巴结转移

胸段食管癌颈部及上纵膈淋巴结转移附属医院胸心外科俞力超郭昭扬许运龙连锋胸段食管癌淋巴结转移的规律，近年来国内外文献陆续报导。由于手术方式不同等原因，因而颈部及上纵膈淋巴结清除率有一定差异，可能影响手术治疗效果。我院从１９８９年１月至１９９６年１２月，...