Nomograms and prognosis for superficial esophageal squamous cell carcinoma

In recent years,endoscopic resection,particularly endoscopic submucosal dis-section,has become increasingly popular in treating non-metastatic superficial esophageal squamous cell carcinoma(ESCC).In this evolving paradigm,it is crucial to identify factors that predict higher rates of lymphatic invasion and poorer outcomes.Larger tumor size,deeper invasion,poorer differentiation,more infiltrative growth patterns(INF-c),higher-grade tumor budding,positive lymphovascular invasion,and certain biomarkers have been associated with lymph node metastasis and increased morbidity through retrospective reviews,leading to the construction of comprehensive nomograms for outcome prediction.If validated by future prospective studies,these nomograms would prove highly applicable in guiding the selection of treatment for superficial ESCC.

Risk factors for lymph node metastasis in superficial esophageal squamous cell carcinoma

In this editorial,we comment on the article by Wang et al published in the recent issue of the World Journal of Gastroenterology in 2023.We focused on identifying risk factors for lymph node metastasis(LNM)in superficial esophageal squamous cell carcinoma(SESCC)patients and how to construct a simple and reliable clinical prediction model to assess the risk of LNM in SESCC patients,thereby helping to guide the selection of an appropriate treatment plan.The current standard treatment for SESCC is radical esophagectomy with lymph node dissection.However,esophagectomy is associated with considerable morbidity and mortality.Endoscopic resection(ER)offers a safer and less invasive alternative to surgical resection and can enable the patient's quality of life to be maintained while providing a satisfactory outcome.However,since ER is a localized treatment that does not allow for lymph node dissection,the risk of LNM in SESCC limits the effectiveness of ER.Understanding LNM status can aid in determining whether patients with SESCC can be cured by ER without the need for additional esophagectomy.Previous studies have shown that tumor size,macroscopic type of tumor,degree of differentiation,depth of tumor invasion,and lymphovascular invasion are factors associated with LNM in patients with SESCC.In addition,tumor budding is commonly associated with LNM,recurrence,and distant metastasis,but this topic has been less covered in previous studies.By comprehensively evaluating the above risk factors for LNM,useful evidence can be obtained for doctors to select appropriate treatments for SESCC patients.

Clinical evidence of neoadjuvant immunotherapy for resectable locally advanced esophageal carcinoma:A systematic review

Background:Immune checkpoint inhibitors(ICIs)as the neoadjuvant therapy for resectable locally advanced esophageal carcinoma(rlaEC)remains challenging given the poor reports of efficacy and safety.This study aimed to summarize reliable evidence for the preoperative neoadjuvant immunotherapy of rlaEc by analyzing all the published clinical trials on the ICIs as the neoadjuvant therapy for rlaEC.Methods:PubMed,Cochrane Library,Embase and ClinicalTrials.gov were searched from inception until June 1st,2023,for available reports to perform a meta-analysis.The primary endpoints were RO resection,objective response rate(ORR),pathological complete response(pCR)and major pathological response(MPR),as well as treatment-related adverse events(AEs)and postoperative complications.The Stata 14.0 software was employed to estimate pooled effect size.Results:A total of 18 single-arm clinical trials involving 625 patients met the inclusion criteria.Meta-analysis showed that,among these patients with rlaEC,the pooled R0 resection rate was 97.0%(95%CI:94.0%-99.0%),the p0oled ORR was 70.0%(95%CI:64.0%-76.0%),the p0oled pCR and MPR rate were 34.0%(95%CI:29.0%-39.0%)and 56.0%(95%CI:47.0%-65.0%)respectively.The incidence of main treatment-related AEs and postoperative complications was about 6%-45% and 8%-19% respectively.Conclusions:Patients with rlaEC were tolerated to neoadjuvant immunotherapy and it might be beneficial to improve efficacy.But this meta-analysis had limitations and the conclusions still needed to be validated by more rigorous phase II randomized controlled clinical trials.

Endoscopic debulking resection with additive chemoradiotherapy:Optimal management of advanced inoperable esophageal squamous cell carcinoma

BACKGROUND There is no remedial strategy other than definitive chemoradiotherapy for patients with advanced esophageal squamous cell carcinoma(ESCC) who are not eligible to undergo surgical treatment.AIM To introduce a novel therapy called endoscopic debulking resection(Ed R) followed by additive chemoradiotherapy(CRT) and evaluate its efficacy and safety.METHODS Advanced, inoperable ESCC patients between 1 January 2015 and 30 December 2019 were investigated retrospectively. Patients who received Ed R followed by CRT were deemed the Ed R + CRT group and those without CRT were deemed the Ed R group. Overall survival(OS), progression-free survival(PFS), and adverse events were evaluated.RESULTS A total of 41 patients were enrolled. At a median follow-up of 36 mo(range: 1-83), the estimated 1-, 2-, and 3-year cumulative OS rates of patients who underwent Ed R plus additive CRT were 92.6%, 85.2%, and 79.5%, respectively, which were higher than those of patients who underwent Ed R alone(1-year OS, 83.3%;2-year OS, 58.3%;3-year OS, 50%;P = 0.05). The estimated 2-year cumulative PFS rate after Ed R + CRT was 85.7%, while it was 61.5% after Ed R(P = 0.043). According to the univariate and multivariate Cox regression analyses, early clinical stage(stage ≤ IIB) and additive CRT were potential protective factors for cumulative OS. No severe adverse events were observed during the Ed R procedure, and only mild to moderate myelosuppression and radiation pneumonia were observed in patients who underwent additive CRT after Ed R.CONCLUSION Ed R plus CRT is an alternative strategy for selective advanced inoperable ESCC patients.

Endoscopic and surgical resection of T1a/T1b esophageal neoplasms: A systematic review

AIM: To investigate potential therapeutic recommendations for endoscopic and surgical resection of T1a/ T1b esophageal neoplasms. METHODS: A thorough search of electronic databases MEDLINE, Embase, Pubmed and Cochrane Library, from 1997 up to January 2011 was performed. An analysis was carried out, pooling the effects of outcomes of 4241 patients enrolled in 80 retrospective studies. For comparisons across studies, each reporting on only one endoscopic method, we used a random effects meta-regression of the log-odds of the outcome of treatment in each study. "Neural networks" as a data mining technique was employed in order to establish a prediction model of lymph node status in superficial submucosal esophageal carcinoma. Another data mining technique, the "feature selection and root cause analysis", was used to identify the most impor-tant predictors of local recurrence and metachronous cancer development in endoscopically resected patients, and lymph node positivity in squamous carcinoma (SCC) and adenocarcinoma (ADC) separately in surgically resected patients. RESULTS: Endoscopically resected patients: Low grade dysplasia was observed in 4% of patients, high grade dysplasia in 14.6%, carcinoma in situ in 19%, mucosal cancer in 54%, and submucosal cancer in 16% of patients. There were no significant differences between endoscopic mucosal resection and endoscopic submucosal dissection (ESD) for the following parameters: complications, patients submitted to surgery, positive margins, lymph node positivity, local recurrence and metachronous cancer. With regard to piecemeal resection, ESD performed better since the number of cases was significantly less [coefficient: -7.709438, 95%CI: (-11.03803, -4.380844), P < 0.001]; hence local recurrence rates were significantly lower [coefficient: -4.033528, 95%CI: (-6.151498, -1.915559),P < 0.01]. A higher rate of esophageal stenosis was observed following ESD [coefficient: 7.322266, 95%CI: (3.810146, 10.83439), P < 0.001]. A significantly greater number of SCC patients were submitted to surgery (log-odds, ADC: -2.1206 ± 0.6249 vs SCC: 4.1356 ± 0.4038, P < 0.05). The odds for re-classification of tumor stage after endoscopic resection were 53% and 39% for ADC and SCC, respectively. Local tumor recurrence was best predicted by grade 3 differentiation and piecemeal resection, metachronous cancer development by the carcinoma in situ component, and lymph node positivity by lymphovascular invasion. With regard to surgically resected patients: Significant differences in patients with positive lymph nodes were observed between ADC and SCC [coefficient: 1.889569, 95%CI: (0.3945146, 3.384624), P<0.01). In contrast, lymphovascular and microvascular invasion and grade 3 patients between histologic types were comparable, the respective rank order of the predictors of lymph node positivity was: Grade 3, lymphovascular invasion (L+), microvascular invasion (V+), submucosal (Sm) 3 invasion, Sm2 invasion and Sm1 invasion. Histologic type (ADC/SCC) was not included in the model. The best predictors for SCC lymph node positivity were Sm3 invasion and (V+). For ADC, the most important predictor was (L+). CONCLUSION: Local tumor recurrence is predicted by grade 3, metachronous cancer by the carcinoma insitu component, and lymph node positivity by L+. T1b cancer should be treated with surgical resection.

Clinical impact of surveillance for head and neck cancer in patients with esophageal squamous cell carcinoma

AIM To evaluate the clinical impact of surveillance for head and neck(HN) region with narrow band imaging(NBI) in patients with esophageal squamous cell carcinoma(ESCC).METHODS Since 2006, we introduced the surveillance for HN region using NBI for all patients with ESCC beforetreatment, and each follow-up. The patients with newly diagnosed stage Ⅰ to Ⅲ ESCC were enrolled and classified into two groups as follows: Group A(no surveillance for HN region); between 1992 and 2000), and Group B (surveillance for HN region with NBI; between 2006 and 2008). We comparatively evaluated the detection rate of superficial head and neck squamous cell carcinoma (HNSCC), and the serious events due to metachronous advanced HNSCC during the follow-up.RESULTS A total 561 patients(group A: 254, group B: 307) were enrolled. Synchronous superficial HNSCC was detected in 1 patient (0.3%) in group A, and in 12 (3.9%) in group B (P=0.008). During the follow up period, metachronous HNSCC were detected in 10 patients(3.9%) in group A and in 30 patients(9.8%) in group B(P = 0.008). All metachronous lesions in group B were early stage, and 26 patients underwent local resection, however, 6 of 10 patients (60%) in group A lost their laryngeal function and died with metachronous HNSCC.CONCLUSION Surveillance for the HN region by using NBI endoscopy increase the detection rate of early HNSCC in patients with ESCC, and led to decrease serious events related to advanced metachronous HNSCC.

Study of preoperative diagnostic modalities in Chinese patients with superficial esophageal squamous cell carcinoma

BACKGROUND Endoscopic ultrasonography(EUS)and magnifying endoscopy(ME)reliably determine indications for endoscopic resection in patients with superficial esophageal squamous cell carcinoma(SESCC).ME is widely accepted for predicting the invasion depth of superficial esophageal cancer with satisfying accuracy.However,the addition of EUS is controversial.AIM To evaluate the diagnostic efficiency of ME vs EUS for invasion depth prediction and investigate the influencing factors in patients with SESCC to determine the best diagnostic model in China.METHODS We retrospectively analyzed patients with suspected SESCC who completed both ME and EUS and then underwent endoscopic or surgical resection at Sun Yat-Sen University Cancer Center between January 2018 and December 2021.We evaluated and compared the diagnostic efficiency of EUS and ME according to histological results,and investigated the influencing factors.RESULTS We included 152 lesions from 144 patients in this study.The diagnostic accuracies of ME and EUS in differentiating invasion depth were not significantly different(73.0%and 66.4%,P=0.24);both demonstrated moderate consistency with the pathological results(ME:kappa=0.58,95%confidence interval[CI]:0.48-0.68,P<0.01;EUS:kappa=0.46,95%CI:0.34-0.57,P<0.01).ME was significantly more accurate in the diagnosis of high-grade intraepithelial(HGIN)or carcinoma in situ(odds ratio[OR]=3.62,95%CI:1.43-9.16,P=0.007)subgroups.Using a miniature probe rather than conventional EUS can improve the accuracy of lesion depth determination(82.3%vs 49.3%,P<0.01).Less than a quarter of circumferential occupation and application of a miniature probe were independent risk factors for the accuracy of tumor invasion depth as assessed by EUS(<1/4 circumferential occupation:OR=3.07,95%CI:1.04-9.10;application of a miniature probe:OR=5.28,95%CI:2.41-11.59,P<0.01).Of the 41 lesions(41/152,27.0%)that were misdiagnosed by ME,24 were corrected by EUS(24/41,58.5%).CONCLUSION Preoperative diagnosis of SESCC should be conducted endoscopically using white light and magnification.In China,EUS can be added after obtaining patient consent.Use of a highfrequency miniature probe or miniature probe combined with conventional EUS is preferable.

Endoscopic diagnosis and treatment of early esophageal squamous neoplasia

Esophageal cancer is one of the leading causes of cancer-related death and is associated with high morbidity and mortality.It carries a poor prognosis as more than half of patients present with advanced and unresectable disease.One contributing factor is the increased risk of lymph node metastases at early stages of disease.As such,it is essential to detect squamous cell neoplasia (SCN) at an early stage.In order to risk stratify lesions,endoscopists must be able to perform image enhanced endoscopy including magnification and Lugol's chromoendoscopy.The assessment of both the horizontal extent and depth of any lesion is also of utmost importance prior to treatment.Endoscopic mucosal resection and submucosal dissection remain the standard of care with literature supportive their respective use.Radiofrequency ablation and other endoscopic treatments are currently available although should not be considered first line at this time.Our objective is to review the current options for the endoscopic diagnosis and treatment of esophageal SCN.

Relationships of early esophageal cancer with human papillomavirus and alcohol metabolism

BACKGROUND It is well known that an alcohol consumption habit together with inactive heterozygous aldehyde dehydrogenase-2(ALDH2)is an important risk factor for the development of esophageal squamous cell carcinoma(ESCC).It remains controversial whether human papillomavirus(HPV)infection contributes to the occurrence/development of ESCC.There has been no study in which the relationship between ESCC and HPV in addition to alcohol dehydrogenase-1B(ADH1B)and ALDH2 genotypes was evaluated.AIM To evaluate relationships between HPV infection and development of esophageal cancer,particularly early esophageal cancer,based on ADH1B/ALDH2 polymorphisms.METHODS We conducted an exploratory retrospective study using new specimens,and we enrolled 145 patients who underwent endoscopic resection for superficial ESCC and had been observed for more than two years by both physical examination and endoscopic examination in Hokkaido University Hospital.Saliva was collected to analyze genetic polymorphisms of ADH1B/ALDH2.We performed in situ hybridization for resected specimens to detect HPV by using an HPV type 16/18 probe.RESULTS HPV was detected in 15(10.3%)of the 145 patients with ESCC.HPV-positive rates in inactive ALDH2*1/*2 and ALDH2*1/*1+*2/*2 were 10.8%and 9.8%,respectively(P=1.00).HPV-positive rates in slow-metabolizing ADH1B*1/*1 and ADH1B*1/*2+*2/*2 were 12.0%and 10.0%,respectively(P=0.72).HPV-positive rates in the heavy or moderate alcohol consumption group and the light or rare consumption group were 11.1%and 8.7%,respectively(P=0.68).HPV-positive rates in the heavy smoking group and the light or no smoking group were 11.8%and 8.3%,respectively(P=0.59).The 3-year incidence rates of secondary ESCC or head and neck cancer after initial treatment in the HPV-positive and HPVnegative groups were 14.4%and 21.4%(P=0.22),respectively.CONCLUSION In the present situation,HPV status is considered to be less important than other risk factors,such as alcohol consumption,smoking habit,ADH1B/ALDH2 polymorphisms,and HPV status would therefore have no effect on ESCC risk management.

Endoscopic Mucosal Resection

Endoscopic mucosal resection is indicated in limited esophageal carcinomas with in?ltration of the mucosa. As submucosal cancer is combined with a rate of lymph node metastasis in up to 30% mucosectomy is not the procedure of choice. The main techniques of endoscopic mucosal resection are the “suck and cut” technique using a cap on the endoscope or a ligation device to create a pseudocroup of the carcinoma. Submucosal injection of saline or other solutions is recommended prior to diathermic mucosectomy in order to reduce the risk of perforation or haemorrhage. The long term results of endoscopic mucosal resection show tumor speci?c 5 year survival rates of about 97% especially if the indication is restricted to m1 and m2 mucosal carcinomas.

Preemptive analgesic effects of flurbiprofen axetil in patients undergoing radical resection of esophageal carcinoma via the left thoracic approach

Background Systemic non-steroidal anti-inflammatory drugs have been evaluated for their possible preemptive analgesic effects.The efficacy of flurbiprofen axetil for preemptive analgesia in patients undergoing radical resection of esophageal carcinoma via the left thoracic approach needs further investigation.The aim of this study was to research the preemptive analgesic effects of flurbiprofen axetil in thoracic surgery,and the influence of preoperative administration on postoperative respiratory function.Methods This randomized,double-blind,controlled trial enrolled 60 patients undergoing radical resection of esophageal carcinoma via the left thoracic approach.Anesthesia management was standardized.Each patient was randomly assigned to receive either 100 mg flurbiprofen axetil intravenously 15 minutes before incision （PA group） or intravenous normal saline as a control （C group）.Postoperative analgesia was with sufentanil delivered by patient-controlled analgesia pump.Postoperative sufentanil consumption,visual analog scale pain scores,plasma levels of interleukin-8,and oxygenation index were measured.Results Compared with the preoperative baseline,postoperative patients in the PA group had no obvious increase in pain scores （P 〉0.05）,but patients in the C group had significantly increased pain scores （P〈0.05）.Pain scores in the C group were significantly higher at 24 hours postoperatively than preoperatively.Intergroup comparisons showed lower visual analog scale scores at 2-24 hours postoperatively in the PA group than the C group （P 〈0.05）.Sufentanil consumption and plasma interleukin-8 levels at 2 and 12 hours postoperatively were significantly lower in the PA group than the C group （P 〈0.05）.The oxygenation index at 2 and 12 hours postoperatively was significantly higher in the PA group than the C group （P〈0.05）.Conclusions Intravenous flurbiprofen axetil appears to have a preemptive analgesic effect in patients undergoing radical resection of esophageal carcinoma via the left thoracic approach,and appears to contribute to recovery of respiratorv function and to reduction of the postoperative inflammatory reaction.

RECONSTRUCTION OF ESOPHAGUS WITH WHOLE STOMACH THROUGH ESOPHAGEAL BED AFTER RESECTION OF THE UPPER ESOPHAGEAL CARCINOMA A REPORT OF 160 CASES

From September 1985 to December 1992, 160 cases of reconstruction of the esophagus with the whole stomach through the esophageal bed after resection of the upper esophageal carcinoma were performed with neither operative mortality nor intrathoracic complications. The leakage rate of the cervical anastomosis with Gambee's single layer method was 1.2%. The main steps of the operative procedure consisted of : (1) making a right thoracotomy for dissecting and removing the entire thoracic esophagus; (2) laparotomy for mobilizing the whole stomach, constricting it to tube shape and doing a pyloroplasty; and (3) pulling up the mobilized tube-like stomach through the posterior mediastinal space(i.e. the esophageal bed) out of the left neck incision and then the esophagogastrostomy with Gambee's single layer anastomosis was performed.

Elafin 表达水平与食管癌切除术患者预后的相关性

目的分析Elafin表达水平与食管癌切除术患者预后的相关性。方法选取2020年1月至2022年1月就诊于我院外科的食管癌患者200例。监测患者人白细胞弹性蛋白酶特异性抑制剂(Elastase specific inhibitors,Elafin)表达水平,并行食管癌切除术。随访1年后根据预后情况分为不良预后组和对照组。比较两组患者临床资料、Elafin表达水平等情况。应用多因素Logistic回归分析Elafin表达水平等因素与食管癌切除术患者预后的相关性。应用ROC曲线分析相关因素预测食管癌切除术患者预后的价值。结果纳入研究的200例患者中有12例病例脱落。剩余188例患者中有41例纳入不良预后组,147例纳入对照组,预后不良发生率为21.81%(41/188)。两组患者年龄、葡萄糖等临床资料对比,差异无统计学意义(P>0.05)。但不良预后组临床分期Ⅲ期、低分化和有淋巴结转移所占的比例均大于对照组(P<0.05),不良预后组Elafin水平低于对照组(P<0.05)。多因素Logistic回归分析显示,临床分期(OR=5.898)、分化程度(OR=3.012)和淋巴结转移(OR=4.876)是影响食管癌切除术患者预后的独立危险因素,Elafin水平(OR=0.117)是影响食管癌切除术患者预后的保护性因素。ROC曲线显示,Elafin水平预测食管癌切除术后预后的诊断效能高于临床分期、分化程度和淋巴结转移,其中Elafin水平的最佳截点为0.49 ng/mL,此时敏感性为92.0%,特异性为80.9%。列线图预测食管癌切除术患者预后不良的一致性指数(C-index)为0.927(95%CI:0.873~0.951)。结论临床分期越高、分化程度越低和有淋巴结转移是影响食管癌切除术患者预后的危险因素,而Elafin表达水平则是保护性因素,早期监测有助于调整治疗方案、改善预后。

右美托咪定复合瑞芬太尼对食管癌根治术患者应激反应的影响

目的探讨右美托咪定复合瑞芬太尼对食管癌根治术患者应激反应的影响。方法选择2021年3月至2023年3月周口市中心医院接诊的行食管癌根治术的患者90例,随机均分为对照组和观察组2组,每组45例。对照组采取瑞芬太尼静脉麻醉,观察组采用右美托咪定复合瑞芬太尼静脉麻醉。比较2组患者麻醉相关指标、应激反应相关指标及不良反应发生情况。结果与对照组比较,观察组瑞芬太尼使用剂量减少,苏醒时间、拔管时间均缩短(t=35.240,P<0.001;t=11.810,P<0.001;t=10.340,P<0.001)。观察组患者术后3 d血清促肾上腺皮质激素、皮质醇水平均低于对照组(t=7.622,P<0.001;t=4.467,P<0.001)。观察组不良反应发生率低于对照组( χ^( 2)=4.406,P=0.036)。结论右美托咪定复合瑞芬太尼减少了食管癌根治术患者麻醉药物的剂量,减轻了应激反应,且安全性高,具有较高的临床推广价值。

右美托咪定联合七氟烷对食管癌根治术患者应激指标、认知功能及HMGB1水平的影响

目的探讨右美托咪定联合七氟烷对食管癌根治术患者应激指标、脑氧代谢指标、认知功能及高迁移率族蛋白B1(high mobility group protein B1,HMGB1)水平的影响。方法选取2020年1月至2022年12月周口市中心医院收治的124例食管癌患者,随机分为对照组及观察组各62例。观察组麻醉诱导前给予右美托咪定,对照组麻醉诱导后给予生理盐水,两组采用相同的麻醉诱导及麻醉维持方案。比较两组患者应激反应指标、脑氧代谢指标、术后认知功能障碍发生情况及外周血HMGB1含量。结果在T_(0)时两组皮质醇(Cor)、丙二醛(MDA)水平、脑氧摄取率(CERO_(2))及动脉—颈内静脉血氧含量差(Da-jvO_(2))无显著差异(P>0.05);T_(1)及T_(2)时观察组患者Cor及MDA水平、CERO_(2)及Da-jvO_(2)水平均显著低于对照组患者(P<0.05)。观察组术后认知功能障碍发生率(6.45%)与对照组(22.58%)相比显著降低(P<0.05)。观察组术后1 d及3 d外周血HMGB_(1)水平显著下降(P<0.05)。结论麻醉诱导前输注右美托咪定应用于食管癌根治术可缓解患者应激反应、调节脑氧代谢并降低术后认知功能障碍的发生率。

cT1N0M0期食管癌内镜下非治愈性切除的研究进展

随着消化内镜诊疗活动的广泛开展,内镜下切除已成为cT1N0M0期食管癌的标准治疗方案之一。然而,术后病理确认的非治愈性切除患者仍然面临复杂的后续管理选择。本文就cT1N0M0期食管癌内镜下非治愈性切除的国内外研究进展进行综述,指出现有指南有关非治愈性切除的定义尚存争议,同时针对这部分患者,应在临床实践中制定选择性的个体化管理策略。

老年食管癌患者术后反流性食管炎的影响因素

目的探讨老年食管癌患者术后发生反流性食管炎的影响因素。方法选取医院2018年7月至2021年5月收治的154例老年食管癌根治术患者为研究对象,根据是否并发反流性食管炎分组,采用单因素及logistic回归模型分析相关指标与老年食管癌根治术后发生反流性食管炎关系,并制定针对性干预措施。结果154例老年食管癌根治术患者有44例(28.57%)发生反流性食管炎。两组吸烟史、体重指数(BMI)、饮酒史、血糖水平、白蛋白水平、消化道重建方式、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评分差异有统计学意义(P<0.05)。BMI、吸烟史、血糖水平、消化道重建方式、HAMA评分、HAMD评分是诱发反流性食管炎影响因素。结论老年食管癌根治术后反流性食管炎发生风险较高,主要与BMI、吸烟史、血糖水平、消化道重建方式、HAMA评分、HAMD评分有关,临床应重视具有上述风险因素患者的早期合理干预,以降低反流性食管炎发生风险,改善预后。

食管癌根治术后患者阶段性综合吞咽训练方案的优化与实施

目的探讨阶段性综合吞咽训练在食管癌根治术患者中的应用效果。方法选取胸外科住院食管癌术后患者60例,按照病区随机分为干预组和对照组各30例。干预组实施阶段性综合吞咽训练方案,对照组实施常规吞咽康复护理方案。比较两组术后首次经口进食时间、吞咽功能、摄食能力、营养相关指标以及吞咽障碍相关并发症发生率。结果两组均完成研究,干预组首次经口进食时间、吞咽障碍相关并发症发生率显著短于和低于对照组,术后吞咽功能和摄食能力得分及营养相关指标显著优于对照组(均P<0.05)。结论阶段性综合吞咽训练方案的实施有利于促进食管癌根治术后患者吞咽功能恢复,改善术后营养状态,降低吞咽障碍相关并发症发生率。

术前AAPR联合CONUT评分对食管癌根治术后辅助化疗患者预后的影响

目的 探究术前白蛋白/碱性磷酸酶比值(AAPR)联合控制性营养状态(CONUT)对食管癌根治术后辅助化疗患者预后的影响。方法 选取2021年1月至2022年8月于青岛大学附属泰安市中心医院行食管癌根治术患者100例。采用受试者工作特征(ROC)曲线分析AAPR、CONUT评分对患者6个月不良预后结的预测效能,并计算最佳截断值,比较不同水平AAPR、CONUT评分患者的3个月不良反应发生率以及1年生存情况。结果 AAPR、CONUT评分及两者联合预测食管癌根治术后辅助化疗患者不良预后的AUC分别为0.781、0.807、0.892,AAPR、CONUT评分的最佳截断值分别为0.59、3.05;高AAPR组的不良反应发生率均小于低AAPR组(P <0.05);高CONUT评分组的不良反应发生率均大于低CONUT评分组(P <0.05);高AAPR组的1年生存率高于低AAPR组(81.48%vs.60.86%,HR 0.400,95%CI 0.189~0.848,P=0.014);高CONUT评分组的1年生存率低于低CONUT评分组(58.97%vs.80.33%,HR 2.656,95%CI 1.211~5.824,P=0.015)。结论 AAPR越低,CONUT评分越高,食管癌根治术后辅助化疗患者的不良预后风险越高,应密切关注患者的营养状况变化,以积极改善预后。

路径式呼吸功能训练在食管癌根治术后加速康复外科中的应用效果

目的分析路径式呼吸功能训练在食管癌根治术后加速康复外科(ERAS)中的应用效果。方法选取2020年1月至2022年12月河南省胸科医院80例接受食管癌根治的患者,依照随机法划分成研究组(40例)和常规组(40例),常规组接受ERAS引导下的常规干预,研究组在此基础上联合路径式呼吸功能训练。对比两组术后恢复状况、肺功能[最大通气量(MVV)、第一秒用力呼气容积(FEV_(1))]、血气指标[动脉二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))]、疼痛程度[视觉模拟评分(VAS)]、并发症发生率。结果与常规组相比,研究组住院时间、术后输液时间、胸管留置时间较短(P<0.05);与常规组相比,干预后研究组MVV、FEV_(1)水平较高(P<0.05);与常规组相比,干预后研究组PaCO_(2)、PaO_(2)水平较高(P<0.05);与常规组相比,术后24、48、72 h研究组VAS评分较低(P<0.05);研究组并发症发生率较常规组低(P<0.05)。结论路径式呼吸功能训练应用于食管癌根治术后ERAS中能缩短术后恢复时间,改善肺功能和血气指标,并能缓解疼痛、降低并发症发生率。