目的 评价国产吻合器和闭合器在食管癌消化道重建术中的应用价值。 方法 回顾性分析2005年3月-2008年4月期间收治的387例食管癌手术患者的临床资料，根据不同消化道重建方式分为手工吻合组（n=172）和器械吻合组（n=215），对两组患者吻合时间、术中出血量及术后并发症发生情况进行对比分析。 结果 全组无手术死亡。器械吻合组和手工吻合组术中出血量的差别无统计学意义（Pgt;0.05），但前者的吻合时间、住院时间均少于后者（Plt;0.05）。手工吻合组术后吻合口出血多于器械吻合组（5.2%比1.4%，Plt;0.05），发生吻合口漏亦多于器械吻合组（6.4%比2.8%，Plt;0.05）。随访1.5～2年，排除失访患者后，器械吻合组吻合口狭窄发生率低于手工吻合组（4.6%比10.3%，Plt;0.05）。 结论 国产吻合器与和缝合器用于食管癌的消化道重建安全有效，值得在基层医院推广应用。
Objective This study analyzed the pattern and influence factors of lymph node metastasis in thoracic esophageal cancer to provide a reference for the lymph node dissection for esophageal cancer. Methods Clinical data of 177 patients with thoracic esophageal cancer receiving the lymph node dissection in our department from 2015 to 2016 were retrospectively analyzed. There were 125 males and 52 females with a median age of 64 years, ranging from 18 to 86 years. We excluded cervical esophageal cancer and adenocarcinoma of the esophagogastric junction and analyzed the relationship between lymph node metastasis and tumor pathological type, depth of invasion, degree of differentiation and length. Results Of the 177 patients, 76 (42.9%) were found to have lymph node metastasis. In the 4 977 dissected lymph nodes, metastasis was identfied in 361 (7.3%) lymph nodes. The rate of lymph node metastasis in thoracic esophageal carcinoma was not related to the location and length of the tumor (P>0.05), but related to the depth of invasion and the degree of differentiation (P<0.05). Conclusion Lymph node metastasis is prone to present in the early stage of thoracic esophageal cancer. According to the characteristics of lymph node metastasis in thoracic esophageal carcinoma, we need have a standardized, systematic and focused lymph node dissection.
ObjectiveTo investigate the predictive value of prognostic nutritional index (PNI) in complications after thoracoscopy-assisted radical resection of esophageal cancer.MethodsWe collected the clinical data of patients who underwent thoracoscopy-assisted esophagectomy in the First Affiliated Hospital of Xinjiang Medical University from January 2015 to June 2020. The predictive value of PNI for postoperative complications was evaluated by establishing receiver operating characteristic (ROC) curve and the optimal cut-off point was determined. The patients were divided into a high PNI group and a low PNI group according to the cut-off point. The differences of baseline data and perioperative complications-related indicators between the two groups were compared and analyzed. Univariate and multivariate analyses were used to investigate the influence of PNI and other related indexes on postoperative complications.ResultsA total of 116 patients were enrolled in this study, including 75 males and 41 females, aged 65 (58-69) years. The area under ROC curve was 0.647, and the optimal cut-off point was 51.9. According to the cut-off point, there were 45 patients in the high PNI group and 71 patients in the low PNI group. The overall complication rate (χ2=10.437, P=0.001) and the incidence of postoperative pulmonary infection (χ2=10.811, P=0.001) were statistically different between the two groups. The results of univariate analysis showed that the duration of ventilator use (Z=–3.136, P=0.002), serum albumin value (t=2.961, P=0.004), and PNI value (χ2=10.437, P=0.001) were the possible risk factors for postoperative complications after thoracoscopy-assisted esophagectomy. The results of multivariate analysis suggested that the duration of ventilator use (OR=1.015, P=0.002) and the history of drinking (OR=5.231, P=0.013) were independent risk factors for postoperative complications, and high PNI was the protective factor for postoperative complications (OR=0.243, P=0.047).ConclusionPNI index has a certain value in predicting postoperative complications, which can quantify the preoperative nutritional and immune status of patients. Drinking history and duration of ventilator use are independent risk factors for postoperative complications of thoracoscopy-assisted esophagectomy, and high PNI is a protective factor for postoperative complications.
Objective To investigate the feasibility, safety, and short-term efficacy of minimally invasive McKeown esophagectomy (MIME) in patients with locally advanced thoracic esophageal squamous cell carcinoma (TESCC) after neoadjuvant immunotherapy. Methods The clinical data of the patients with locally advanced TESCC in the First Affiliated Hospital of University of Science and Technology of China from July 2022 to March 2023 were restrospectively analyzed. They were divided into a neoadjuvant immunotherapy (NI) group and a non-neoadjuvant immunotherapy (NNI) group according to different preoperative neoadjuvant therapy. The perioperative clinical data and 3-month follow-up data were compared between the two groups. Results A total of 47 patients were collected, including 31 males and 16 females with a mean age of (67.57±7.64) years. There were 29 patients in the NI group and 18 patients in the NNI group. There were no statistical differences in baseline data, perioperative complications, short-term complications, surgical time, intraoperative bleeding, postoperative adjuvant therapy, metastasis/recurrence within 3 months, R0 resection rate, postoperative pathological staging decline, or College of American Pathologists (CAP) tumor regression grade between the two groups (P＞0.05). Conclusion Neoadjuvant immunotherapy combined with minimally invasive McKeown esophagectomy can be safely and effectively performed for patients with locally advanced TESCC without increasing operation time, intraoperative blood loss and perioperative complications.
目的探讨残胃代食管治疗胃大部切除术后食管癌的手术方法及效果 方法回顾分析我院1996年2月至2012年7月手术治疗14例胃大部切除术后食管癌患者的临床资料。其中男13例，女1例，年龄57.2（49～65）岁；5例行弓上吻合，9例行弓下吻合。 结果手术时间（2.3+0.4）h，术中失血量（270.0+60.0）ml；术后禁饮食时间（7.3+1.8）d，住院时间（13.7+3.1）d，无吻合口瘘和围术期死亡；术后并发症发生率为28.57%（4/14），以肺部炎症和心律失常为主。术后1年、3年和5年生存率分别为85.7%、50.0%和21.4%。 结论残胃代食管，将残胃连同脾脏、胰尾移至胸腔，行食管残胃吻合术，适用于治疗胃大部切除术后中下段食管癌，具有一定的优越性。
Conduit failure and conduit airway fistula are rare complications after esophagectomy, however they can be catastrophic resulting in high mortality. Survivors can expect a prolonged hospital course with multiple interventions and an extended period of time prior to being able to resume oral nutrition. High index of suspicion can aid in early diagnosis. Conduit failure usually requires a period of proximal esophageal diversion and staged reconstruction. Conduit airway fistulas may be amenable to endoscopic repair but this has a high failure rate and many patients will require surgical repair with closure of the fistula and interposition of vascularized tissue to minimize recurrence.
Objective To explore the predictive value of peripheral blood cells in the efficacy of neoadjuvant immunotherapy combined with chemotherapy for esophageal squamous cell carcinoma. Methods A retrospective study was conducted on patients with esophageal squamous cell carcinoma (clinical stages Ⅱ-Ⅳa) who underwent neoadjuvant immunotherapy combined with chemotherapy at the Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College from April 2020 to November 2023. According to whether the pathology was completely relieved after treatment, patients were divided into a pathological complete remission group and a pathological incomplete remission group. According to the CAP criteria for tumor pathological regression grading after neoadjuvant therapy, patients were divided into groups (TRG=0, 1 defined as good efficacy, TRG=2, 3 defined as poor efficacy). Results A total of 92 patients with esophageal squamous cell carcinoma were included, including 72 males and 20 females. The average age was 65.86±7.66 years. The complete remission of pathology was closely related to the number of lymphocytes in the blood before treatment (P=0.019). The AUC for predicting complete remission of esophageal squamous cell carcinoma after neoadjuvant immunotherapy combined with chemotherapy was 0.678, the maximum Yoden index was 0.328, and the optimal cutoff value was 1.845. The incidence of postoperative pulmonary infection in the group with incomplete pathological remission (25% vs. 5.6%, P=0.030) was higher than that in the group with complete pathological remission. According to the optimal cutoff value classification, there was a statistically significant difference (P<0.05) in the pathological N stage and pathological TNM stage between the two groups. The efficacy response was closely related to the number of red blood cells in the blood before treatment (P=0.009). The AUC for predicting TRG response after neoadjuvant immunotherapy combined with chemotherapy in esophageal squamous cell carcinoma was 0.669, the maximum Yoden index was 0.385, and the optimal cutoff value was 4.235. There were significant differences in postoperative pathological T staging (P=0.000), N staging (P=0.041), and TNM staging (P=0.000). According to the optimal cutoff value classification, there was a statistically significant difference in age (P=0.000) and hypertension (P=0.022) between the two groups. Conclusion Before neoadjuvant therapy, lymphocyte absolute value≥1.845 and red blood cell count<4.235 have good predictive effects on pathological complete remission and pathological response of esophageal squamous cell carcinoma after neoadjuvant immunotherapy combined with chemotherapy.