河北省磁县医院1973-2005年4418例食管癌和贲门癌病例分析

目的动态观察河北省磁县医院食管癌和贲门癌就诊患者的临床特征，加深对该地区食管癌和贲门癌发病情况的了解。方法严格记录磁县医院33年间（1973-2005年）食管癌和贲门癌患者手术记录，逐年分析手术患者的患病情况、性别、年龄、血型等。结果33年间该医院共手术治疗食管癌和贲门癌4418例，平均每年收治133人，各年度收治人数无显著差异（P〈0．05）。33年间收治食管癌2892例，占65％，贲门癌1526例，占35％。食管癌和贲门癌患者中男性（2916）多于女性（1502）（男：女，1．9：1），尤以贲门癌更明显（男：女，3．6：1）（P〈0．05）。食管癌和贲门癌高发年龄段为50-59岁。有血型记录的食管癌1587例，贲门癌868例，食管癌和贲门癌B型血（37％，36％）患者所占比例均高于其它血型（P〈0．05）。而AB血型的人在食管和责门癌中所占的比例都最低（10％，11％）。有家族史的食管癌思者675例，占23％；贲门癌319例，占21％。中段食管癌最常见，占79％，而上段少见，占5％。结论食管癌和贲门癌是磁县地区最常见的恶性肿瘤，男性明显高于女性，贲门癌更为显著；食管和贲门癌患者均以B型血多见，男性多于女性，50-59岁为高峰年龄段。     

高龄食管癌和贲门癌212例治疗分析

食管癌和贲门癌是常见的消化道恶性肿瘤 ,其临床确诊时多属中晚期 ,且患者年龄较大 ,治疗上手术切除和局部放射治疗都是行之有效的办法 ,我院 1 986年— 1 996年以来用这两种方法治疗 70岁以上高龄食管癌和贲门癌 2 1 2例 ,现报告如下。1　临床资料2 1 2例 70岁以上高龄食管癌和贲门癌者患者中 ,最大年龄 84岁 ,中位年龄 74 .6岁。所有病例均经纤维胃镜检查并经病理活检证实。两组性别、年龄、发病部位、临床分期、病理检查情况见表 1～表 4。　　经手术的 1 2 0例中 ,共有慢性支气管炎、高血压、冠心病、糖尿病、肺结核等1种以上合并症的有…     

高龄食管癌和贲门癌107例手术治疗临床分析

我院1993年1月至1998年12月共手术治疗食管癌、贲门癌1935例,70岁以上（高龄）者占107例（5.5％）,本文就其患者手术的相关问题回顾性分析如下:     

中晚期食管癌和贲门癌外科治疗73例临床分析

本文总结７３例中晚期食管癌，贲门癌手术治疗效果，切除率９０．４％，并发症２２．７％，死亡率６．６％，１，２，３年生存率分别为８２．３％，６９．４％，５２．３％。病灶大小，淋巴结转移，分期，术后辅助治疗是影响生存期的主要因素。     

450例高龄食管癌和贲门癌外科治疗结果分析

我院1981～1985年五年间,外科治疗食管癌和贲门癌1530例。其中60岁以上(高龄组)450例,59岁以下(非高龄组)1080例。二者比较高龄组切除率88％,非高龄组90.1％。五年生存率高龄组38.4％,非高龄组35％。前两者比较差异无显著性(P>0.05)。切除死亡率高龄组5.3％,非高龄组3.5％,二者比较差异有显著性(P<0.05)。导致高龄患者切除死亡率高的主要原因是术前并存症的存在。本文重点对高龄病人术前并存症的处理,以及术后并发症的防治进行了讨论。     

食管癌、贲门癌术后胃排空障碍 (附12例病例分析)

胃排空障碍是食管癌、贲门癌术后一种少见的并发症，误诊将给患者带来不必要的痛苦和经济负担^[1]，甚至死亡，近年来国内外均有这方面的报道。从1992年1月－1999年12月，我科共行食管癌、贲门癌切除术693例，术后并发胃排空障碍12例，现报告如下。     

食管癌和贲门癌切除术残端阳性22例分析

本文报告食管癌和贲门癌切除术311例,残端癌的阳性率为7.1％(22/311),其中食管癌为5.4％(12/221),贲门癌为11.1％(10/90)。并分析了残端癌发生的相关因素。认为断端癌组织阳性与胃、食管切除的长度、是否有淋巴结转移。肿瘤的组织类型有关。3年随访结果表明断端癌组织阳性者的预后明显低于阴性患者,但断端癌组织并不影响局部吻合口愈合。     

食管癌和贲门癌切除术后膈疝24例临床病理分析

目的：总结食管癌和贲门癌切除术后隔疝的临床特点。讨论其发生的原因。方法：对我院自1958以来9320例食管癌和贲门癌手术切除后发生的24例隔疝的临床资料进行回顾分析。结果：本组发生率为0.26%，在术后4d内早期发生的9例中，仅1例出现相关症状，而在其余15例中11例有明显症状，本组3例为绞窄性疝，4例为滑动疝，21例通过正侧位胸片或床旁相确诊，2例通过钡餐灌肠确，1例则在因其他并发症二次开胸时发现，23例行手术治疗，15例经胸部切口，6例经腹部切口，2例为胸腹联合切口。21例修补成功，2例死于术后并发症，死亡率为9.5%。结论：食管癌和贲门癌术后膈疝是一个相对少见，但有较高死亡率的并发症，术后早期出现的膈疝常缺乏典型的症状，及时清晰的床旁相是诊断的关键。膈疝一旦确诊，应及时手术，手术入路以经胸途径为佳，膈疝发生的原因既有手术操作的不当，也有患者自身素质的因素。     

食管癌和贲门癌695例外科治疗体会

我院从1972年1月至1988年7月,手术治食管癌和贲门癌695例,现分析报告如下。临床资料男489例,女206例。年龄最小25岁,最大76岁。其中40岁以下76例,60岁以上98例,40-60岁521例,占75％。肿瘤最长11厘米(6/695),最短2厘米(4/695),以4-6厘米最多,占86％(598/695)。肿瘤多数已在Ⅲ-Ⅵ期。临床病程、肿瘤部位与手术切除率的关系见表1、2。     

同一个体食管贲门双源癌中人乳头瘤病毒感染和p16INK4A蛋白表达

目的 探讨河南食管癌高发区HPV感染与食管/贲门癌变的关系和p16INK4A蛋白表达的意义。方法 利用聚合酶链式反应技术（PCR）检测17例双源癌患者食管鳞癌组织和贲门腺癌组织人乳头瘤病毒16型（HPV16）感染情况,应用免疫组织化学方法检测p16INK4A蛋白在17例双源癌鳞癌组织和腺癌组织中的表达。结果 17例双源癌组织中8例食管鳞癌组织,5例贲门腺癌组织中检测到HPV16-DNA（47% vs. 29%）,且有2例患者食管鳞癌和贲门腺癌组织中同时检测到HPV16-DNA的存在。p16INK4A蛋白在两种组织中均有较高表达。在HPV相关的双源癌中,p16INK4A蛋白表达在腺癌组织中较鳞癌组织高（75% vs.25%,P＜0.05）。结论 河南食管癌高发区同一个体食管鳞癌和贲门腺癌中均有不同程度HPV感染,提示HPV可能是二者共同相关致病危险因素,高危型HPV16感染可能在河南食管癌高发区食管和贲门癌变过程中起重要作用。p16INK4A蛋白表达在腺癌组织中较鳞癌组织高,有可能成为HPV相关性贲门癌的一个筛查指标。     

内镜下局部注射加微波加温治疗上消化道癌肿20例报告

本文报道经内镜下注射加微波加温治疗20例晚期癌肿,其中食管癌11例,贲门胃底癌4例,胃窦癌3例,贲门癌术后复发癌2例。治疗4～12次,梗阻症状缓解率达100％。本疗法近期疗效满意,随访1～10个月未发現远处转移现象,无穿孔危险。适用于不宜手术的晚期癌肿,可改善病人的生活质量,延长其生命。     

Analysis of Lymph Node Metastases of 1,526 Cases with Thoracic Esophageal and Cardiac Carcinomas： A Random Sampling Report from the Fourth Hospital of Hebei Medical University from 1996 to 2004

Objective  To summarize the regular pattern and state of lymph node metastasis of patients with esophageal and cardiac carcinomas, so as to analyze factors influencing lymph node metastasis. Methods  Clinical data collected from 1,526 thoracic esophageal and cardiac carcinoma patients who were admied in the Fourth Hospital of Hebei Medical University during a period from January 1996 to December 2004, were randomly selected and an Access Database of the patient’s information was set up. Eight clinico-pathologic factors, including the patient’s age, tumor location and size, pathological classification, the depth of tumor invasion, vascular tumor embolus (VTE), the state of surrounding organ encroachment and the status of tumor residues, were identified. A correlation between these factors and metastases was statistically analyzed using SPSS13.0 so ware. Results  Lymph node metastatic sites from esophageal carcinomas included the thoracic and abdominal cavity. Lymph node metastasis from the superior esophageal carcinomas mainly occurred in the neck and thoracic cavity. There was a two-way lymph node metastasis in the patients with the middle esophageal carcinoma. The inferior esophageal carcinomas mainly metastasized to the paraesophageal, paragastric cardia, and left gastric artery lymph nodes. The rate and degree of the metastasis from the inferior esophageal carcinomas were significantly higher compared to those of the superior and the middle esophageal carcinomas (P < 0.0125). The degree of abdominal lymph node metastasis from carcinomas of the gastric cardia was significantly higher compared with that of esophageal carcinomas. In the group with carcinoma of the gastric cardia, the rate and degree of the lymph node metastases in the paragastric cardia and left gastric artery were significantly higher compared to the group with esophageal carcinoma (P < 0.05). Paraesophageal lymph node metastasis from carcinomas of the gastric cardia in the thoracic cavity frequently occurred, too, and the degree of the metastasis was similar to that of esophageal carcinoma. There was no significant difference in the rate and degree of the paraesophageal lymph-node metastasis between the group with carcinoma of the gastric cardia compared to those with esophageal carcinoma (P > 0.05). Multifactorial logistic regression analysis showed that the tumor size, depth of tumor encroachment, VTE, and tumor residues could all bring about obvious impact on lymph-node metastases (P < 0.05). Conclusion  Lymph node metastasis from superior esophageal carcinomas mainly occurs in the neck and thoracic cavity. The middle esophageal carcinomas presented a two-way lymph-node metastasis (both the upwards and the downwards), and the lymph node metastasis from inferior esophageal carcinomas mainly occurred in the thoracic and abdominal cardia were most commonly found in the abdominal cavity, with frequent paraesophageal lymph-node metastasis. The sufficient attention should be paid to neck lymph node clearance in cases of esophageal carcinoma. What is of the greatest concern is the clearance of the le gastric artery lymph nodes, and also in cases of gastric cardia carcinoma, clearance, the paraesophageal lymph nodes. With an increase in the tumor size and depth of tumor encroachment, and occurrence of VTE and tumor residual cells, the risk of lymph node metastasis is significantly raised (P < 0.05). This work was supported by a grant from the Hebei Provincial Program for Subjects with High Scholarship and Creative Research Potential.     

Association of cyclin D1 (G870A) polymorphism with susceptibility to esophageal and gastric cardiac carcinoma in a northern Chinese population

Our aim was to investigate the association of cyclin D1 (G870A) single nucleotide polymorphism with susceptibility to esophageal and cardiac carcinoma in a northern Chinese population. By polymerase chain reaction-single strand conformation polymorphism analysis, cyclin D1 (G870A) genotyping was carried out among 120 patients with esophageal squamous cell carcinoma (ESCC), 87 patients with gastric cardiac adenocarcinoma (CAC), and 183 age- and gender-matched controls. The cyclin D1 genotype distribution among ESCC patients was significantly different from that among healthy controls (chi(2) = 7.372, p = 0.025). The G/G genotype was significantly less frequent among ESCC patients (9.2%) than among healthy controls (20.8%) (chi(2) = 7.192, p = 0.007). The G/G genotype significantly reduced risk for the development of ESCC compared to the combination of G/A and A/A genotypes (adjusted odds ratio [OR] = 0.37, 95% confidence interval [CI] = 0.16-0.83). After stratification according to smoking status, the A/A frequency among smoking ESCC (34.3%) and CAC patients (35.7%) was significantly higher than that among smoking healthy controls (18.6%) (chi(2) = 5.426 and 5.599, p = 0.020 and 0.018, respectively). Smokers with the A/A genotype had an about 2-fold increased risk for both of ESCC and CAC compared to the G/A and G/G genotypes, with an adjusted OR of 2.26 in ESCC (95% CI = 1.14-4.49) and of 2.42 in CAC (95% CI = 1.17-4.98). No correlation between the cyclin D1 genotype and development of ESCC or CAC was found among nonsmokers. Determination of the cyclin D1 (G870A) single nucleotide polymorphism may be suitable to identify individuals with increased risk for ESCC or CAC in the northern Chinese population.     

中药通光藤治疗食管癌胃癌的临床观察（附112例报告）

本文报告了中药通光藤制剂治疗１１２例晚期食管癌和胃癌的临床疗效。结果显示：完全和部分缓解率（ＣＲ＋ＰＲ）为９．８％，微效率（ＭＲ）２５％，稳定率（ＳＤ）５２．７％。经该药物治疗后，所有病人的生活质量和免疫力得到改善，吞咽困难和疼痛症状减轻。没有出现血液学、心脏、肝和肾脏毒性。因此，该药物可作为有效的抗癌中药在临床推广应用。     

食管癌患者SIL_(-2R)和IL_(-6)的研究

本文对25例食管癌患者和31例健康对照者外周血单个核细胞(PBMC)经 PHA 刺激后 IL_(-6)产生能力和细胞培养上清中 SIL-_(2R)水平做了研究,同时检测了血清中 SIL_(-2R)水平。结果显示,食管癌患者产生 IL_(?)能力显著升高(P<0.001);食管癌患血清 SIL_(-2R)水平同健康者相比也显著升高(P<0.001),而细胞培养上清SIL_(-2R)浓度,两者比较差异无显著性(P>0.05)。     

食管鳞癌浸润深度（T分期）与淋巴结转移的关系

目的：探讨食管鳞癌浸润深度（T 分期）与淋巴结转移的关系,为临床评判淋巴结转移情况提供重要依据。方法纳入分析的89492例食管鳞癌手术患者,均来自郑州大学第一附属医院河南省食管癌重点开放实验室50万例食管癌和贲门癌临床信息资料库,其中男59143例,年龄（59±8）岁;女30349例,年龄（60±8）岁。分析食管鳞癌浸润深度（T 分期）与淋巴结转移的关系。结果在纳入分析的89492例食管鳞癌患者中,Tis、T1a、T1b、T2、T3、T4a和 T4b期患者所占的比率依次为0.7%、2.9%、6.8%、30.6%、58.5%、0.4%和0.1%;35581例发生淋巴结转移,淋巴结转移率为39.8%（35581/89492）;103932枚淋巴结发生转移,淋巴结转移度为11.5%（103932/900771）。在 Tis ~ T4b分期中,T4a 期淋巴结转移阳性率和淋巴结转移度均最高（58.3%和22.8%）,其次是 T4b期（55.2%和14.8%）。随着 T 分期的增加（Tis ~ T4a ）,淋巴结转移率和淋巴结转移度增加（χ2=3132.13,P <0.001;χ2=236.12,P <0.001）、转移风险增高（R2=0.951）。不同 T分期的淋巴结转移率和淋巴结转移度之间均呈显著性正相关（ r =0.975,P <0.001;r =0.884,P <0.001）。结论食管鳞癌浸润深度（T 分期）与淋巴结转移密切相关,提示 T 分期可以作为临床上间接评判淋巴结转移的重要参考指标。