贲门失弛缓症的内镜诊断与治疗（附7例报告）

对７例贲门失弛缓症的内镜诊断与治疗进行讨论，认为内镜检查与活检组织检查合并应用不仅能诊断贲门失弛缓症，而且对于排除癌变或与贲门癌及其它性质的狭窄相鉴别很有用，但仍需和钡餐检查相互配合。内镜下食管狭窄扩张术和内镜下肌切开术被认为是目前治疗贲门失弛缓症的简单、快速、有效、安全的新方法，值得提倡。     

食管贲门癌高龄患者外科治疗的探讨

对高龄食管贲门癌患者手术指征的选择,不宜把病人年龄、心电图改变、肿癌大小作为绝对指征。决定病人可否手术是病人的“生理年龄”比实际年龄更为重要。凡肿瘤在一年以内,食管钡餐相小于10cm,软组织影不大,无远处淋巴转移,心脏代偿功能较好。在作好术前准备,如进行全面的体格检查及必要的辅助检查,了解各系统情况;矫正低蛋白、贫血、脱水及电解质紊乱,加强支持疗法,抗感染,且术中仔细操作,加强麻醉处理,心脏监护,确保血压平稳,避免使用对呼吸道剌激性大的药物等,这样均可使患者耐受手术。     

Kardiafunktion nach proximal-gastrischer Vagotomie

Zusammenfassung In einer prospektiven Studie wurde an 36 Patienten mit chronisch-rezidivierenden Ulcera duodeni die Kardiafunktion vor und nach proximal-gastrischer Vagotomie manometrisch und pH-metrisch untersucht. Zusätzlich wurden 5 cm oral der Kardia Oesophagusbiopsien entnommen. Als Kontrollkollektiv dienten 12 gesunde Probanden. Ein direkter Einfluß der proximal-gastrischen Vagotomie auf die Kardiafunktion ließ sich dabei nicht nachweisen. Im Gegenteil, eine bei 38,9% der untersuchten Ulcus-Patienten präoperativ nachweisbare Oesophagitis heilt 12 Monate nach proximalgastrischer Vagotomie weitgehend aus. Dieser positive Effekt der Vagotomie ist eher über eine günstige Beeinflussung des Regurgitates als über einen Effekt auf die Kardiafunktion zu deuten.

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Cardia function after proximal-gastric vagotomy

Summary In 36 patients with chronic duodenal ulcer disease LES-function before and after proximal-gastric vagotomy was examined manometrically and by determining pH-values in a prospective study. In addition, esophagus biopsies were taken 5 cm proximal of the cardia. 12 healthy volunteers served as controls. A direct effect of proximal-gastric vagotomy on LES-function could not be shown. On the contrary, in 38,9 % of the patients examined, preoperatively proven esophagitis disappears nearly completely 12 months following proximal gastric vagotomy. This positive effect of vagotomy is to be interpreted as a beneficial effect on regurgitated intestinal juice, more so than an effect on cardia function itself.

     

Sex hormones and oesophageal adenocarcinoma: influence of childbearing?

The male predominance of oesophageal adenocarcinoma might be explained by oestrogen protection in women. If true, female patients might have sex hormonal disturbances rendering impaired fertility. The influence of childbearing on the risk of oesophageal adenocarcinoma was investigated in a Swedish population-based case (n=63) -control (n=141) study. Childless women were not at increased risk compared to childbearing (OR=0.82; 95% CI=0.25-2.72), as neither were women with 0-1 children compared to women with at least three children (OR=0.93; 95% CI=0.35-2.49). In conclusion, we found no inverse association between childbearing and oesophageal adenocarcinoma.     

Epigenetically silenced PD-L1 confers drug resistance to anti-PD1 therapy in gastric cardia adenocarcinoma

ObjectivesThe anti-PD-1/PD-L1 therapy has been demonstrated safe and effective for cancer patients. However, our previous data showed that it had no obvious effects on gastric cardia adenocarcinoma (GCA). Thus, we investigated how the expression level of the PD-L1 was affected by the anti-PD-1 therapy, because it has been demonstrated that the PD-L1 level affects the therapeutic efficient of the anti-PD-1 therapy.Materials and methodsThe mRNA and protein levels of PD-L1 in the GCA tissues and corresponding normal tissues were determined by qPCR and ELISA. Promoter methylation was analyzed by bisulfite sequencing. Finally the methylation of PD-L1 promoter was confirmed in the mice.ResultsThe level of PD-L1 was up-regulated in the GCA tissues when compared to the adjacent non-tumor tissues. The anti-PD1 therapy could reduce the PD-L1 levels in patients with cancer recurrence. The promoter of PD-L1 was more hypermethylated in the secondary GCA after the anti-PD-1 therapy when compared with the adjacent non-tumor tissues or the primary GCA without the anti-PD-1 therapy. Furthermore, the promoter methylation of PD-L1 could be induced by the anti-PD-1 therapy in the mice model. Finally, the anti-PD-1 plus DNA hypomethylating agent azacytidine could significantly suppressed the tumor growth better than the anti-PD-1 therapy.ConclusionsHere we demonstrated that the unresponsiveness of GCA to the anti-PD-1 therapy might result from the promoter methylation and down-regulation of PD-L1. The anti-PD-1 plus azacytidine might be a more promising approach to treat GCA.     

贲门癌患者围手术期上消化道动力学观察

目的观察贲门癌对食管运动功能的影响以及手术后残余食管、残胃的运动功能改变。方法　用低顺应性三腔聚乙烯液压毛细管灌注导管对22例正常人和31例中晚期贲门癌患者进行了食管压力测定。所有受检者均仰卧位,每次吞咽5ml水,采用定点牵拉法。计算机自动计算出各部位的静息压、收缩压、收缩及松弛时间、传播速度。结果贲门癌患者手术前与正常人的各项指标(除下括约肌外)相比较,贲门癌患者食管下段收缩时间明显长于正常人。贲门癌患者手术前后的数据比较:①手术后上括约肌收缩压明显高于手术前。②手术后食管上段静息压和收缩压均明显高于手术前。③手术后食管中段收缩压明显低于手术前。④手术后胃的压力明显低于手术前。⑤手术后食管中段静息压明显低于胃的压力。结论①贲门癌这一疾病并未改变食管运动功能。②手术后近期吻合口处有一高压带,可起到阻止胃腔正压向食管腔传递的压力屏障作用。③手术使食管中段收缩运动功能减弱。④术后反射性引起食管上段收缩增强,从功能上讲似能阻止可能发生的食管咽返流。     

贲门部浸润性癌预后的探讨

探讨贲门部浸润性癌的预后;与幽门部浸润性癌进行对比分析。方法贲门部癌５０例,对照组幽门部部５０例,采用临床病理学资料和免疫组织化学方法进行对比分析。结果①临床病理学,Ｃ．Ｃａｓ和Ｐ．Ｃａｓ之间除淋巴结转移（Ｐ〈０．０５）有显著差异外,其它无显著性差异。②生存曲线分析,Ｃ．Ｃａｓ和Ｐ．Ｃａｓ之间,在淋巴结转移（Ｐ〈０．０１）和淋巴管侵入（Ｐ〈０．０５）方面有显著差异;在１００例进行性胃癌当中癌的浸润     

食管、贲门癌切除手术后使用17种结晶氨基酸的临床研究

对21例食管癌、贲门癌病人在切除术后使用17种L-结晶氨基酸(AAM组),经中心静脉高营养法输入,进行蛋白质合成及氮平衡的临床研究,并与输入相似容量及热量的水解蛋白11例(PRH组)对比。结果AAM组术后可维持血浆蛋白在术前水平及防止白蛋白值下降,而PRH组则不能防止白蛋白值下降;AAM组术后可达到氮平衡,而PRH组为负平衡。在细胞免疫功能及血清氨基酸谱测定方面两组均有促进作用,但AAM组均较PRH组为优。     

低张气钡双对比造影检查对早期贲门癌的诊断价值探讨

目的评价低张气钡双对比造影检查对早期贲门癌的诊断价值。方法回顾分析本科2007年6月～2010年6月采用低张气钡双对比造影检查诊断出早期贲门癌的28例患者的临床资料,与采取胃镜检查及病理检查做出的诊断进行比较。结果 28例患者中后经病理证实为早期贲门癌26例,其中隆起型12例,溃疡型8例,平坦型6例。误诊2例（1例为胃底静脉曲张,1例为炎性息肉）。结论低张气钡双对比造影检查因为经济、方便、无创,它是早期贲门癌最直接、有效的检查方法,如果结合胃镜检查及病理检查可以提高诊断准确率。     

X线和内镜在贲门失弛缓症诊断中的价值

目的 :比较X线和内镜在贲门失弛缓症诊断中的价值及二者应用优选问题。方法 :对28例贲门失弛缓症患者作X线和内镜检查 ,对照分析。结果 :X线诊断符合率为92 9 % ,而内镜为64 3% ,x2=4.9,P<0 05。结论 :X线和内镜均适用贲门失弛缓症的诊断 ,X线较内镜符合率更高