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Objective To explore the feasibility of gastroesophagostomy when patients with esophagus carcinoma com bined with stomach carcinoma.Methods In March 2011 to May 2016,our department completed with the method of genera tion of esophagus stomach in the treatment of esophageal cancer merger 18 cases of gastric cancer patients.Age 52-67,16 ca ses of esophageal lesions located in the middle section,2 cases located in the chest.4 cases were gastric lesions located in the proximal stomach,14 cases were located in the distal stomach Four kinds of surgical methods can be chosen from.Proximal or distal stomach could be used to replace esophagus and the blood supply came from left gastric artery or right gastroepiploic artery.Stomach tissue separation and reverse gastric tube were used if the length of stomach was insufficieut.Results When resection of esophageal and gastric carcinoma were accomplished simultaneously,residue stomach can be used as a replacement of esophagus if patients were rigidly selected.Conclusion Residue stomach was a good substitute after radical resection of esoph agus and gastric dual-source carcinoma.Patients chosen and surgery design were both important.
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Objective To explore the feasibility of gastroesophagostomy when patients with esophagus carcinoma com bined with stomach carcinoma.Methods In March 2011 to May 2016,our department completed with the method of genera tion of esophagus stomach in the treatment of esophageal cancer merger 18 cases of gastric cancer patients.Age 52-67,16 ca ses of esophageal lesions located in the middle section,2 cases located in the chest.4 cases were gastric lesions located in the proximal stomach,14 cases were located in the distal stomach Four kinds of surgical methods can be chosen from.Proximal or distal stomach could be used to replace esophagus and the blood supply came from left gastric artery or right gastroepiploic artery.Stomach tissue separation and reverse gastric tube were used if the length of stomach was insufficieut.Results When resection of esophageal and gastric carcinoma were accomplished simultaneously,residue stomach can be used as a replacement of esophagus if patients were rigidly selected.Conclusion Residue stomach was a good substitute after radical resection of esoph agus and gastric dual-source carcinoma.Patients chosen and surgery design were both important.
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Objective Thoracic cavity fistula following esophagus carcinoma resection is a serious complication with a high mortality.This study aims at a better therapy for thoracic cavity fistula following esophagus carcinoma resection by summarizing the ex-perience with the four-tube strategy ( jejunal fistula tube, stomach tube, chest drainage tube, and nasal fistula tube) in the treatment of the complication. Methods We retrospectively analyzed the clinical data about 62 cases of thoracic cavity fistula following esopha-gus carcinoma resection, 35 treated with the four-tube strategy ( treatment group) and the other 27 with the three-tube ( stomach tube, chest drainage tube, and nasal fistula tube) method ( control group) .We compared the hospital days, wound healing time, mortality, and incidence of anastomotic stenosis at 6 months after operation between the two groups of patients. Results Compared with the controls, the treatment group showed remarkable decreases in the hospital days (P0.05 ) . Conclusion Compared with the three-tube method, the four-tube strategy has the advantages of shorter healing time and lower mortali-ty, and therefore is preferable for the treatment of thoracic cavity fis-tula following esophagus carcinoma resection.
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Se presenta el caso clínico de una paciente de 57 años de edad, que acudió al Servicio de Gastroenterología del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, por presentar pirosis y reflujo gastroesófagico, de manera que se le indicó un estudio endoscópico con el cual se detectó una lesión elevada en el tercio superior del esófago, que fue extirpada y en el examen hístico reveló la presencia de un carcinoma esofágico asociado a papilomavirus humano y esofagitis de grado II. Se mantuvo el seguimiento clínico de la paciente, cuya evolución fue satisfactoria luego de aplicado un tratamiento integral a los efectos.
The case report of a 57 year-old patient who went to the Gastroenterology Service from "Saturnino Lora Torres" Teaching Clinical-Surgical Provincial Hospital in Santiago de Cuba for presenting pyrosis and gastroesophagheal reflux is presented, so that an endoscopic study was indicated with which a high lesion was detected in the supper third of the esophagus that was extirpated and in the hystic examination the presence of an esophageal carcinoma was revealed associated with human papillomavirus and grade II esophagitis. The patient's clinical follow-up was maintained and her clinical course was satisfactory after applying a comprehensive treatment for this disorder.
Subject(s)
Alphapapillomavirus , Esophageal Squamous Cell Carcinoma , Endoscopy, Digestive SystemABSTRACT
Objective To study the diagnosis and treatment in patients of esophagus carcinoma and esophagogastric junction carcinoma after operation with paralysis gastroparesis syndrome (PGS).Methods From March 1996 to December 2013 in the Affiliated Hospital of Putian University,the clinical data of PGS in 42 patients with esophagus carcinoma and esophagogastric junction carcinoma after operation were selected, and retrospectively analyzed.Results All the patients were presented with gastric retention, no obvious abdominal pain,and anal exhaust has been restored.Enteron radiography shows anastomosis and pylorus were unobstructed and gastric motility was weaken or disappear.All patients were treated with gastrointestinal decompression, nutritional support, maintaining water electrolyte metabolism balance, promoting gastrointestinal peristalsis and reducing stomach wall edema.The stomach function recovery of 40 cases was within 10-15 days, respectively.Two patients cured by pyloroplasty when they were not improved by conservative treatment for 2 months.And the stomach function recovery were within 28 days and 35 days.Conclusion Gastroparesis syndrome is a functional disease,the cure rate is high, the treatment of first choice was conservative treatment, however, for the intractable gastroparesis, pyloroplasty maybe another good choice.
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Objective:To explore the effect of paclitaxel (PTX) and cisplatin (DDP) on the expression of NKG2D ligands of hu-man esophagus carcinoma cell EC9706 and on the cytotoxicity of cytokine-induced killer (CIK) cells, as well as to discuss its molecu-lar mechanisms. Methods: The half maximal inhibitory concentration (IC50) values of PTX and DDP against EC9706 cells for 24 h were measured by MTT assay. The expression levels of NKG2D ligands (MICA, MICB, ULBP1, ULBP2, and ULBP3) on the EC9706 cell surface before and after 24 h culture with 1/2 IC50 of PTX or DDP were assayed by flow cytometry. Cytotoxicity of CIK cells against EC9706 cells before and after 24 h culture with 1/2 IC50 PTX or DDP was analyzed by lactate dehydrogenase release assay at an effector to target cell ratio (E:T) of 20:1 and 30:1, respectively. The expression levels of DNA damage repair genes (ATM, ATR, CHK1, CHK2, and p53) of EC9706 cells before and after 24 h incubation with 1/2 IC50 PTX or DDP were detected by quantitative fluorescent PCR. Results:The IC50 values of PTX and DDP were 10 and 5μg/mL, respectively. MICB, ULBP2, and ULBP3 on EC9706 cells were upregulated after 24 h culture with 1/2 IC50 PTX (P0.05), whereas ATM, ATR, CHK1, and CHK2 were over-expressed after 24 h treatment with 1/2 IC50 DDP (P<0.05). Conclusion:PTX or DDP can enhance the susceptibility of EC9706 cells to CIK cell-mediated lysis by upregulating the expression of NKG2D ligands through activating DNA damage repair genes.
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Objective To explore the surgical treatment of cervical and upper thoracic esophageal carcinoma in patients aged 70 or ol-der. Methods A retrospective analysis were made among 68 patients who were over 70 years old, and all the patients have undergone stom-ach esophagus cervical anastomosis through esophageal carcinoma excision and regional lymph node cleaning. Results All the 68 patients have completed the surgery successfully, and they have recoveried well except 3 cases of death. And the main postoperative complication was cardiopulmonary complication and anastomotic fistula. Conclusion Operative treatment of ercervical and upper thoracic esophageal carcino-ma for elderly patients is characterized with highly difficulty and more complications. Stomach esophagus cervical anastomosis through 2-inci-sion with left chest and left neck could simplify the operative procedure, decrease the postoperative complication and improve the curative effect.
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Objective To investiGate the efficacy of three-dimensional conformal radiotherapy( 3-DCRT)combined with concurrent S-l for locally advanced esophaGus carcinoma in the elderly. Methods Fifty-four elderly patients with locally advanced esophaGus carcinoma were randomly divided into test Group(27 cases treated with 3-DCRT combined with S-l)and control Group(27 cases treated with 3-DCRT alone). DiaGnosis in all cases was confirmed by patholoGy. Results The complete remission rate and overall efficiency rate in test Group were 62. 96% and 85. l9% respectively,and 33. 33% and 59. 26% in control Group(χ2 =4. 75,P=0. 029;χ2 =4. 52,P=0. 033). All 23 patients with dysphaGia in test Group were in remission,and l6 of 22 patients with dysphaGia in control Group were in remission,and there was statistical siGnificant difference between two Groups(χ2 =7. 24,P=0. 007). The one-and two-year survival rates in test Group were 74. l% and 54. 8%respectively,and 55. 6% and 36. l% in control Group(χ2 =3. 9l,P=0. 047;χ2 =3. 98,P=0. 046). Toxicities of Grade 0-Ⅱ in both Groups were similar,and there was no statistical siGnificant difference(χ2 =l. 08,P=0. 299). Conclusion The complete remission rate,overall efficiency rate and one-and two-year survival rates of 3-DCRT combined with concurrent S-l were siGnificant hiGher than 3-DCRT alone in the treatment for the elderly patients with locally advanced esophaGus carcinoma. And ti’s adverse effects were well tolerated.
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Objective To summary the experience of T4 esophageal carcinoma surgery and to explore the methods and operating skills on descending thoracic aortic resection with prosthetic vascular graft replacement in patients with T4 locally advanced esophageal carcinoma invading descending thoracic aorta.Methods From Jan.2001 to Dec.2010,36 patients with esophageal carcinoma underwent esophagectomy and descending aortic replacement simultaneously in our hospital.The clinical data were retrospectively reviewed.All patients had a left posterior lateral incision via the 6th intercostal space.The vascular adventitia of the descending thoracic aorta in the left side was incised,and the aorta was clamped in the proximal and distal side of the invaded segment.Then the invaded segment was resected and replaced with artificial vessels.Esophageal carcinoma was radically resceted,and left cervical esophageal-gastro anastomosis was performed in all patients.Results Radical resection of esophageal carcinoma was achieved in all patients.There was no perioperative death,or severe complications such as paraplegina,acute renal failure and intestinal dysfunction occurred.Two patients had chylous hydrothorax,and one had late stage anastomotic stoma fistula.The post-operative hospital stay was 10-42 d,mean (15.5 ± 7.2 )d.The pathological examination revealed that all the patients had squamous cell carcinoma.The aortic tunica adventitia was invaded in all the patients,9(25％ ) had tunica media invasion,and there was no tunica intima invasion observed.The 1-,3-,and 5-year survival rate was 80.6％,46.2％ and 20.0％ respectively.Conclusion Combined esophagectomy and descending aortic replacement for locally advanced T4 esophageal carcinoma invading aorta can be considered as radical operation for selected patients,and it can improve the survival rate and life quality of the patients.
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OBJECTIVE To investigate the cause,diagnosis and treatment of the empyema of the anastomotic fistula after esophageal cancer resection.METHODS The clinical data of 624 cases after esophageal cancer and cardia cancer resection from Jan 2000 to Dec 2006 were analyzed retrospectively which included 14 cases of the empyema of the anastomotic fistula.RESULTS All the cases were treated with the closed thoracic drainage,in which 9 cases were cured with closing double-tube chest douching technique,3 cases were succeeded to operate secondary thoracotomy for anastomosis,1 case died after being sent to the higher grade hospital,1 case died for toxic shock and respiratory failure without the chance of reoperation.CONCLUSIONS The key measures of prevention of empyema of post-operative esophagogastrostomy anastomotic fistula inside thorax are strictly distincting between indication and contraindication,carefully preparating before operation,commanding operative time and technical skill,strengthening nursing management,and fulfilling the oral manipulation and nursing prcedures about the drainage tube after operation.
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Objective:To find out the high risk factors of psychosis in the patients after the esophagus carcinoma resection.Methods:We diagnose psychosis disease though the symptom of the patients.900 patients of esophagus carcinoma,who occurred psychosis after the esophagus carcinoma resection,were compared with those who didn't occurred.Results:Some problems in cognition,emotion,action and consciousness were found.The incidence of the psychosis after esophagus carcinoma resection was not correlated with the different gender and different modus operandi,but significantly correlated with the age,the time in ICU after operation and the time that the patients gave up smoke and wine before the operation.Conclusion:The high risk factors in the patients of esophagus carcinoma after operation with psychosis maybe include the age,the time in ICU after operation and the time that the patients gave up smoke and wine before the operation.We should frome these sides to take more care for these patients in our work.
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The INK4a-ARF locus is located on CDKN2A point in human chromosome 9p21 and is known to encode two functionally distinct tumor-suppressor genes p16INK4a (MTS1/CDKN2/INK4a/p16) and p14ARF, have been shown to play significant roles in cell-cycle regulation in cancer. p16 is encoded by the exon 1a-exon 2-exon 3 transcript and functions as a negative regulator of the cell cycle through its inhibition of cyclin-dependent kinases (CDKs) 4 and 6 and subsequent blockage of the cyclindependent phosphorylation of pRB . Thus, loss of p16 function leads to deregulation of pRB's suppressive block of the G1-to-S transition and cell proliferation. In contrast, p14ARF is encoded by the exon 1?-exon 2 transcript and acts upstream of p53. Biochemical evidence has demonstrated that p14ARF physically interacts with human double minute 2 (HDM2) gene product and consequently stabilizes p53, leading to G1 cell-cycle arrest. Overall, somatic mutation of the INK4a/ARF tumor suppressor locus, resulting in functionally deficient p16 and possibly p14ARF proteins, seems to be a prevalent event in the development of oesophagus carcinoma.
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Protein synthesis and nitrogen equilibrium have been investigated in the early postoperative period in 21 patients with carcinoma of esophagus and cardia after resection. They received 17-L-crystalline amino acid (AAM) and glucose infusion through parenteral route and were compared with a series' of 11 patients taking similar volume and calorie with protein hydrolysate (PRH) and glucose.In AAM series, the plasma protein could be maintained in preoperatiye level but not in PRH series. In AAM series a nitrogen equilibrium was reached while in PRH series was a negative equilibrium. The cellular immunity and serum amino acid spectrum were improved or replaced in both series, but they were better in AAM series. The improvement in nitrogen balance was probably mainly due to an increase in protein synthesis.