强直性脊柱炎患者的食管运动功能

研究诱导型一氧化氮合酶 （ｉｎｄｕｃｉｂｌｅ ｎｉｔｒｉｃ 　ｏｘｉｄｅ ｓｙｎｔｈａｓｅ, ｉＮＯＳ）在电离辐射导致的神经细胞凋亡中的作用。 方法：以单剂量２．０ Ｇｙ γ射线照射出生后 ０ ｄ的 Ｗｉｓｔａｒ大鼠,用 ＡＢＣ法检测照射后第 ０．５、１、２、４、６、８、１２、２４、４８小时大脑皮质内ｉＮＯＳ的表达。结果：照射组各时间点均有不同程度的ｉＮＯＳ表达,第６小时达峰值。各对照组未见ｉＮＯＳ表达。结论：ｉＮＯＳ所具有的神经毒作用可能是电离辐射导致的发育中脑神经细胞凋亡的重要因素。     

Narrowing the embryologic window of the adriamycin-induced fetal rat model of esophageal atresia and tracheoesophageal fistula

We recently reported on a new fetal rat model of esophageal atresia (EA) with tracheoesophageal fistula (TEF) induced by prenatal exposure to adriamycin (1.75 mg/kg i. p. injected daily to the pregnant dam from the 6th to 9th gestational days). With this treatment regime, many fetuses were resorbed and the number of associated malformations was very high. The present study demonstrates that similar doses of the drug administered only on the 8th and 9th gestational days allow higher fetal survival (9.7 3.9 vs. 6.8 4.7 fetuses per litter, P < 0.01) with a similar incidence of EA-TEF (41.2% vs. 56.4%, n. s.) and decreased occurence of associated anorectal and genitourinary malformations. Since this model is an instrument for further investigation of the disturbed cellular and morphogenetic events leading to EA and TEF, the narrowing of the embryologic window obtained by the present study will allow better focusing of the research on the critical period of time involved.     

Einfluß des operationstraumas auf die NK-zell-aktivität beim ösophaguskarizinom nach transmediastinaler dissektion vs. transthorakaler en-bloc-resektion

Zusammenfassung Um den Einfluß des chirurgischen Traumas beim Ösophaguskarzinom auf das zelluläre Immunsystem zu erfassen, wurden perioperativ in einer prospektiven Studie die Aktivität der natürlichen Killerzellen sowie die Serumkonzentrationen von Interleukin-2, Interleukin-6 un TNF- bei transmediastinaler Dissektion (n=12) vs. transthorakaler En-bloc-Resektion (n=10) der Speiserörhre im Vergleich zu einer Kontrollgruppe mit thorakoabdominalen chirurgischen Eingriffen bei nicht maligner Grunderkrankung erfaßt. Die Bestimmung der NK-Zell-Aktivität erfolgte präoperativ sowie am 4. und 10. Tag postoperativ durch einen standardisierten Europiumchlorid-release-Assay unter Verwendung von K-562-Targetzellen, die Lymphokine Interleukin-2, Interleukin-6 und TNF- wurden zusätzlich am 1. und 7. Tag postoperativ mit stadardisierten ELISA-Assays bestimmt.In unserem Patientengut sank die NK-Zellaktivität am 4. postoperrativen Tag sowohl in der Kontrollgrupe al auch bei beiden Operations verfahren zur Speiseröhrenresektion signifikant (p<0,05) zum Ausgangswert: in der Kontrollgruppe durchschnittlich um 45%, nach transmediastinaler Speriseröhrendissektion (1-Höhlen-Eingriff) durchschnittlich um 34%, nauch transthorakaler En-bloc-Resektion (2-Höhlen-Eingriff) im Mittel um 63% zum präoperativen Wert. Die transthorakale En-bloc-Resektion der Speiseröhre führte durch das größere chirurgische Trauma zu einer stäkeren Abnahme der zytotoxischen Aktivität der natürlichen Killerzellen. Eine Suppression der immunologischen Tumorabwehr insbesondere in der vulnerablen perioperativen Phase kann damit indirekt das Risiko der Manifestation von hämatogene Metastasen auf dem Boden einer intraoperativen Tumorzelldissemination u. a. bedingt durch Tumormanipulation begünstigen und damit prognostisch relevant werden.

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Influence of surgical trauma on natural killer cell activity in esophageal carcinoma following transmediastinal dissection compareed with transthoracic en bloc resection

In order to assess the impact of surgical trauma involved in the therapy of esophageal carcinoma on the cellular immune system, a perspective study was performed involving perioperative hematological parameters. The activity of natural killer cells and the serum concentrations of interleuin-2, interleukin-6 and TNF- were measured in 12 cases of transmediastinal dissection and 10 cases of transthioracic en bloc esophageal resection and compared to values of a control group of thoracic and abdominal surgical patients with non-malignant maladies. Natural killer cells assume a central role in the non-specific immunological response in tumor patients. Their main function is the destruction of tumor cells via cytotoxic activities amplified by the release of interleukin-2 and TNF-. Natural killer cell activity was measured prior to surgery and on postoperative days 4 and 10 using a standardized europium chloride release assay, utilizing K 562 target cells. Lymphokines interleukin-2, interleukin-6, and THF- were also measured on postoperative days 1 and 7 using standardized ELISA assays. The activity of natural killer cells in our patient group sank significantly (P<0.05) on postoperative day 4 and likewise in the control group and both study groups, activity sank to the original values. In the control groups, natural killer cell activity averaged 45% of preoperative values, in comparison with an average of 63% following transmediastinal esophageal carcinoma resection (one cavity procedure), and transthoracic en bloc resection patients only reached 61% of preoperative values, transmediastinal dissection patients assumed 75%, and 77% was achieved by control group members. Transthoracic en bloc resection of the esophagus led to a more extreme reduction in cytotoxic cellular activity owing to the greater surgical trauma. Suppression of the immunological tumor resistance, especially in the vulnerable perisurgical pahse, can have an indirect negative effect on the manifestation risk of hematogenic metastases owing to intraoperative tumor cell dissemination resulting from tumor manipulation and may thus be prognostically relevant.

     

Caustic ingestion in childhood: current treatment possibilities and their complications

In a review of 15 pediatric patients who had ingested caustic substances, the authors describe the diagnostic and therapeutic procedures to be followed as well as the complications that may occur with their use. The cases reported include 1 esophageal rupture caused by balloon dilatation and 1 recurrent stenosis treated with a silastic tutor.     

RTOG Phase I study on fast neutron teletherapy for squamous cell carcinoma of the esophagus

From August, 1977, through January, 1981, the Radiation Therapy Oncology Group sponsored a Phase I study (RTOG 77-09) on the use of fast neutrons for treating inoperable squamous cell carcinomas of the esophagus. A total of 39 evaluable patients were treated with curative intent using either fast neutrons alone or in combination with low LET irradiation as part of a mixed beam fractionation scheme. Actuarial survival curves are presented for both the "neutrons alone" and the "mixed beam" treatment groups. There was no significant survival difference between these groups of patients. The projected survival at two years is less than 10%, which is comparable with megavoltage photon results for an unselected series of patients. The size of the primary lesion and the initial Karnofsky performance status were found to be the most important prognostic indications for prolonged survival. Sixteen of 39 patients were felt to have achieved local clearance of their tumor at some time during their follow-up with the median time until a local recurrence being 17 months. Treatment related complications and patterns of metastatic spread are discussed. In general, it appeared that the response of large tumors to neutron irradiation resulted in necrosis and fistula formation. In many cases this was accompanied by persistent/recurrent tumor within the high dose radiation volume.     

生长抑素治疗食管静脉曲张破裂出血30例疗效分析

目的：观察生长抑素治疗食管静脉曲张破裂出血的疗效。方法：治疗组30例用生长抑素静滴维持，对照组30例用垂体后叶素及硝酸甘油静滴维持。结果：治疗组48h内止血27例，止血率为90％，对照组48h止血16例，止血率为53．3％。两组相比止血率有非常显著性差异（P＜0．01）。结论：生长抑素治疗食管静脉曲张破裂出血，具有止血速度快，止血率高及无明显副作用等优点，疗效优于垂体后叶素。     

咽食管严重狭窄和闭锁的手术治疗

目的　探讨咽、食管严重狭窄和闭锁的手术治疗方法及效果。方法　分析了 1983年 1月～ 2 0 0 1年 6月山东医科大学附属医院 (现山东大学齐鲁医院 )耳鼻咽喉科手术治疗的 2 7例咽、食管严重狭窄和闭锁病例 ,其中伴有喉狭窄 12例 ,颈段气管狭窄 1例。根据病因划分包括化学腐蚀伤 2 5例 ,外伤 2例。修复方式 :结肠上徙 2 0例 ,游离空肠移植 6例 ,单纯胸大肌肌皮瓣整复 1例。 12例喉狭窄中利用胸骨舌骨肌筋膜整复 8例 ,胸骨舌骨肌筋膜和会厌下移联合整复 4例。 1例颈段气管狭窄利用胸锁乳突肌肌骨膜瓣修复。结果　 2 7例中 2 5例恢复吞咽功能 ,2例失败。 12例喉狭窄 10例恢复喉的呼吸、发音及吞咽保护全功能 ,2例仅恢复喉的发音及吞咽保护功能 ;1例气管狭窄经手术整复 ,最终拔除气管套管。结论　结肠上徙适于治疗范围大、位置低的严重狭窄或食管闭锁 ;游离空肠移植需要在颈部有正常的食管腔及吻合血管 ;胸大肌肌皮瓣适于修复范围较局限的咽、颈段食管狭窄     

食管癌患者手术切除前后SA、CEA和SCP检测的临床意义

目的　探讨食管癌患者手术切除前后血清 SA、CEA、SCP水平的变化。方法　应用放免法测定 4 3例食管癌患者血清 CEA含量 ,化学法测定 SA和 SCP含量 ,并以 35名正常健康人作对照。结果　食管癌患者在手术切除前血清 SA、CEA、SCP水平非常显著地高于正常人组 (P<0 .0 1) ,手术切除后 6个月转移者血清 SA、CEA、SCP水平持续异常 ,未转移者血清 SA、CEA、SCP在正常水平。结论　血清 SA、CEA、SCP含量测定的变化与食管癌患者的病情和预后密切相关 ,有一定的临床应用价值     

前程加速超分割放射治疗食管癌疗效分析

目的 :评价前程加速超分割治疗食管癌放疗疗效及放射反应。方法 :对 96例食管癌随机分为前程加速超分割组 (前超组 )和常规组 ,每组 4 8例 ,全部经病理证实。男性 6 3例 ,女性 33例 ;年龄 4 1岁～ 70岁 ,中位年龄 5 7岁 ;病变部位胸上段 2 1例 ,胸中段 6 3例 ,胸下段 12例。病变长度 :<5cm 2 9例 ,5 0cm～ 7 0cm 5 7例 ,>10cm 10例。全部采用 6MVX线外照射 ,常规组 1次 /天 ,2 0Gy/次 ,5次 /周 ,总剂量 6 4Gy～ 6 8Gy ,4 4～ 4 5天完成。前超组 2次 /天 ,1 5Gy/次 ,间隔 6小时以上 ,总剂量 6 4～ 6 8Gy ,35～ 37天完成。 结果 :随访率 96 9%。 1、3、5年生存率前超组为 81 15 %、4 4 1%和 2 6 8% ,常规组为6 1 7%、2 5 1%和 16 9%。前超组 1、3年生存率高于常规组 (u值为 2 97及 2 6 4 ,P <0 0 1) ,5年生存率无显著意义 (u =1 71,P >0 0 5 )。前超组和常规组放射性食管炎发生率分别为 2 7 16和 16 7% (χ2 =1 5 2 ,P =0 2 0 ) ;放射性气管炎发生率前超组为 18 8% ,常规组为 12 5 % (χ2 =0 71,P =0 4 0 )。结论 :食管癌前程加速超分割治疗的 1年和 3年生存率高于常规组 ,5年生存率无明显差异 ,患者对前超组放疗副作用与常规组相比无明显增加。     

贲门癌切除机械吻合术后的胃食管反流

目的:探讨贲门癌切除食管胃机械吻合术后重建食管与胃食管反流之间的关系.方法:对30例术后患者进行食管胃压力测定,其中16例行24h食管pH监测,12例行内镜检查和病理学检查.结果:测压结果显示:吻合口与吻合口下方的静息压相似,比较差异无显著性(P＞0.05),而吻合口上方静息压增高,平均为3.42mmHg,经比较吻合口上方和吻合口下方差异有显著性(P＜0.05).值得注意的是其压力值(3.42mmHg)远低于正常括约肌的静息压(10～45mmHg),因此其抗反流作用的程度是有限的.本组16例术后食管24h pH监测表明食管的酸暴露时间延长,食管酸暴露时间百分比平均为13.78%,为正常人的11倍,反流次数增加,最长反流时间达43min,说明手术后的胃食管反流是客观存在的.内镜检查和病理检查,83.3%有异常现象及食管炎征象,进一步证实术后患者有不同程度的反流性食管炎.结论:1)贲门癌切除食管胃吻合术后存在胃食管反流.2)反流的发生不因机械吻合或手工吻合而异.3)反流的发生与术后时间长短无关.4)24h食管pH监测是最敏感的观察方法.5)半卧位睡眠是预防反流的有效方法.6)反流的治疗主要应用促动力药和粘膜保护剂.