经腹扩大食管裂孔在近侧部胃癌根治术的应用

目的探讨经上腹正中延长切口扩大食管裂孔方法在近侧部胃癌根治术的应用效果。方法对1997年￣2004年52例近侧部胃癌经腹扩大食管裂孔行根治切除术的病例进行回顾性总结分析。结果52例中无手术死亡,食管断端无癌残留,无吻合口瘘等术后近期并发症。结论经上腹延长切口扩大食管裂孔行近侧部胃癌根治术,创伤小,食管下段切除充分,操作较简单,有实用价值。     

中药防治癌前病变现状及其机制

中药在防治食道癌前病变、口腔癌前病变、鼻咽癌前病变、胃癌前病变、肝癌前病变和宫颈癌前病变等方面取得了显著成效,其逆转癌前病变主要是通过调节细胞周期调控基因,细胞生长、增殖、分化调控基因及相关蛋白基因,细胞凋亡基因,转录因子等表达来发挥作用,另外中药还可对端粒酶活性、DNA水平等进行调整,也可能通过改善免疫相关基因如细胞黏附分子来提高机体的抗癌变能力。     

老年食管癌手术患者全身麻醉复合硬膜外麻醉与全身麻醉的比较

目的比较老年食管癌手术患者全身麻醉复合硬膜外麻醉与全身麻醉的效果。方法将76例老年食管癌患者随机分为全麻组(n=38):仅用全身麻醉;复合组(n=38):采用全身麻醉复合硬膜外麻醉。记录在围麻醉期两组患者的平均动脉压(MAP)、心率(HR)、全麻药用量、术后苏醒时间、苏醒质量和拔管时间,并进行比较。结果两组患者的麻醉效果满意。复合组患者的MAP、HR、全麻药用量、术后苏醒时间和拔管时间均明显低于全麻组(P<0.05或P<0.01.)。结论全身麻醉复合硬膜外麻醉的效果优于全身麻醉。     

食管癌术后完整胸胃的排空功能

目的观察保留完整的胸胃在未附加幽门引流术的情况下,对半固体食物的排空过程,探讨完整胸胃的排空规律。方法20例胸段食管癌病人分2组,近期术后组(12例)和远期术后组(8例),另设对照组(健康成年人10例)。观察不同时期病人,在进食试餐后120min内不同时间点的胃排空率(GER)和0～30min及30～120min的胃排空速率(GEV),并进行组间比较。结果近期术后病人的GER与术前相比,餐后5～100min明显快于术前(P<0.05);120minGER无差别(P>0.05);近期术后病人餐后GEV:0～30min加快而30～120min延迟,两个时间段的GEV比较差别显著(P<0.001);远期术后与近期术后病人的GER各时间点比较无显著性差异(P>0.05)。结论食管癌近期术后大部分病人的胸胃对半固体食物排空呈双相,但120min总排空率与术前相比无差别;远期术后病人胸胃对半固体食物的排空与近期术后无差别,食管癌病人手术时不需要常规附加幽门引流术。     

肠内营养支持在食管癌围手术期中的应用效果

【摘要】 目的 探析肠内营养支持在食管癌围手术期中的应用效果。方法 选择2017年12月～2018年10月在我院接受手术治疗的84例食管癌患者作为研究对象,按随机数字表法分为对照组和观察组,每组各42例。对照组术后行肠外营养支持,观察组术后行肠内营养支持,比较两组患者的营养指标、免疫功能以及术后康复状况。结果 术后第1d,两组患者的转铁蛋白(IF)、血清白蛋白(ALF)、血清总蛋白(TP)以及体质量指数(BMI)比较均无显著性的差异（P＞0.05）;术后第8d,观察组的上述营养指标均显著高于对照组（P＜0.05）,且观察组术后第8d的CD3+、CD4+、CD8+、CD4+/CD8+、IgA、IgM、IgG水平均明显优于对照组（P＜0.05）;观察组术后并发症发生率较对照组低,住院时间较对照组明显缩短（P＜0.05）。 结论 对食管癌围手术期患者实施肠内营养支持能够有效改善其营养状况,提高机体免疫力,有利于促进患者术后康复,可在临床推广应用。     

Assessment of optic nerve and optic tract alterations in patients with orbital space-occupying lesions using probabilistic diffusion tractography

AIM: To investigate the diffusion changes in both the optic nerve and optic tract in orbital space-occupying lesion patients with decreased visual acuity, and its clinical significance using probabilistic diffusion tractography (PDT). METHODS: Twenty patients with orbital space-occupying lesions and 25 age- and gender-matched healthy persons were included. All patients and controls underwent routine orbital magnetic resonance imaging and diffusion tensor imaging (DTI), using a 3.0T magnetic resonance scanner (Trio Tim Siemens). After the image data were preprocessed, each DTI parameters of the optic nerve and optic tract was obtained by PDT, including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD). The asymmetry index (AI) of each parameter was calculated. Compared the parameters of the affected side optic nerve and ipsilateral optic tract with the contralateral side by paired sample t-test; compared AI of parameters of optic nerve and optic tract between the patient group and the control group by independent sample t-test. Patients were divided into three subgroups according to the low vision grade standard of WHO, compared the FA and AI of FA between the three subgroups by single factor variance analysis. RESULTS: The affected side optic nerve presented significantly decreased FA, increased MD, AD, and RD values compared to the unaffected side (P<0.05). The AI of FA, MD, AD, and RD of optic nerve in the patients was significantly higher than that of the controls (P<0.05). The comparison results of the optic tract showed that there was no significant difference between the patient group and control group in terms of the bilateral optic tracts in patients (P>0.05). The AIs of the FA value of the optic nerve in the eyesight <0.1 subgroup was significantly higher than that in the other groups (P<0.05). CONCLUSION: FA, MD, AD, and RD of the affected side optic nerve of the orbital space-occupying lesions have significantly changed, the FA value is the most sensitive. The PDT could be a useful tool to provide valid quantitative markers of optic nerve injuries and evaluate the severity of orbital diseases, which other examinations cannot be acquired.     

树突状细胞疫苗与食管癌免疫治疗

随着树突状细胞(DC)体外扩增技术和肿瘤抗原制备、负载体系等DC疫苗制备技术的发展,与食管癌治疗相关的多种DC疫苗相继出现,包括多肽负载DC疫苗、食管癌细胞-DC融合疫苗、核酸负载DC疫苗、自体肿瘤抗原负载DC疫苗等,其中多肽负载DC疫苗及凋亡的自体肿瘤细胞负载DC疫苗等在临床应用中已取得较好疗效.     

局部晚期可手术食管鳞癌的治疗策略

局部晚期可手术食管鳞癌的治疗日趋综合化、个体化,围绕手术这个基石,有诸多组合模式,如术后化疗、术后放疗、术后放化疗、围手术期化疗、新辅助化疗、新辅助放疗及新辅助放化疗等,也包括非手术治疗的根治性同步放化疗、放疗联合免疫治疗等模式,更有新的治疗模式的探讨。其中,新辅助放化疗越来越得到业内人士的广泛认可。本文对上述治疗模式加以简要综述,以期规范食管癌的治疗。     

食管癌淋巴管的形态学观察

目的:观察食管癌淋巴管的形态分布规律、超微结构特征,为探讨食管癌淋巴转移机理提供形态学依据.方法:采用半薄切片光镜观察、超薄切片电镜观察人食管癌组织中央区、周边区和正常区内淋巴管的形态学变化.结果:食管癌中央区未见淋巴管,周边区淋巴管数量较正常区明显增多,管腔扩大;毛细淋巴管管壁破坏,细胞器发生明显改变.正常区毛细淋巴管的形态和超微结构未见明显改变.结论:毛细淋巴管壁的破坏和内皮细胞的开放连接可能是食管癌淋巴道转移的主要途径.