Expression of ATP7B in human gastric cardiac carcinomas in comparison with distal gastric carcinomas

AIM： To analyze expression of ATP7B in gastric cardiac adenocarcinomas, its clinicopathologic significance, in comparison with distal gastric adenocarcinomas. METHODS： Immunohistochemical avidin-biotin peroxidase complex method was applied to detect the expression of ATP7B in 49 cases of cardiac carcinomas, the corresponding adjacent non-neoplastic epithelium and 55 cases of distal gastric carcinomas. RESULTS： The proportion of ATP7B positive samples in gastric cardiac carcinomas （51.0%, 25 of 49） was significantly higher than that in the corresponding adjacent non-neoplastic epithelium （22.4%, 11 of 49） （P = 0.003）. ATP7B expression in poorly differentiated gastric cardiac carcinomas was significantly higher than that in well/moderately differentiated gastric cardiac carcinomas （P = 0.030）. ATP7B expression in gastric cardiac carcinomas was independent of age, tumor size, nodal stage and metastasis status. ATP7B protein was detected in 30.9% （17/55 cases） of distal gastric carcinomas, markedly lower than that in gastric cardiac carcinomas （P = 0.037）. CONCLUSION： ATP7B protein is frequently overexpressecl in gastric cardiac carcinomas, and correlated with the differentiation of cardiac carcinoma. ATP7B expression in gastric cardiac carcinomas is significantly higher than that in distal gastric carcinomas, which might partially explain the difference of chemotherapy response and prognosis between these two gastric carcinomas.

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

OBJECTIVE To summarize the regular pattern and state oflymph node metastasis of patients with esophageal and cardiaccarcinomas,so as to analyze factors influencing lymph nodemetastasis.METHODS Clinical data collected from 1,526 thoracicesophageal and cardiac carcinoma patients who were admitted inthe Fourth Hospital of Hebei Medical University during a periodfrom January 1996 to December 2004,were randomly selectedand an Access Database of the patient's information was set up.Eight clinico-pathologic factors,including the patient's age,tumorlocation and size,pathological classification,the depth of tumorinvasion,vascular tumor embolus (VTE),the state of surroundingorgan encroachment and the status of tumor residues,wereidentified.A correlation between these factors and metastases wasstatistically analyzed using SPSS13.0 software.RESULTS Lymph node metastatic sites from esophagealcarcinomas included the thoracic and abdominal cavity.Lymphnode metastasis from the superior esophageal carcinomasmainly occurred in the neck and thoracic cavity.There was atwo-way lymph node metastasis in the patients with the middleesophageal carcinoma.The inferior esophageal carcinomas mainlymetastasized to the paraesophageal,paragastric cardia,and leftgastric artery lymph nodes.The rate and degree of the metastasisfrom the inferior esophageal carcinomas were significantly highercompared to those of the superior and the middle esophagealcarcinomas (P<0.0125).The degree of abdominal lymph node metastasis fromcarcinomas of the gastric cardia was significantly higher comparedwith that of esophageal carcinomas.In the group with carcinomaof the gastric cardia,the rate and degree of the lymph nodemetastases in the paragastric cardia and left gastric artery weresignificantly higher compared to the group with esophagealcarcinoma (P<0.05).Paraesophageal lymph node metastasis fromcarcinomas of the gastric cardia in the thoracic cavity frequentlyoccurred,too,and the degree of the metastasis was similar to thatof esophageal carcinoma.There was no significant difference inthe rate and degree of the paraesophageal lymph-node metastasisbetween the group with carcinoma of the gastric cardia comparedto those with esophageal carcinoma (P>0.05).Multifactoriallogistic regression analysis showed that the tumor size,depth oftumor encroachment,VTE,and tumor residues could all bringabout obvious impact on lymph-node metastases (P<0.05).CONCLUSION Lymph node metastasis from superioresophageal carcinomas mainly occurs in the neck and thoraciccavity.The middle esophageal carcinomas presented a two-waylymph-node metastasis (both the upwards and the downwards),and the lymph node metastasis from inferior esophagealcarcinomas mainly occurred in the thoracic and abdominal cavities.The metastases of carcinoma of the gastriccardia were most commonly found in the abdominalcavity,with frequent paraesophageal lymph-nodemetastasis.The sufficient attention should be paidto neck lymph node clearance in cases of esophagealcarcinoma.What is of the greatest concern is theclearance of the left gastric artery lymph nodes,andalso in cases of gastric cardia carcinoma,clearance,the paraesophageal lymph nodes.With an increasein the tumor size and depth of tumor encroachment,and occurrence of VTE and tumor residual cells,therisk of lymph node metastasis is significantly raised (P<0.05).

Transthoracic echo: A sensitive tool for detecting cardiac extension of renal cell carcinoma?

Renal cell carcinoma is a common urological malignancy with the unique ability to invade the inferior vena cava(IVC) and to extend into the right atrium of the heart. Of those with Renal cell carcinoma only 4%-25% are found to have IVC invasion and of those only 2%-10% extend into the right atrium. If treated surgically, extension of tumor thrombus is not a determinant of survival; therefore it is imperative to determine the presence and extent of tumor thrombus in order to determine surgical approach and tumor resection. To date this has been primarily accomplished by magnetic resonance imaging and computed tomography. We present a case of 61 years old African American woman in which transthoracic echocardiography provided a more accurate determination/characterization of the presence and degree of tumor thrombus and extension.

内镜下光动力疗法联合氟尿嘧啶与奥沙利铂治疗晚期贲门—胃底癌患者的临床研究

目的:探讨内镜下光动力疗法(PDT)联合氟尿嘧啶与奥沙利铂治疗晚期贲门—胃底癌患者的临床效果。方法:回顾性分析2020年1月—2022年1月安阳市中医院收治的82例晚期贲门—胃底癌症患者的临床资料,根据治疗方法的不同将其分为对照组和观察组,每组各41例。对照组患者接受氟尿嘧啶与联合奥沙利铂治疗,观察组患者在对照组的基础上接受内镜下PDT治疗。比较两组患者血清肿瘤标志物水平、治疗效果、并发症发生情况及生活质量。结果:治疗后,两组患者MMP-2、CA125、CEA水平均低于治疗前,且观察组患者低于对照组患者,差异均有统计学意义(t=2.215、2.687、4.337,P<0.05)。两组患者治疗总有效率比较,差异无统计学意义(χ^(2)=4.556,P>0.05)。两组患者不良反应发生率比较,差异无统计学意义(χ^(2)=0.082,P>0.05)。观察组患者治疗8周后、治疗12周后生活质量评分均高于对照组患者,差异均有统计学意义(t=3.464、4.152,P<0.05)。结论:内镜下PDT联合氟尿嘧啶与奥沙利铂治疗晚期贲门—胃底癌患者,能够提高其血清肿瘤标志物水平,改善其治疗效果,提高其生活质量,且安全性较高。

经腹与经左胸贲门癌根治术治疗老年贲门癌的临床效果及对应激反应的影响

目的探究经腹与经左胸贲门癌根治术治疗老年贲门癌的临床效果及对应激反应的影响。方法选取2019年3月—2020年3月黄河科技学院附属医院收治的98例老年贲门癌患者为研究对象,运用随机数表法分为经左胸入路治疗组(经左胸组)和经腹入路治疗组(经腹组),各49例。比较两组患者手术指标、术后疼痛及应激反应情况、并发症发生率、术后1年生存率。结果经腹组手术时间、术后引流量、术中出血量、住院时间分别为(187.79±24.97)min、(299.97±89.97)mL、(65.89±9.15)mL和(11.13±2.98)d,均优于左胸组,差异有统计学意义(t=4.415、3.647、3.700、4.954,P均<0.05)。经腹组运动与静息时视觉模拟评分法评分均低于经左胸组,术后超氧化物歧化酶水平高于经左胸组,C反应蛋白和丙二醛水平低于经左胸组,差异有统计学意义(P均<0.05)。经腹组术后肺部并发症发生率为4.08%,低于经左胸组的16.33%,差异有统计学意义(χ^(2)=4.009,P<0.05);两组其他手术并发症和术后1年存活率对比,差异无统计学意义(P均>0.05)。结论经腹入路治疗可减轻老年贲门癌患者术后疼痛和氧化应激反应,减少并发症的发生。

NON-THORACOTOMY ESOPHAGECTOMY FOR CARCINOMA OF THE ESOPHAGUS AND CARDIA

Objective: To try to use Non Thoracotomy Esophagec tomy (NTE) for patient with carcinoma of esophagus and cardia avoiding thoracotomy, and by utilizing a cervical esophagogastric anastomosis in order to reduce peri operative morbidity and mortality. Methods: 18 patients were treated with NTE between 1989 to 1998. Of them, 5 adenocarcinoma of the cardia and 13 squamous cell carcinoma of the esophagus (2 upper thoracic, and 11 distal third). Everting stripping were performed in all patients. Esophagus were extracted either upwards (n=2) or downwards (n=16). The esophageal substitute was a resulting gastric tube (n=5) or the stomach (n=13) and was positioned in the posterior mediastinum. Results: The mean age of the patients was 64 years (ranged 40 to 72). The male:female ratio was 10:8. The mean intra operative blood loss was 400 ml. There was no hospital deaths. Only one patient had a cervical esophagogastric anastomotic leakage. Conclusion: NTE is to be recom mended because of its operative ease, safety and rare operative complications. CT scanning of the thorax and bronchoscopy is necessary before using the technique of NTE.

宫颈鳞癌三尖瓣转移合并先心病1例报告及文献复习

宫颈癌主要转移途径包括:局部侵犯,淋巴结转移,血行转移。晚期常转移至肺、肝、骨、脑及远处淋巴结[1-2],罕见转移至心脏,根据尸检结果,宫颈癌心脏转移的发生率为0.3%~8.0%,死亡前诊断率仅4.0%[3-4]。转移部位多位于心外膜或心肌,极其罕见于心脏瓣膜[5]。宫颈癌心脏转移后的平均生存期仅6个月[6],大部分患者在1年内死亡[5],系统性治疗为转移以后的主要治疗手段,局部治疗有助于改善症状。

化疗联合免疫治疗肺鳞癌伴心脏侵犯患者一例

肺鳞癌伴心脏侵犯是一种极罕见的恶性肿瘤,死亡率较高,临床上缺乏特异性、易漏诊、误诊。本文报道了晚期肺鳞癌伴心脏侵犯一例,患者经免疫治疗联合化疗后,预后良好,无不良事件发生,证明此方案安全有效。现报道其诊治经过,以供临床参考。

靶向联合免疫检查点抑制剂治疗对肝细胞癌患者心肌肌钙蛋白T的影响

目的探讨肝细胞癌患者靶向联合免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)治疗过程中出现心肌肌钙蛋白T(cTnT)升高的发生率及临床特征。方法收集2017年1月至2021年12月复旦大学附属中山医院厦门医院肝肿瘤内科住院治疗的125例接受靶向联合ICIs治疗的肝细胞癌患者临床资料,根据治疗过程中cTnT水平变化分为cTnT正常组(cTnT<0.03 ng/mL,n=114)和cTnT升高组(cTnT≥0.03 ng/mL,n=11),分析2组患者的基线特征以及cTnT升高组患者cTnT升高前后的临床指标改变。结果肝细胞癌患者靶向联合ICIs治疗过程中cTnT升高发生率为8.8%(11/125),其中心肌炎的发生率为0.8%(1/125)。高龄、糖尿病史、心脏疾病史可能是cTnT升高的危险因素。11例患者cTnT升高后左心室射血分数显著下降(P=0.020),左心室舒张末期内径显著减小(P=0.013),白介素2受体水平显著增加(P=0.038)。结论靶向联合ICIs治疗肝细胞癌可引起患者cTnT升高;监测cTnT变化有助于早期发现心肌损伤,对预防药物相关的心脏不良事件具有重要意义。

贲门癌选择胸腹联合切口的标准

目的 探讨贲门癌选择胸腹联合切口的合理标准。方法 2000年2月～2004年2月，对269例贲门癌对所采用的切口、手术方式、术后并发症及生存率进行统计分析。结果 经左胸入路110例，经腹入路113例，胸腹联合切口46例，切除率为88．5％（238／269），联合脏器切除共30例。经左胸切口、经腹切口和胸腹联合切口的根治性切除率分别为，81．8％（90／110）、84．1％（95／113）和91．3％（42／46），胸腹联合切口的根治性切除率最高。经腹切口上切缘癌残留率为3．5％（4／113），与其他两组有显著差异（P〈0．05）。术后5年生存率：经胸切口为30．9％，经腹切口为31．8％，胸腹联合切口为34．8％，胸腹联合切口组的生存率高于其他两组，差异有显著性（P〈0．05）。结论 胸腹联合切口有利于贲门癌的根治，肿瘤浸润食管是选择胸腹联合切口的合理标准。

吻合器在食管癌和贲门癌切除术的应用

报告我院自1982年2月至1987年底应用吻合器治疗食管癌和贲门癌207例的临床经验.其中食管癌171例,贲门癌34例,食管双原位癌2例;弓下吻合58例,弓上吻合122例,胸膜顶吻合27例.并发症发生率为16.4%,吻合口瘘发生率为2.4%,吻合口狭窄发生率为5.8%,手术死亡率为2.4%.本文还讨论了吻合口瘘和狭窄的发生原因和提高吻合技术的重要性.

食管、贲门癌切除食管胃分层吻合术患者生命质量评价

目的 探讨食管、贲门癌切除食管胃分层吻合术的手术效果 ,评价患者手术后生命质量。 方法 根据手术方式不同将 2 6 4例食管、贲门癌患者分为两组 ,食管胃分层吻合组 :16 2例 ,行食管、贲门癌切除 ,食管胃黏膜连续缝合 ,食管胃分层吻合术 ;器械吻合组 :10 2例 ,行食管、贲门癌切除 ,食管胃吻合器吻合术。均用欧洲癌症研究与治疗组织(EORTC) QL Q- C30和自制量表对患者术后 3～ 6个月生命质量进行测评 ,并进行比较。 结果 食管胃分层吻合组有137份问卷、器械吻合组有 77份问卷符合评分要求。食管胃分层吻合组在体力功能和情感功能维度得分高于器械吻合组 (P<0 .0 5 ) ,吞咽困难维度、胃食管反流症状维度得分低于器械吻合组 (P<0 .0 5 ) ,其他维度两组比较差别无显著性意义 (P>0 .0 5 )。 结论 食管胃分层吻合术后患者体力功能和情感功能优于器械吻合术 ,吞咽困难、反流症状少于器械吻合术 ,生命质量高于器械吻合术。

食管癌贲门癌术式与术后并发症的相关分析

目的:回顾性总结手术切除的1179例食管癌贲门癌病例,对手术方式和术后并发症的相关性做比较。方法:采用4种开胸入路手术方式。结果:1)右胸腹颈三切口手术157例发生并发症多。2)左胸颈二切口全胃食管床内移植123例,手术简便安全,并发症少。3)左胸主动脉弓上吻合215例,并发症最多。4)左胸主动脉弓下吻合684例,手术简单安全,并发症最少。结论:推荐食管上段癌手术选择右胸腹颈三切口术式,中段癌选左胸颈二切口,下段癌选择主动脉弓下吻合或左颈吻合,尽量少用主动脉弓上吻合。

食管多源癌的诊断及外科治疗

目的探讨食管多源癌的诊断及手术治疗方法。方法29例食管多源癌患者经食管X线钡餐造影检查及纤维胃镜下碘染色确诊,并经手术切除标本的病理检查证实。29例中行根治性切除22例,姑息性切除5例,探查2例而未能切除。结果术前确诊21例,术中及术后确诊8例;发现病灶67个,早期病例6例;肿瘤的手术切除率75.9%(22/29),无手术死亡,发生并发症7例。术后随访25例,随访时间7个月～3年。1年生存率77.8%,3年生存率41.6%。结论对食管癌患者常规进行上消化道X线钡餐造影检查,应用内镜下碘染色活检方法可提高诊断率,降低漏诊率,并进行积极的外科治疗,有望改善治疗效果。

食管、贲门癌术后感染危险因素研究

目的研究食管、贲门癌术后感染的危险因素,为预防与控制术后感染提供科学依据。方法回顾分析医院2004年8月-2006年12月行食管、贲门癌根治术的512例患者,分析患者的性别、年龄等15项变量与术后感染的关系,用2χ检验和四格表检验作单因素分析,用Logistic回归作多因素分析。结果食管、贲门癌术后感染率为11.13%,单因素分析发现糖尿病、吸烟、呼吸系统疾病、手术方式、发热、术后白细胞等与术后感染有显著的关联(P<0.05),而性别、年龄、手术时间、血红蛋白、肿瘤TNM分期、心血管疾病等与感染的发生无显著关联;多因素分析筛选出4个术后感染的相关因素:吸烟、呼吸系统疾病、手术方式、发热,差异有统计学意义(P<0.05)。结论吸烟、呼吸系统疾病、手术方式、发热与食管、贲门癌术后感染有关,手术前后积极采取必要的措施,可降低术后感染的发生率。

35岁以下青年人食管癌和贲门癌的外科治疗

本文报告1952年9月～1986年12月,196例35岁以下青年人食管癌和贲门癌的外科治疗结果,占同期手术6984例的2.81％。食管癌手术切除率为81.37％,与中年和老年组比较无明显差异。而切除死亡率为2.60％,明显低于后两组。5年生存率为29.13％,高于老年组。对提高早期诊断率、手术适应证的选择及远期疗效等问題进行了探讨。

食管癌、贲门癌患者T细胞亚群水平及临床意义

目的探讨食管癌、贲门癌的发生发展与机体免疫状态的关系。方法采用流式细胞术(FCM)检测56例食管癌、贲门癌患者外周血中T细胞亚群水平,并与30例正常人(对照组)比较。结果与对照组比较,食管癌、贲门癌患者CD4+T细胞下降,CD8+T细胞增加,CD4+/CD8+比值下降(P<0·05)。但是与肿瘤的病理类型、细胞分化程度、pTNM分期、肿瘤大小及淋巴转移程度无明显相关。结论食管癌、贲门癌患者的细胞免疫状态存在明显异常,检测患者外周血T淋巴细胞亚群表达对评估患者的细胞免疫功能,疾病的诊断具有积极意义。

食管癌和贲门癌病人术后胸内吻合口瘘的营养支持分析

目的:探讨目前食管癌和贲门癌病人术后胸内吻合口瘘的营养支持方式。方法:回顾分析本院诊治的1 109例食管癌和贲门癌手术病人中,18例出现术后胸内吻合口瘘营养支持方式对其治疗的影响。结果:肠内营养组与肠外营养组比,并发症的发生率低,程度轻,营养状况显著改善,病死率和住院时间明显降低。结论:肠内营养对于胸内吻合口瘘病人的恢复以及并发症的预防和治疗具有较好的作用。

食管癌和贲门癌2638例外科治疗分析

1975至1988年外科治疗食管癌和贲门癌2638例,总切除率79.0％,其中食管癌切除率84.4％(1362/1613),贲门癌切除率70.3％(721/1025)。术后六项主要并发症发生率12.3％,其中吻合口瘘率4.1％。总手术死亡率2.1％,切除死亡率2.5％。切除术后5年及10年生存率分别为食管癌22.4％和15.1％,贲门癌15.3％和13.8％。分析表明影响术后5年生存率主要因素为临床病理分期。本文并对切除率,手术并发症及防治措施,提高远期生存率方面进行讨论。

不同平面胃食管吻合术后食管腔内24小时pH监测

目的为了解食管癌、贲门癌切除术后胃食管在颈部、弓上和弓下吻合术后发生胃食管反流的差异。方法对１０例正常人和３０例在３个不同平面作胃食管吻合的患者术后１～３月进行残留食管腔内连续２４小时ｐＨ监测。结果（１）食管癌、贲门癌患者术后无论吻合平面位于何处，术后近期内２４小时食管腔内ｐＨ各项监测指标均高于正常（Ｐ＜０．０１）；（２）２４小时总反流次数在３个不同吻合平面吻合术间无差异（Ｐ＞０．０５）；（３）其余监测指标颈部吻合＞弓上吻合＞弓下吻合（Ｐ＜０．０１）。结论食管癌、贲门癌患者术后普遍存在胃食管反流现象。吻合平面越高，反流越严重。降低吻合平面，缩小胸胃体积有利于减少术后反流，提高生活质量。