内镜引导下冷冻治疗30例食管癌临床研究

A Clinical Investigation of Endoscope-guided Cryotherapy in 30 Cases with Esophageal Cancer

[目的]研究内镜引导下食管癌冷冻治疗后的进食缓解情况以及对免疫功能的调节作用。[方法]2004年1月至2004年4月内镜下对30例食管癌行食管腔内冷冻,再开胸手术切除,用光镜及电镜观察癌细胞变化及局部淋巴反应,同时检测血清免疫球蛋白和淋巴细胞亚群。[结果]冷冻治疗后进食缓解率63.3%(19/30)。食管癌周围淋巴结广泛肿大,呈滤泡增生反应,癌细胞坏死。冷冻前后血清免疫球蛋白IgG、IgA、IgM、补体C3和NK比较无显著性差异(P>0.05);冷冻后CD4+、CD19+较冷冻前增高,但是无统计学意义(P>0.05);冷冻后CD8+30.92%,低于冷冻前的34.98%(P<0.05)。[结论]采用JT冷冻治疗机及其配套的食管腔内软管冷冻探头进行食管癌腔内冷冻,能杀伤癌细胞并调节机体免疫功能,操作方法方便快捷,并发症少。

[Purpose] To investigate the effect of cryotherapy on dysphagic symptom relief and immunity improvement in patients with esophageal cancer. [Methods] From Jan. 2004 to Apr. 2004, 30 cases with esophageal cancer received intracavity cryotherapy before surgery. The pathologic changes of cancer cells and regional lymph node reaction were observed under light or electron microscope, and the subsets of T cells and immunoglobulin level were detected. [Results] After cryotherapy, dysphagic symptom was relieved in 19 cases （63.3%, 19/30）. Lymph nodes around esophageal carcinoma swelled, with cancer cell necrosis and lymph node folliculosis. The serum level of IgG, IgA, IgM, complement C3 and the number of nature killer （NK） cells had not changed obviously before and after cryotherapy （P〉0.05）, also the levels of CD4^＋ and CD19^＋ （P〉 0.05）, but CD8^＋ decreased from 34.98% to 30.92% （P〈0.05）. [Conclusions] Cryotherapy with JT type cryotherapeutic instrument and its cryotherapeutic probe, could kill cancer cells and improve immunity, and is convenient to manipulate, with less complications.