Fibrovascular polyp of the esophagus requiring esophagectomy

Fibrovascular polyps of the esophagus are rare, with only 110 cases reported in the world literature to date. Dysphagia is the most common symptom. The diagnosis is usually made by barium swallow or upper endoscopy, but almost a third of cases can be missed with these studies. Treatment is surgical. Only four cases in the literature underwent esophagectomy for removal. We present a female patient with a fibrovascular polyp of the esophagus who required a transhiatal esophagectomy to safely remove this mass.     

自发性食管破裂的护理

目的 总结自发性食管破裂患者的护理措施，提高护理水平。方法 在保守及手术治疗的同时，严密观察病情变化，做好心理护理，加强呼吸道、消化道及各种管道的护理。结果 7例患者治愈出院。结论 精心的专业化护理在治疗自发性食管破裂中起重要作用。     

食管癌贲门癌术后胸胃排空障碍的临床分析

目的探讨食管癌贲门癌术后胸胃排空障碍的诱因、诊断和治疗。方法回顾性分析1990年1月-2003年12月我院施行1369例食管癌贲门癌切除术的病人临床资料。结果本组病例发生胸胃排空障碍17例,发生率1.24%,其中机械性胸胃排空障碍5例,功能性胸胃排空障碍12例,均发生于术后3～12d,再次手术治疗5例;治愈16例,死亡1例。结论上消化道造影、胃镜是鉴别机械性胃排空障碍和功能性胃排空障碍的重要方法,对食管癌术后机械性胃排空障碍应采取手术治疗,而功能性胃排空障碍采取保守治疗多能好转。     

Post-operative esophageal leak treated with removable silicone-covered polyester stent

Self-expanding removable covered stents are increasingly being used for the treatment of benign esophageal diseases such as leaks or perforations and stenosis. They are easy to place and remove and good outcomes have been reported. We report a case of a postoperative esophageal leak successfully managed with a removable silicone-covered polyester stent.     

CD44v6和组织蛋白酶D表达与食管癌预后的关系

目的　研究CD4 4v6和组织蛋白酶D(cathepsinD ,CD)表达与食管癌生物学行为的关系。方法　应用免疫组化法 ,检测 6 5例食管鳞状细胞癌组织中CD4 4v6和CD表达水平。结果　在食管癌中CD4 4v6和CD表达阳性率分别为 5 8.5 %和 6 4 .6 %。CD4 4v6和CD表达均与肿瘤分级、浸润、淋巴结转移和预后相关。结论　CD4 4v6和CD异常表达与食管癌的病理生物学行为密切相关 ,可作为是预测食管癌转移潜能和评估食管癌预后的客观指标     

食管癌高发及低发区患者DNA修复功能的研究

本文对食管癌高、低发区食管癌患者和正常人,经MNNG诱导的DNA损伤修复功能进行了研究。实验采用外周血淋巴细胞培养的方法。每组又分为对照组及MNNG诱导组。样品以~3H-TdR标记后经液闪仪计数法进行检测。结果发现,低发区正常人经MNNG诱导的DNA损伤修复功能明显高于对照组,两个地区食管癌患者修复能力均低于正常人,与地区无关。     

Congenital esophageal atresia successfully treated by early ligation of a tracheoesophageal fistula and delayed repair of the esophagus in a premature infant: Report of a case

We report herein the case of a premature infant with esophageal atresia (EA) and a tracheoesophageal fistula (TEF) associated with cardiac anomalies who was successfully treated by an early ligation of the TEF following gastrostomy, and delayed repair of the esophagus. A 1212-g male was born prematurely at 31 gestational weeks, at which time he was diagnosed as having EA with TEF and patent ductus arteriosus (PDA), ventricular septal defect (VSD), and atrial septal defect (ASD). A gastrostomy was initially performed but following extubation he gradually became tachypneic. A chest roentogenogram revealed atelectasis and ground-glass appearance, and reintubation was required. Ligation of the TEF was performed 53h after his birth. Following the improvement of his respiratory condition through ventilatory support and the intratracheal administration of pulmonary surfactant, he underwent repair of the esophagus on the 6th day of life. Postoperatively, he suffered from heart failure, but was treated with peritoneal dialysis and pharmacological closure of the PDA. Weaning the infant from the ventilator proved difficult, but it was finally achieved when he had reached a weight of 2268g at 3 months of age by enteral feeding. Our experience of this case demonstrates that early ligation of TEF should be performed for a premature infant with EA and TEF before respiratory distress syndrome (RDS) has developed. If a gastrostomy is required to prevent gastric distention, it should be followed by simultaneous or immediate ligation of the TEF.     

The diagnosis and treatment of esophageal perforations resulting from nonmalignant causes

Esophageal perforations are extremely difficult to diagnose and treat. We report herein our results of a review of 26 patients with esophageal perforation which were spontaneous in 11, iatrogenic in 11, and caused by a foreign body in 4. Surgical treatment was performed in 7 of the patients with spontaneous rupture, but the remaining 19 patients were treated conservatively. The abnormality was found by plain radiography (X-ray) in 22 (85%) of the 26 patients, and by computed tomography (CT) in all 13 patients who underwent this procedure. The detection rates by esophagography and esophagoscopy were 100%, or all of 25 patients examined, and 60%, or 9 of 15 patients examined, respectively. Of 12 patients with underlying diseases, 4 (33%) died after the perforation, whereas only 1 (7%) of 14 patients without any underlying disease died. Postoperative empyema developed in all of 3 patients treated by intraoperative unfixed intrathoracic drainage (UID), but in none of the 4 treated by fixed intrathoracic drainage (FID). Conservative treatment achieved satisfactory results for spontaneous esophageal ruptures confined to the mediastinum, and for iatrogenic perforations and esophageal perforations caused by foreign bodies, provided there was no serious underlying disease such as advanced cirrhosis. Moreover, intraoperative FID proved useful in helping to prevent postoperative empyema.     

内镜下卢戈液染色诊断早期食管癌

目的：研究内镜下卢戈液染色诊断早期食管癌的临床可行性。方法：168例患者经内镜下喷洒卢戈氏液对食管粘膜染色后观察，并取不染区组织进行病理检查。结果：168例患者中有123例食管粘膜呈不规则片状不染或着色不良，经病理检查发现食管鳞癌16例，腺癌4例，各种程度的不典型增生52例，不同程度的炎症51例。正常着色者25例，深染者14例与散在小点状着色不良者6例中病理结果为轻度慢性炎症35例，未见明显异常者10例。结论：内镜下卢戈液染色是提高食管癌及癌前病变检出率的有效方法。     

经胸小切口在食管癌切除手术中的应用

目的探讨经胸小切口治疗食管癌手术的地位和可行性。方法对132例不同分期的食管癌行经胸小切口根治性手术,全部采用颈部吻合。结果切口平均长度13.0±2.0 cm,开关胸时间、开胸时出血量、术后伤口疼痛、呼吸功能受限及患肢活动等方面有显著差异,在手术时间、淋巴结清扫、术中出血及术后胸腔引流和常规手术无差异。结论经胸小切口食管癌根治手术安全、可行,并且有创伤小、恢复快等优点,便于推广应用。