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。     

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。     

微创治疗迟发性脑内血肿(附78例报告)

目的：评价微创治疗迟发性脑内血肿的疗效。方法：采取锥颅穿刺置管 尿激酶灌注引流方法，回顾分析78例迟发脑内血肿的临床资料。结果：78例迟发脑内血肿经微创治疗后存活71例，死亡5例，总死亡率6％。格拉斯哥昏迷指数(GCS)、年龄、瞳孔变化、血肿大小、脑挫伤程度及并发症等6项指标可影响治疗效果。结论：迟发性脑内血肿采取微创治疗具有安全性、少创、经济、恢复时间短、并发症少、死亡率低等优点。是一种有效可靠的方法。     

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