瘤体内DNA倍体异质性与食管鳞状细胞癌病理特性的关系

目的探讨食管鳞状细胞癌瘤体内ＤＮＡ倍体异质性及其与肿瘤病理学特性的关系。方法采用多点取材方法，应用流式细胞术对８０例中晚期食管鳞癌标本的ＤＮＡ倍体类型进行分析。如果一个标本中的３个样品中的倍体类型不一致，即判定为倍体异质性肿瘤（ＰＨＴ），其余为非倍体异质性肿瘤（Ｎ－ＰＨＴ）。然后用统计学方法分析ＤＮＡ倍体异质性与肿瘤病理学特性的关系。结果８０例中，共检出异倍体肿瘤７１例（８８．８％），ＤＮＡ指数范围为０．７７～１．７４。倍体异质性肿瘤的检出率为４７．５％（３８／８０）。倍体异质性与肿瘤的侵润程度，淋巴结转移及患者预后有关（Ｐ＜０．０５～０．０２５），而与组织分级和瘤体大小无关（Ｐ＞０．０５）。结论ＤＮＡ倍体异质性是一种重要的肿瘤生物学现象。深入研究它将对判断肿瘤的病理特性、患者预后及协助组织学分级具有重要的价值。     

An experimental model for the study of transient lower oesophageal sphincter relaxation and motor function of the proximal stomach in humans

A simple and reliable experimental model would be useful in human research on new drugs which target transient lower oesophageal sphincter (LOS) relaxation. The aim was to investigate the effect of repeated distensions on the rate of transient LOS relaxation, LOS pressure and motor function of the proximal stomach. Twelve healthy subjects were studied with a multilumen manometric assembly incorporating a sleeve sensor for the LOS and a bag positioned in the proximal stomach and connected to a barostat. Intrabag volume was set at 75% of the threshold for gastric discomfort and maintained for two 30-min distension periods separated by a 45-min washout with the bag deflated. The studies lasted 145 +/- 2 min. The rate of transient LOS relaxations was similar during the two distensions, 3.5;2-4 vs 3;2.5-4 (median;interquartile range) and so was LOS pressure. Baseline intrabag pressure, as a measure of gastric tone, and the number of pressure waves, as a measure of phasic contractions, were also similar, 11.3;9.3-12.3 mmHg vs 10.8;9.3-12.5 mmHg and 16;13-28 mmHg vs 19;15-29 mmHg, respectively. Our model allows to perform 1-day studies which can assess two experimental conditions on transient LOS relaxations and motor function of the proximal stomach within an acceptable time span.     

我国食管癌发病危险因素的Meta分析

目的：评价我国食管癌发病的危险因素。方法：通过Meta分析对国内13篇公开发表的有关食管癌发病危险因素的病例-对照研究进行定量综合分析，共对12个因素进行评价，计算每个因素的综合OR值．结果：共有9个因素有显意义，分别为：吸烟(ORs=1．69)、饮酒(ORs=1．81)、酸菜(0Rs=2．22)、烫食(ORs=2．41)、家族史(ORs=4．00)、精神因素(ORs=3．06)、干硬食物(ORs=2．07)、吃饭快(ORs=1．82)、水果(ORs=0．39)．结论：吸烟、饮酒、酸菜、烫食、家族史、精神因素、干硬食物及吃饭快为食管癌发病的危险因素，水果为保护因素，而蔬菜、饮茶以及肉类对食管癌发病的作用尚不能确定。     

食管癌组织中癌细胞凋亡和相关基因表达的临床研究

目的　探索食管癌组织中癌细胞凋亡和相关基因p2 1、p5 3、Bcl- 2表达的关系。方法　采用免疫组化法检测 4 0例食管癌手术切除标本中p2 1、p5 3、Bcl- 2的表达及细胞凋亡的变化。结果　 4 0例食管癌组织中p2 1、p5 3和Bcl- 2的阳性表达率分别为 5 2 .5 % (2 1 4 0 )、80 % (32 4 0 )和 6 0 % (2 4 4 0 ) ,癌细胞凋亡指数 (AI)为 (2 0 35±1 30 2 ) % ,p2 1阳性表达时凋亡指数高于其阴性表达 ,p5 3阳性表达时凋亡指数低于其阴性表达。结论　p2 1和p5 3的阳性表达与癌细胞凋亡有密切关系 ,检测p2 1和p5 3的表达水平可以协助判断食管癌的分化程度及预后     

生长抑素治疗食管胃底静脉曲张破裂出血的临床研究

目的 探讨生长抑素治疗食管胃底静脉曲张破裂出血的临床效果。方法 应用奥曲肽治疗食管胃底静脉曲张破裂出血患者41例,并与垂体后叶素治疗的32例及三腔管治疗的25例进行对照。观察3组平均止血时间、24h止血率以及治疗前后门静脉主干直径、血流速度、血流量的变化。结果 奥曲肽治疗组、垂体后叶素治疗组、三腔管治疗组平均止血时间分别为194.27±28.88min、358.11±151.43min、134.71±32.12min,24h止血率分别为63.41％、37.50％、72％。奥曲肽治疗组止血率显著高于垂体后叶素治疗组(P<0.01)。奥曲肽治疗前后门静脉内径分别为10.86±0.41mm、13.84±0.35mm,二者有显著差异。奥曲肽治疗后其门静脉血流速度,血流量与治疗前相比较也有显著差异(P<0.01,P<0.05)。结论 奥曲肽能使门脉内径相对缩小、血流量减少和血流速度加快,从而使门脉压力降低达到止血的目的。     

经内镜注射硬化剂治疗食管静脉曲张(附15例报告)

经内镜注射5％鱼肝油酸钠治疗食管静脉曲张15例,共注射45次。其肝功能按Child分级,A级1例,B级8例,C级6例。曾经作过脾切除,分流或断流术者7例。8例急症出血患者经用硬化疗法获得了止血成功。1例急症患者死亡。6例作了择期预防出血的注射,治疗后均得到改善。治疗出血方面,硬化疗法在15例患者中14例有效,随访6～12月无再出血。     

Evaluation of an aortic stent graft for use in surgery on esophageal cancer involving the thoracic aorta

Objective: The purpose of this experimental study was to investigate whether aortic stent grafting can be applied to the treatment of an esophageal cancer involving the thoracic aorta. Methods: The canine thoracic aorta was partially resected without aorta being clamped after emplacement of an endovascular stent graft. Study I; The aortic whole layer of 1 cm in length and 1/4 of the circumference was resected and was covered by a free fascia patch of the abdominal rectal muscle immediately after stent graft placement. Study II; The aortic adventitia and the outer half of the media of the same size was resected on day 3, 7,14, 21, and on day 28, after the stent graft placement. The resected portion was covered by the free fascia patch in half experimental dogs, and was uncovered in the others. Study III; The aortic adventitia and the outer half of the media of 1 cm in length and 1/2 of the circumference was resected and was uncovered on day 7 after stent graft placement. Histological examinations were performed on day 28 and at one year after aortic resection. Results: The aortic wall could be resected in all cases with no complication, except in resection of 1/2 the circumference where the aorta had become narrow. There was no difference in healing of the resected portion of the aorta between with and without fascia covering. Conclusion: An aortic endovascular stent graft could be applied to surgery for an esophageal cancer involving the aorta.     

食管癌患者与对照组血清维生素A水平分析

目的:为了解食管癌患者和非食管癌患者体内维生素A的水平及其与食管癌发病的关系.方法:采用微量荧光法对32例食管癌患者(实验组)和32例非食管癌患者(对照组)血清中维生素A含量进行了测定.结果:显示实验组与对照组血清维生素A均值分别为1.55μmol/L,1.69μmol/L.经统计学处理两组血清维生素A水平有显著性差异(P<0.01).结论:提示食管癌的发生可能与机体维生素A水平有关,这种关系需进一步探讨.     

Technique and early clinical results of endoscopic variceal ligation (EVL)

Summary Endoscopic variceal ligation (EVL) is a new technique designed to be used instead of sclerotherapy. Small elastic O rings ligate varices resulting in their strangulation and eradication. During a 12-month period, EVL was employed in 53 consecutive patients, of whom 36 (68%) had alcoholic cirrhosis 17 were Child-Pugh class A, 22 class B, and 14 class C. Varices were graded from I to IV and repeat treatments were given at 1–2 week intervals until the varices were eliminated. At follow-up ranging from 6–18 months (mean 11.5), 217 EVL treatment sessions had been performed. Of the 13 patients (24%) who died during the study, 11 died during the index hospitalization. Active bleeding was controlled in 19 of 21 patients (90%). Of 40 survivors 13 patients (33%) had 1–2 (mean 1.4) recurrent variceal bleeds while 34 patients had repeat EVL treatment. Elimination of distal varices was achieved in 26 and 7 had reduction of varices from grade III–IV to grade I–II or less. Eradication required a mean of 4.4 EVL sessions in Child's A and B patients and 7.0 sessions in Child's C patients (P<0.025). No significant treatment-related complications were observed. EVL appears to control active bleeding, is associated with a low incidence of non-bleeding complications, and may be used as an alternative to sclerotherapy.     

Histological score for cells with irregular nuclear contours for the diagnosis of reflux esophagitis in children

Histological criteria for the diagnosis of reflux esophagitis include basal zone hyperplasia, stromal papillae elongation, and inflammatory infiltrate. However, endoscopic esophageal biopsy specimens may include little or no lamina propria. Intraepithelial T lymphocytes, seen in hematoxylin and eosin-stained sections as cells with irregular nuclear contours (CINC), may have a higher density in children with esophagitis. We evaluated the diagnostic accuracy of a numerical score built up by grading the "classical" parameters and its correlation with CINC density in grasp biopsy specimens obtained from children undergoing esophagogastroduodenoscopy with and without esophagitis. We analyzed esophageal biopsy specimens from 349 children (median age, 5 years) subdivided in 4 groups according to the previous routine histology report: group 1, 144 children with esophagitis; group 2, 65 controls; group 3, 51 children with dubious esophagitis; and group 4, 75 children with esophagitis on endoscopy but a normal histology report. A numerical value was assigned to each parameter; the sum of these values represented the histological score. We also evaluated intraepithelial CINC density (ie, number of CINC per high-power field). We separately analyzed histological sections with and without lamina propria. For both total score and for CINC density, we calculated a cutoff using a receiver operating characteristic curve. Cutoffs of 6 for score and of 4 for CINC density provided the best sensitivity and specificity. Sensitivity of the histological score was better in biopsy specimens containing lamina propria (94%) than in those without lamina propria (4%). Sensitivity of CINC density was satisfactory in both specimens with (78%) and without (75%) lamina propria. Specificity was satisfactory for both parameters. In conclusion, when lamina propria was present in sections of endoscopic esophageal biopsy specimens, histological score provided a better diagnostic accuracy for the diagnosis of esophagitis. However, when no lamina propria was present, as was the case in 67% of our children, CINC density had better sensitivity. In addition, this latter parameter showed esophageal mucosa damage in 34% of previously dubious cases or cases with esophagitis at endoscopy but a previous routine histology report of normal mucosa.