进展期食管贲门胃底癌内镜下三联治疗

目的研究失去手术、放疗、全身化疗机会的进展期食管＿贲门＿胃底癌内镜下三联疗法的疗效。方法采用激光光动力学加微波局部注射化疗药物的内镜下三联治疗法，共治疗１９例患者，并根据患者食管梗阻程度、内镜下肿瘤类型、病变范围，对进展期食管贲门胃底癌采用不同方法进行治疗。结果获得显著疗效者１４例，有效者５例。结论内镜下三联治疗法，是一种安全、有效治疗进展期食管＿贲门＿胃底癌的方法     

损伤性食管穿孔的诊断和治疗(附38例报告)

1966年2月至1993年8月治疗38例损伤性食管穿孔。损伤性食管穿孔以食管异物引起为最多见,共23例,占60.5％;其次为外伤性8例,器械性和手术误伤7例。行食管修补术12例,11例成功(91.7％);18例行颈部、纵隔或胸腔引流术;8例保守治疗。38例中痊愈29例,治愈率76.3％;死亡9例(23.7％)。作者认为早期诊断和及时处理对提高治愈率至关重要,应根据发病时间、病情程度选择不同的治疗措施。     

Detection of telomerase activity in malignant neoplasms and nonmalignantepithelial tissues of human esophagus

AIM To study the expression of telomerase activity in malignant esophageal neoplasms and normal humanesophageal epithelia.METHODS Telomerase activity was assayed by the telomere repeat amplification protocol (TRAP)method. All the neoplasms and epithelia of esophagus were confirmed by routine pathological diagnosis.RESULTS Telomerase activity was assayed in 18 normal esophageal epithelial tissues and in 35 malignantneoplasms of esophagus, including 27 cases of esophageal carcinoma and 8 cases of cardiac carcinoma.Telomerase activity was detected in most of malignant neoplasms of esophagus (91.4%, 32/35) and in allthe normal esophageal epithelial tissues except one (18/19).CONCLUSION The results suggest that in addition to contributing to proliferation of immortal blast cellsand neoplastic cells, telomerase activity may also play a similar role in regeneration of normal epithelia ofhuman esophagus. The potential use of telomerase activity as a diagnostic marker in human esophagealneoplasm might not be suitable.     

Endoscopic mucosal resection for early adenocarcinoma arising in Barrett's esophagus

A 58‐year‐old man was diagnosed to have an esophageal adenocarcinoma arising in Barrett's esophagus by screening examination at the previous hospital. Endoscopically, a slightly reddish elevated lesion with a central depressed component was detected in the Barrett's epithelium. Endoscopic ultrasonography showed the thickness of the second layer of the esophagus and no enlarged lymph node. Histological examination of a biopsy specimen revealed well or moderately differentiated adenocarcinoma. From these findings, the lesion was diagnosed as a mucosal esophageal cancer, type IIa + IIc, arising in Barrett's esophagus. As he refused operation, the lesion was resected endoscopically with his informed consent. Histologically, the resected specimens showed moderately differentiated adenocarcinoma arising in Barrett's esophagus. The adenocarcinoma had invaded the superficial muscularis mucosa, but was limited to the deep one with no vessel invasion. Barrett's esophagus often has a double muscularis mucosa. Connective tissues containing vascular and lymphatic vessels exist between them. However, one consideration is whether the existence of vessels between the double muscularis mucosa and the presence of vessel invasion are risk factors for metastasis. In order for a definitive indication for endoscopic mucosal resection, the frequency of lymph node and distant metastasis in cases of early Barrett's cancer needs to be investigated.     

Endoscopically treated esophageal lipoma presenting with recurrent dysphagia after esophagectomy for esophageal carcinoma

We have reported a case of endoscopically treated lipoma of the cervical esophagus. The patient was referred to our hospital with a chief complaint of dysphagia and underwent an esophagectomy through right thoracotomy, followed by esophagogastrostomy for superficial esophageal cancer 3¹/₂ months before. However, this benign lesion was not revealed by preoperative check‐up. He again complained of dysphagia after esophagectomy and lipoma of the cervical esophagus was confirmed. Esophageal lipomas are relatively rare in the digestive tract; however, lipoma of the cervical esophagus can cause upper airway obstruction in the case of regurgitation of the tumor. Therefore, this disease must be considered in the examination of the patient with dysphagia.     

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。     

miR-429对食管鳞癌细胞EC9706的影响及其分子机制探讨

目的:探讨miR-429对食管鳞癌细胞的影响及其靶向潜在的分子机制。方法:将miR-429 mimics、miR-429 mimics NC、miR-429 inhibitor和miR-429 inhibitor NC分别转染至食管鳞癌细胞EC9706,分别设为miR-429 mimics组、miR-429 mimics NC组、miR-429 inhibitor组和miR-429 inhibitor NC组。利用实时荧光定量检测各组miR-429的表达情况,MTT法检测细胞增殖率,通过TargerScans Human7.1预测miR-429靶基因并利用荧光素酶活性检测对其进行验证,蛋白免疫印迹检测各组细胞中E盒锌指结合蛋白1（ZEB1）蛋白的表达情况。结果:空白对照组、miR-429 mimics NC组、miR-429 inhibitor NC组之间miR-429相对表达量差异不明显（P＞0.05）。与miR-429 mimics NC组相比,miR-429 mimics组食管鳞癌EC9706细胞中miR-429表达量显著上调（P＜0.05）;与miR-429 inhibitor NC组相比,miR-429 inhibitor组食管鳞癌EC9706细胞中miR-429表达量显著下调（P＜0.05）。与miR-429 mimics NC组相比,miR-429 mimics组中EC9706细胞增殖率显著下降（P＜0.05）,miR-429 inhibitor NC组中EC9706细胞增殖率无显著差异（P＞0.05）,miR-429 inhibitor组中EC9706细胞增殖率显著增加（P＜0.05）。预测miR-429靶基因为ZEB1,荧光素酶活性检测证实ZEB1为miR-429靶基因。与miR-429 mimics NC组相比,miR-429 mimics组EC9706细胞中ZEB1蛋白表达量显著下调（P＜0.05）,miR-429 inhibitor NC组EC9706细胞中ZEB1蛋白表达量无显著差异（P＞0.05）,miR-429 inhibitor组EC9706细胞中ZEB1蛋白表达量显著上调（P＜0.05）。结论:miR-429可通过靶向ZEB1抑制食管鳞癌细胞增殖。     

硅膜-镁合金可降解支架置入兔食管可行性及组织反应——外和体内初步研究

目的 体外研究硅膜-镁合金可降解支架的机械特性和降解行为,体内研究其置入兔食管的可行性及组织反应.方法 体外测试硅膜-镁合金可降解支架的机械压缩恢复性能和降解行为.30只健康荷兰兔随机分为硅膜-镁合金支架组(n=15,透视导引下将支架置入兔食管下1/3段)和对照组(n=15,未作任何干预),支架置入后1、2、4周两组兔分别接受食管造影,同时于各时间点分别处死5只兔,取材作组织学检查.结果 体外测试显示硅膜-镁合金可降解支架表现出良好的柔韧性和弹性,在pH4.0、pH7.4磷酸缓冲液中降解均慢于镁合金裸支架;体内测试显示支架置入后所有实验兔耐受性良好,食管直径在置入前为(9.2±0.8) mm,置入后1、2、4周分别为(9.7±0.7)mm、(9.6±0.8)mm、(9.6±0.5)mm(P＞0.05).支架组6只兔发生支架移位(1周时1只,2周时1只,4周时4只).支架组食管上皮、平滑肌层变薄等食管壁重建与对照组比较,差异有统计学意义(P＜0.05);支架置入后食管壁损伤及胶原沉积等组织反应与对照组比较,差异无统计学意义(P＞0.05).结论 硅膜-镁合金可降解支架置入兔食管技术上可行,可提供至少2周支撑力,支架移位率可接受,未发生严重食管壁损伤及胶原沉积.     

胸上中段食管癌后程加速外照射联合腔内放疗的临床分析

目的 探讨中上段食管癌后程加速外照射联合腔内放疗的疗效。方法112例中上段食管癌患者随机分为56例后程加速超分割放射治疗（后超组）,开始常规分割放疗,为5次／周,2.0Gy／次,总量30Gy／3周,然后改2次／天,1．5Gy／次,间隔6小时以上,共2周。56例后程加速1周,腔内放疗2周（腔内组）,腔内放疗采用低剂量率192Ir,食管黏膜参考点剂量3．0Gy／次,每周一、周五,共2周,总量12Gy／4次。结果后超组和腔内组近期有效率分另q为98．2％、100％（P〉0．05）。3、5年生存率分别为48．2％、51．7％（P〉0．05）;35．7％、37．5％（P〉0．05）,两组无差异显著性,3、5年局部控制率分别为69．6％、73．2％;53．5％、57．1％（P〉0．05）,两组无差异显著性。结论后程加速联和腔内放疗,能有效控制肿瘤,值得临床应用。