Abstract: Esophageal carcinoma is one of the most common malignant tumours in China, surgery is one of the traditional therapy with a high complications rate. Among them, the anastomotic fistula was significant. At present, with the development of surgical technique, the incidence of anastomotic fistula become lower day by day, postoperative pulmonary complications of esophageal carcinoma has taken place of anastomotic fistula and become the main complications. The causes of pulmonary complication including pulmonary embolism, infection and acute lung injury have been revealed by recent researches. This article reviews the pathogenesis， prophylaxis and therapeutics of postoperative pulmonary complications of esophageal carcinoma.
Abstract: Objective To Evaluate the clinical outcome of gastric tube in radical surgeries to treat esophageal and cardial carcinoma. Methods From January to October 2008, 74 patients with esophageal or cardial carcinoma in Ruijin Hospital were enrolled in our study. Based on the surgical method, they were divided into the gastric tube group and the traditional way group. The gastric tube group had 46 patients, including 36 male patients and 10 female patients, whose age averaged 59.67±9.96 years (36 to 77 years). Among them, 31 patients had esophageal carcinoma with 1 upper, 23 middle and 7 lower esophageal carcinoma, and 15 patients had cardial carcinoma. In this group, 2 patients were treated with anastomosis in the left neck, 19 with anastomosis in the upper aortic arch, 10 with anastomosis in the lower aortic arch and 15 cardial carcinoma patients underwent radical resection. In the traditional way group, there were 28 patients, 25 male patients and 3 female patients, whose age averaged 59.17±11.33 years (37 to 86 years). In these patients, 22 had esophageal carcinoma with 1 in the upper esophagus, 17 in the middle esophagus, 4 in the lower esophagus; and 6 patients had cardial carcinoma. In this group, 2 patients were treated with anastomosis in the left neck , 17 with anastomosis in the upper aortic arch, 3 with anastomosis in the lower aortic arch, and 6 cardial carcinoma patients underwent radical resection. The rate of anastomotic leakage, operation time, and length of stay in hospital of these two groups were observed. Results All surgeries in the two groups were successfully performed. There was no anastomotic leakage case in the gastric tube group, while there were 4 pulmonary infection cases and 1 death case in the traditional way group. There was no statistically difference in the operation time (180.00±10.34 min vs. 185.00±6.23 min, t=1.669, P=0.078) and length of stay in hospital (16.78±9.98 d vs. 16.89±11.53 d, t=1.665, P=0.075) between the gastric tube group and the traditional way group. Conclusion Gastric tube has a good value in clinical application with fewercomplications and without prolonging operation and hospitalization time, which can surely better quality of life of the patients.
ObjectiveTo investigate the effect of jejunostomy combined with Ivor-Lewis or McKeown operation on the treatment of middle and lower esophageal cancer.MethodsThe clinical data of 127 patients with middle and lower esophageal cancer admitted to our hospital from June 2018 to October 2019 were retrospectively analyzed, including 89 males and 38 females, aged 62.82±8.65 years. The patients were divided into an Ivor-Lewis group (IL group, 72 patients) and a McKeown group (MK group, 55 patients) according to surgical methods. Patients in the IL group received jejunostomy combined with Ivor-Lewis operation, and patients in the MK group received jejunostomy combined with McKeown operation. The operation time, postoperative bedside electrical impedance tomography (EIT) parameters, postoperative inflammatory factor levels, postoperative complications and rehabilitation of the two groups were compared.ResultsThe operation time (262.65±49.78 min vs. 303.04±60.13 min), postoperative eating time (10.54±2.22 d vs. 11.47±2.49 d) and postoperative hospital stay (14.78±2.47 d vs.15.72±2.36 d) in the IL group were significantly shorter than those in the MK group (P<0.05). The blood loss (156.13±52.43 mL vs. 158.87±48.47 mL) and the number of lymph node dissection (29.47±8.88 vs. 30.17±9.80) in the IL group were less than those in the MK group, but the differences were not statistically significant (P>0.05). The repeated measurement analysis of variance showed that the time point could significantly affect tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and IL-8 levels (Ftime point=520.543, 272.379, 147.688, all P<0.05), but the surgical methods and the interactive effect of time point and surgical methods did not affect the levels of TNF-α, IL-6 and IL-8 (P>0.05). Postoperative bedside EIT image parameters were statistically different on the postoperative 1 d, 3 d, 5 d and 7 d between the two groups (P<0.05). Compared with the MK group, the incidences of recurrent laryngeal nerve injury, arrhythmia, pulmonary infection and atelectasis, anastomotic leakage, gastric wall necrosis and stump fistula, secondary thoracotomy and abdominal hemostasis, and intestinal obstruction were lower, but the differences were not statistically different (P>0.05). The recurrence rate of patients in the IL group within 6 months was lower than that in the MK group, but the difference was not statistically significant (8.33% vs. 9.09%, P>0.05).ConclusionJejunostomy combined with Ivor-Lewis or McKeown surgery have equivalent effects on patients with middle and lower esophageal cancer.
【摘要】 目的 觀察CyclinD1在食管鱗狀細胞癌和癌周正常食管組織的表達，從量化角度闡明其在食管鱗狀細胞癌組織中表達的病理學意義及其與CyclinE表達的關系。 方法 用免疫組化MaxVision法檢測CyclinD1、CyclinE在食管鱗狀細胞癌和癌周正常食管組織的表達，Image-pro plus圖像分析軟件對其表達強度進行定量分析，并用表達的陽性單位（positive unit，PU）反映其表達強度。 結果 CyclinD1蛋白在食管鱗狀細胞癌癌細胞核中表達的PU值高于正常食管組織（Plt;0.001）；CyclinD1蛋白表達的PU值與食管鱗狀細胞癌分化程度有關（Plt;0.001）；浸潤漿膜層組的CyclinD1蛋白表達的PU值高于無漿膜層浸潤組（P=0.037）；伴淋巴結轉移組的CyclinD1蛋白表達的PU值高于無淋巴結轉移組（P=0.012）；CyclinD1與CyclinE蛋白在食管鱗狀細胞癌中表達呈正相關（r=0.650，Plt;0.01）。 結論 CyclinD1在食管鱗狀細胞癌中表達上調，且與生物學特性相關，可作為判斷腫瘤患者預后不良的標志之一；CyclinD1和CyclinE可能在食管癌癌變過程中起協同作用。/【Abstract】 Objective To observe the expression of CyclinD1 and its correlation with the expression of CyclinE in esophagus squamous carcinoma. Methods The expressions of CyclinD1 and CyclinE protein were detected by immunohistochemistry (MaxVision method) using the monoclonal antibody and their intensities were assessed quantitatively by Image-pro plus image analysis system. Results The monoclonal antibody was detected in specific cell nucleus. The positive unit (PU) value of CyclinD1 was larger in the esophagus squamous carcinoma than that in the normal esophagus tissue with a statistically significant difference (Plt;0.001). The expression of CyclinD1 was correlated with differentiation of esophagus squamous carcinoma (Plt;0.001) and infiltration degree of esophagus squamous carcinoma (P=0.037). The PU value of CyclinD1 of the nuclei was larger in esophagus squamous carcinoma with lymph node metastasis than those without lymph node metastasis (P=0.012). There was a positive correlation between CyclinD1 protein and CyclinE protein (r=0.650, Plt;0.01). Conclusion The positive expression of CyclinD1 is up-regulated in the esophagus squamous carcinoma. CyclinD1 protein relates to the clinicopathological characteristics and prognostic value in esophagus squamous carcinoma. CyclinD1 expression is bly associated with CyclinE expression in esophagus squamous carcinoma.
摘要:目的:探討晚期食管癌切除、縱隔淋巴結清掃及術中縱隔熱灌注化療對殘留于氣管、支氣管、胸主動脈、奇靜脈等器官的癌性肉眼微小病灶治療效果。方法:選擇食管癌病變浸潤超過外膜層外侵至氣管、支氣管、胸主動脈、奇靜脈等器官患者112例，隨機分為兩組:治療組56例,術中42～43℃無菌蒸餾水2000～2500 mL加入順鉑(DDP)150 mg及氟尿嘧啶(5FU)1200 mg在體外循環下行縱隔熱灌注化療40 min;對照組56例,術中未進行縱隔熱灌注化療。結果:治療組術后第一年有6例出現縱隔區域腫瘤復發及淋巴結轉移,術后第二年有11例縱隔區域腫瘤復發及淋巴結轉移;對照組術后第一年有14例出現縱隔區域腫瘤復發及淋巴結轉移,術后第二年23例出現縱隔區域腫瘤復發及淋巴結轉移。結論:晚期食管癌術中縱隔熱灌注化療可明顯減少或延遲縱隔區域腫瘤復發及淋巴轉移,提高術后第一至第二年生存率。Abstract: Objective: To explore the advanced esophageal cancer resection, mediastinum, lymph node dissection, mediastinum, hot infusion chemoembolization and clinical observation of residual heat infusion chemoembolization and trachea, or the thoracic aorta, bronchus, eye cancer organs such as intravenous of tiny lesions therapeutic effect. Methods: Select esophageal lesions than the outer membrane layer of infiltrating the trachea and bronchus to the thoracic aorta, and 112 cases of patients with venous organs such as random points to two groups: treatment group treated with perfusion of 56 cases at 4243 degrees Celsius sterile 2000 mL distilled water 2500 mL ~ (DDP) joined cisplatin 150 mg, 5fluorouracil (5FU 1200 mg) in extracorporeal circulation downlink mediastinal hot perfusion 40 minutes, control group treated with perfusion of 56 cases without mediastinal hot perfusion chemotherapy. Results: Treatment group in 6 cases occured after first mediastinal tumor recurrence and regional lymph node metastases after 11 cases, the regional recurrence and lymphatic metastasis mediastinal, control group first fill after 14 cases mediastinal tumor recurrence and bureau of regional lymph node metastasis appeared in 23 cases, surgery between regional tumor locally recurrent lymph node metastases. Conclusion: Advanced esophageal intraoperative mediastinal hot perfusion chemotherapy can obviously reduce or delay mediastinal tumor recurrence and regional lymph node metastases, raise the firstsurial.
Objective To investigate the related factors affecting the metastases to left gastric artery lymph nodes in patients of esophageal cancer, and evaluate the clinical significance of resection of left gastric artery. Methods One hundred and eighty-six patients with esophageal cancer undergone esophagectomy and esophagogastrostomy were involved in these case-control study. The left gastric artery, lymph nodes and fat tissue around it were removed in these patients. Patients were divided into 2 groups according to the occurrence of metastases to para left gastric artery lymph nodes. Chi-square test, rank sum test, t-test and the logistic regression were adopted to analyze the correlations between these related factors and the metastases to para left gastric artery lymph nodes. Results Thirty-three patients had para left gastric artery lymph nodes metastases （17. 74%）. Related factors that affect the metastases to para left gastric artery lymph nodes were showed by monovariate analysis as follows： TNM staging of tumor, the metastases to paraesophageal nodes, paracardial nodes and subcarinal nodes （P〈0.001, P=0.025, 0.047,0.038）. Multivariate analysis showed that location of tumor was the only independent factor that influences the metastases of para left gastric artery lymph nodes（P= 0. 002）. Skip metastasis was a distinct feature of esophageal cancer, with a frequency of 78.79%（26/33）. Conclusions This study suggests that the major correlative factor of para left gastric artery lymph node metastasis is location of tumor. Resection of left gastric artery as a routine procedure in radical operation of esophageal cancer should be considered.