房室结折返性心动过速慢径消融的两种有效消融指标疗效比较

目的：评价以出现交界性心律与心房起搏显示慢径前传导阻滞作为有效消融指标在房室结折返性心动速（AVNRT）慢径消融中应用,比较这两种有效消融指标判断方法在慢径消融达到消融终点时的放电时间与消融靶点数的差异性。方法：153例AVNRT病人接受慢径射频消融术,根据X影像部位和局部电图特点确定消融靶点,放电功率10～40 W。按不同的有效消融判断指标分为传统方法消融（出现交界性心律）组（I组）和以心房起搏显示慢径前传导阻滞作为有效消融指标消融组（II组）。I组86例在放电后15 s内以出现交界心律或早搏后继续放电60～90 s;II组67例放电15 s内出现交界心律或早搏后延迟放电至20 s停止放电,以术前AV1：1最短间期心房刺激（S1S1）显示慢径前传阻滞后停止起搏继续放电至60 s。未达到消融终点者再继续选点消融,直至达到消融终点。结果：两组病人均达到消融终点,消融终点及终点类型两组间无差异性。I组86例,共有效消融靶点306个。人均消融（3.59±1.21）个靶点,放电时间（208.94±89.76）s;II组67例,共有效消融靶点150个,人均消融靶点（2.24±0.94）个,放电时间（114.83±38.97）s。人均各项参数Ⅰ组高于Ⅱ组,两组间比较存在显著差异（P（0.05）。15 s内无效消融不计靶点数。结论：显示慢径前传导阻滞作为有效消融指标可客观判放电消融的有效性,减少无效消融的心肌损伤。     

贲门癌经腹入路手术适应证的前瞻性研究

目的探讨贲门癌经腹入路手术的适应证，旨在规范贲门癌经腹入路手术适应证的选择标准。方法根据食管及贲门解剖、贲门癌病理特点、文献资料及临床经验，制定贲门癌经腹入路手术适应证标准，自2001年1月开始，对经腹入路手术治疗的贲门癌病例进行前瞻性研究。至2005年12月，共研究153例。结果符合适应证选择标准的贲门癌病例，经腹入路均能行根治手术。手术切除率100％。标本术后经病理学检查证实切缘均无癌细胞残留，共检出淋巴结781个，癌阳性率为78．75％（615／781）。全组均无吻合口瘘、胸腔积液及肺部感染等并发症，手术死亡率为0。随访期间发现腹腔内有癌转移灶者35例，复发率为22．88％，其中无吻合口复发、胸腔或纵隔转移病例。结论合理掌握贲门癌经腹手术适应证，既能达到根治效果，又能减轻患者创伤、负担及风险，具有重要临床意义。     

晚期食管贲门癌综合治疗的研究

对５０例晚期食管贲门癌包括伴有锁骨上淋巴结已有转移的病人，采用了以手术切除为主，术后辅以化疗、放疗的综合治疗方法。病人应用常规卡铂化疗，一疗程６００ｍｇ，分为３天，每天２００ｍｇ＋５００ｍｌ葡萄糖溶液静脉点滴，每月１疗程，共３个疗程。有癌残留或附近脏器有癌浸润、切除不彻底者给予常规放疗，放疗剂量为４０Ｇｙ￣７０Ｇｙ。手术并发症７例：胸内吻合口瘘１例，颈部吻合口小瘘１例，呼吸衰竭２例，吻合口狭窄２例     

Time trends incidence of both major histologic types of esophageal carcinomas in selected countries, 1973-1995

The purpose of our study was to examine the incidence patterns of 2 major histologic types of esophageal cancer, in selected countries world-wide and to identify components of birth cohort, period and age as determinants of observed time trends using regression modeling. The roles of temporal changes in specification of histology of tumors and of classification of cancers at the gastroesophageal junction as esophageal or gastric in origin were taken into consideration. In all, 56,426 esophageal cancer cases were included. The results indicate that the incidence rate of squamous cell carcinoma of the esophagus has been relatively stable in most of the countries analyzed, although increasing trends were observed in Denmark and the Netherlands (Eindhoven) among men and in Canada, Scotland and Switzerland among women. There was a significant increase in the incidence of esophageal adenocarcinomas in both sexes in the United States (among whites and blacks), Canada and South Australia and in 6 European countries (Scotland, Denmark, Iceland, Finland, Sweden and Norway). In France the increase was limited to men and in Switzerland the increase was observed only in women. Modeling was unable to distinguish which trends were the results of changes in risk between generations (as cohort effects), or changes in all age groups simultaneously (as a period effect).     

Cigarette smoking,alcohol consumption and subsequent gastric cancer risk by subsite and histologic type

The effect of cigarette smoking or alcohol consumption on the risk of gastric cancer has not been clarified. We investigated this relationship, considering the anatomic subsite and histologic type of gastric cancer. A total of 19,657 men (aged 40-59 years at baseline), who responded to the baseline questionnaire and reported no serious illness at that time, were followed for 10 years, from January 1990 to December 1999. Gastric cancer was confirmed histologically in 293 men. Smoking was associated with an increased risk of the differentiated type of distal gastric cancer; compared to the group who never smoked, the adjusted rate ratios (RRs) of gastric cancer for past and current smokers were 2.0 (95% CI 1.1-3.7) and 2.1 (95% CI 1.2-3.6), respectively. No association was observed between cigarette smoking and risk of the undifferentiated type of distal gastric cancer except for a suggestive association with cardia cancer. For alcohol consumption, elevated risk was suggested only for cardia cancer of all histologic types, though the relationship failed to reach significance. Among those who drank alcohol at least once per week, RRs for ethanol intake of 2.7-161.0, 162.0-322.0 and 322.5+ g/week compared to those who drank 0-3 times/month were 2.5 (95% CI 0.7-9.5), 3.3 (0.9-11.6) and 3.0 (0.8-11.1), respectively (p(trend) = 0.66). In conclusion, our results confirm that smoking is related to gastric cancer of the differentiated type. Further studies with more cases are needed to detect a positive association between cigarette smoking or alcohol consumption and cardia cancer.     

贲门癌高发位点的内镜研究

目的 观察和研究贲门癌的高发位点及其临床意义。方法 分析417例早期贲门癌和451例中晚期贲门癌,发现贲门癌有高发位点存在后,在高发现场重复内镜普查205例,验证该高发位点的真实性。结果 417例早期贲门癌中的327例（78.4%)和451例中晚期贲门癌中的336例（74.5%）,始发部位均在贲门黏膜脊根部,在验证性普查的205例中,发现11例贲门癌,其中9例（81.8%)始发部位也在贲门黏膜脊根部。结论 贲门癌的高发位点在贲门黏膜脊根部,它具有重要的临床意义。     

老年食管癌、贲门癌术后护理分析

目的总结老年食管癌、贲门癌术后护理经验，提高手术成功率。方法回顾性分析106例60岁以上老年食管癌、贲门癌手术治疗资料，探讨手术前后护理要点及术后并发症的预防。结果老年患者术后并发症以呼吸衰竭和吻合口瘘为多，是术后死亡的主要原因。结论提高老年患者手术前后护理水平，对预防术后并发症，提高手术成功率有着极其重要的意义。     

河南食管癌高发区ABO血型及血细胞分类记数与食管和贲门癌关系研究

目的 :通过分析河南辉县食管癌高发区食管癌和贲门癌患者ABO血型分布以及全血细胞的变化特征 ,进一步了解这些变化与食管和贲门癌的关系。方法 :统计辉县市人民医院 17年间 (1987～ 2 0 0 3 )食管和贲门癌收治记录 ,分析比较食管和贲门癌患者各血型的分布情况以及各种血细胞数量的差异。结果 :食管癌患者中 ,男女均为B型血比例最高 ,分别占 3 8. 6%和 3 4. 7% ;贲门癌男性患者中 ,O型血所占比例最高(3 9 .6% ) ;贲门癌女性患者中 ,B型血 (4 6. 7% )所占比例远高于其它血型 ;而AB血型的人在食管和贲门癌中所占的比例都最低 (7. 7%V S 13 .2 % )。食管癌及贲门癌患者均出现不同程度的全血细胞降低改变 ,贲门癌患者红细胞降低最明显 (男 :5 0 % ,女 :5 6% ) ,类似的情况还见于血红蛋白。贲门癌患者淋巴细胞降低的检出率高于食管癌患者。贲门癌患者贫血和淋巴细胞降低明显 ,其临床意义尚待进一步研究。结论 :B型血患食管癌的风险较大 ,O型血的男性和B型血的女性患贲门癌的风险较大 ,而AB型患食管和贲门癌的风险均较低。而外周血各项常规指标的变化与食管和贲门癌的关系还有待于进一步研究。     

机械吻合在食管和贲门癌手术中的临床研究

目的探讨机械吻合在食管和贲门癌手术中的临床疗效。方法将食管癌和贲门癌162例患者随机分为机械吻合(A)组,手工吻合(B)组。A组患者术中应用常州GW-1型圆型吻合器吻合,B组常规手术吻合。比较两组手术时间、吻合口瘘发生率及吻合口狭窄率。结果A组平均手术时间90.5min,无吻合口瘘发生,吻合口狭窄率为1.25%,与对照组比较差异有统计学意义(P<0.05)。结论机械吻合在食管和贲门癌手术中安全可靠、疗效确切,可缩短手术时间,减少术后吻合口瘘及吻合口狭窄率。     

局部晚期胃贲门癌的外科治疗

目的:探讨局部晚期胃贲门癌的外科治疗方法和治疗效果。方法:对76例局部晚期胃贲门癌以外科治疗为主的综合治疗结果,从手术方法、手术径路、手术适应证、术前检查和术后治疗等方面进行了探讨。结果:76例行胰体尾脾及部分食管胃切除32例,全胃切除34例,胰体尾脾全胃切除6例,全胃横结肠切除2例,全胃部分结肠切除1例,受侵肝左叶及部分食管胃切除1例。术后发生7例并发症,发生率9.21%。因十二指肠残端瘘死亡1例,死亡率1.32%。经随访1 a、3 a、5 a,生存率分别为60.56%(43/71),35.09%(20/57)和10.87%(5/46)。结论:对局部晚期胃贲门癌进行以手术治疗为主的综合治疗,可获得较好的远期治疗效果。