Esophageal cancer (EC) is the eighth dangerous cancer in the world. As the global population ages, the management of elderly patients with EC poses a challenge as they have many aging-associated diseases and physiological changes. In addition, the data on the tolerability of cancer treatment and the use of combined therapies in the patients to guide their treatment are limited. In this paper, we reviewed the literatures and discussed the effect of surgical resection and the potential complications of elderly patients. We reviewed the basic principles of combined therapy and the potential benefits of chemotherapy or chemoradiotherapy for patients and focused on the management of elderly patients with EC as well as the role of comprehensive assessment for aging to provide treatment options for elderly patients.
目的 观察生姜泻心汤治疗反流性食管炎的临床疗效。 方法 2006年2月-2008年3月，回顾性分析20例反流性食管炎患者，服用生姜泻心汤7 d后，停药观察1个月，应用反流性疾病问卷及胃镜检查，判断治疗效果。 结果 治愈率为35%，有效率为90％。 结论 生姜泻心汤对反流性食管炎有较好的临床疗效。
ObjectiveTo investigate the individualized management of severe gastroesophageal reflux disease (GERD) secondary to scleroderma, particularly the safety and feasibility of laparoscopic Toupet fundoplication for this entity. MethodsFrom June, 2011 to June, 2014 six inpatient cases had severe GERD secondary to scleroderma were documented. Endoscopy, esophageal high-resolution manometry and 24 hours reflux monitoring were applied for GERD evaluation. Maintenance of conservative treatment was carried out for the 2 cases who responsed well to medication therapy, laparoscopic Toupet fundoplication was done for the 4 cases who had extraesophageal symptom and not well controlled by medication. The patients were followed-up for an average of 2.2 years (1 to 4 years) after discharge, and endoscopic was rechecked during the followed-up. ResultsThe esophageal symptom of regurgitation, heartburn and dysphagia, as well as the extraesophageal symptom of cough and asthma significantly relieved during followed-up, meanwhile the anti-reflux medication was reduced or stopped in all the patients. For the 4 surgical patient, one had partial recurrence and no complication occurred. ConclusionsThe management of severe GERD secondary to scleroderma could follow the strategy of controlling the primary disease, living adjustment, anti-reflux medication and surgery step by step. The laparoscopic Toupet fundoplication may be safe, effective and feasible for the medication unmet patients, it deserves further studies.
ObjectiveTo investigate the risk factors for lymph node metastasis (LNM) and prognosis of T1-stage esophageal squamous carcinoma (ESC).MethodsClinical data of 387 patients with T1-stage ESC who underwent surgical treatment in our hospital from March 2013 to March 2018 were collected. There were 281 males and 106 females aged 60 (41-80) years. The patients were divided into a lymph node metastasis group (n=77) and a non-metastasis group (n=310). The risk factors for LNM and prognosis were analyzed.ResultsAmong 387 patients with T1-stage ESC, 77 (19.9%) patients had LNM. The incidence of LNM was 8.4% (8/95) in T1a-stage patients and 23.6% (69/292) in T1b-stage patients. Univariate analysis showed that tumor size, differentiation degree, depth of invasion and vascular tumor thrombus were associated with LNM (P<0.05). Multivariate logistic regression analysis showed that invasion depth of tumor [OR=2.456, 95%CI (1.104, 5.463), P<0.05] and vascular tumor thrombus [OR=15.766, 95%CI (4.880, 50.938), P<0.05] were independent risk factors for LNM. The follow-up time was 41 (12, 66) months. The 1-year, 3-year and 5-year survival rates were 98.71%, 89.67% and 86.82%, respectively. Univariate analysis showed statistically significant differences in tumor invasion depth, vascular tumor thrombus and LNM between the survival group and the death group. Cox analysis showed that LNM [OR=3.794, 95%CI (2.109, 6.824), P<0.05] was an independent risk factor for prognosis.ConclusionT1-stage ESC patients with deeper invasion or vascular tumor thrombus have a higher risk of LNM. The prognosis of T1-stage ESC with LNM is relatively poor.
目的 探讨食管贲门癌术后非计划二次手术的原因及有效的预防和治疗措施。 方法 回顾性分析 2010 年 1 月至 2016 年 1 月在我院胸外科实施食管贲门癌手术 2 655 例患者的临床资料，37 例（1.4%）患者因严重并发症实施了非计划二次手术，其中男 28 例、女 9 例，年龄 65（48～79）岁，总结该 37 例患者的临床特征、二次手术的原因及治疗方法。 结果 吻合口瘘 11 例：1 例行空肠造瘘，2 例行胸壁切口清创+胸腔置管引流术，3 例行颈部切口清创+上纵隔置管引流术，5 例行胸腔探查术（其中 3 例行瘘口修补术），1 例胸胃瘘行胸胃部分切除+食管颈部旷置+空肠造瘘术。乳糜胸 13 例，经胸行胸导管结扎术，其中 1 例右胸结扎失败后再次经腹腔缝扎胸导管。胸腔出血 6 例行开胸探查止血，腹腔出血 2 例，分别经左胸及腹正中探查止血。1 例胸胃扭转，行吻合口切除+胃-食管端端再次吻合术。1 例因双侧声带麻痹行气管切开；1 例因肺大疱破裂气胸行胸腔镜下肺大疱切除术；1 例因肠梗阻行开腹探查粘连松解+空肠造瘘术。1 例胸内瘘患者因二次术后肺部感染死亡，其余患者均治愈出院。 结论 食管贲门癌术后二次手术的主要原因为吻合口瘘、乳糜胸及出血，提高首次手术质量是预防二次手术发生的关键，对需要行二次手术治疗的严重并发症，及时果断的决定可避免病情进一步恶化和提高二次手术的效果。