Reconstruction and repair of atresia or defect of the upper portion of esophagus is difficult. From November 1980 to December 1997, forth-five cases, consisting 35 males and 10 females, were treated with microsurgical technique. The 45 patients fell into the following groups as esophageal atresia of various causes in 21 cases, anastomotic fistula or stenosis following reconstruction of esophagus in 7 cases and late carcinoma of esophagus in 17 cases. The types of reconstruction consisted of transfer of free jejunum with its lower portion carrying a vascular pedicle in 24 cases, free transfer of jejunal graft in 15 cases, free vascularized jejunal graft in 2 cases and free vascularized tubular skin graft in 4 cases. After a follow-up of 6-19 months besides eight cases died from late esophageal carcinoma, thirty-seven cases were survived and could take food by mouth. All of the benign cases could return to work. In patients having late esophageal carcinoma, the operative procedure could improve the life quality and facilitate chemotherapy and radiotherapy.
Abstract: Esophageal carcinoma is one of the most common malignant tumours in China, surgery is one of the traditional therapy with a high complications rate. Among them, the anastomotic fistula was significant. At present, with the development of surgical technique, the incidence of anastomotic fistula become lower day by day, postoperative pulmonary complications of esophageal carcinoma has taken place of anastomotic fistula and become the main complications. The causes of pulmonary complication including pulmonary embolism, infection and acute lung injury have been revealed by recent researches. This article reviews the pathogenesis， prophylaxis and therapeutics of postoperative pulmonary complications of esophageal carcinoma.
ObjectiveTo investigate the short-term curative efficacy of DC-CIK in comprehensive therapy of esophagus cancer. MethodsWe randomly allocated 52 patients with esophagus cancer who had preoperatively confirmed by CT on stage Ⅱ-Ⅲ B into an observation group and a control group with 26 patients in each group. There were 14 male and 12 female patients in the observation group at median age of 60 years (range:49-67 years). There were 16 male and 10 female patients in the control group with median age of 62 years (range:48-65 years).The control group received postoperative chemotherapy, and the observation group received postoperative chemotherapy combined with DC-CIK biotherapy. The combination of paclitaxel and cisplatin for four cycles was choosen as the chemotherapy regimen. Patients in the observation group were treated with DC-CIK biotherapy for 2 weeks after operation. At the fifth week they received the first cycle of chemotherapy. There was a course of biotherapy between two cycles of chemotherapy. The clinical efficacy, lymphocyte subtypes, and intracellular cytokines in peripheral blood of the patients, performance status (KPS) and adverse reactions were compared. ResultsAll patients completed the therapy regimen successfully. In the observation group, the ratios of CD3+, CD4+, CD4+/CD8+, CD56+, and CD19+ increased, and the ratio of CD8+ decreased with significant differences (P<0.05).The biotherapy significantly increased interleukin 2 (IL-2), IL-12, interferon gamma (IFN-γ) and tumor necrosis fator (TNF)-α level (P<0.05). However, in the control group, there was no significant difference between post and pre-therapy in the levels of lymphocytes and cytokines. The effective rate of KPS was 76.92% in the observation group and 46.15% in the control group with a significant difference (P=0.023). No other adverse reactions except 3 patients with fever in the observation group were found. ConclusionThe short-term curative efficacy of DC-CIK in comprehensive therapy of esophagus cancer is distinct. DC-CIK biotherapy can improve patients' immune functions and elevate their life quality, so it is likely to be an effective adoptive immunotherapy for esophagus cancer.
ObjectiveTo explore the in vitro anti-tumor effect of clove extracts (CEs) on radioresistant esophageal cancer cell KYSER and its mechanism.MethodsEthanol extracts of clove bud were prepared. Gas chromatography was used to identify the main active components of CEs. In vitro cell culture method was used to observe the effect of CEs at different concentrations on KYSER cell growth. Methyl thiazolyl tetrazolium (MTT) method was used to detect the effect of different concentration CEs on KYSER’s survival and its’ manner. Transmission electron microscope (TEM) was used to observe the changes of KYSER’s organelle microstructure after CEs treated. Transwell chamber method was used to detect the impact of CEs on KYSER’s migration ability. The apoptosis rate and cell cycle distribution of KYSER treated by CEs were quantitatively determined by flow cytometry. Clone formation experiment was used to detect the clone formation ability of KYSER treaded by CEs.ResultsThe main components of CEs were eugenol, eugenol hydrocarbon, and eugenol acetate. In vitro cell culture showed that 0.4% CEs could inhibit KYSER growth. MTT assay showed that the concentration of CEs≥0.5% could inhibit the survival of KYSER in a dose-dependent manner. TEM assay showed that after treated by 0.5% CEs, KYSER’s microvilli became shorter and wider, ribosomes in the cytoplasm decreased, mitochondria atrophied, and a large number of autophagosomes were formed. Transwell migration assay showed that relative migration rates of KYSER after treated by 0.5% CEs and 0.6% CEs were (65±4)% and (41±3)%, respectively. Compared with the control group, the differences were statistically significant (P<0.001). Flow cytometry showed that the apoptosis rates of the control group, the 0.5% CEs treated group, and the 0.6% CEs treated group were (5.63±0.50)%, (11.77±0.42)%, and (19.44±0.19)%, respectively, and the differences between the control group and the two CEs treated groups were statistically significant (P<0.001). Flow cytometry showed that the G1 phase ratios of cells in the control group, the 0.5% CEs treatment group, and the 0.6% CEs treatment group were (61.99±1.20)%, (75.38±1.50)%, and (78.81±1.00)%, respectively, and the differences between the control group and the two CEs treated groups were statistically significant (P<0.001). The clonal formation experiment showed that after 24 h of CEs treatment, the clonal formation rates of the control group, the 0.5% CEs treatment group, and the 0.6% CEs treatment group were (80.5±1.0)%, (18.1±0.8)%, and (5.0±0.5)%, respectively, and the differences between the control group and the two CEs treated groups were statistically significant (P<0.001).ConclusionCEs can exert anti-tumor effect on radioresistant esophageal cancer cells by inducing autophagy and apoptosis, promoting cell cycle arrest, inhibiting cell energy metabolism, and inhibiting migration.
Using gastric tube to replace the esophagus has been widely used in esophagectomy. This surgical method is gradually replacing the traditional stomach reconstruction. Its advantages in the incidence of postoperative complication, the quality of life and the long-time survival in clinic have proved to be true. Although using tubular stomach in esophagectomy has become the consensus of experts, some details still need some further discussing and this technique should be gradually improved in future. In this review, the superiority and the technical progress of gastric tube are introduced, and we predict the future of tubular stomach and discuss the existed problems.
Transesophageal echocardiogram (TEE) can promote the quality of cardiac surgery and reduce peri-operative complications, and thus has been gradually accepted by cardiac surgeons. Through an esophageal probe, TEE can clearly visualize the internal structure of the heart without interrupting surgical procedure. As a newly developed technology which breaks the limitations tied to the traditional two-dimensional TEE, the realtime threedimensional transesophageal echocardiogram (RT3D-TEE) has the advantages of showing threedimensional structure of the heart and providing full range of anatomical information of the heart. Furthermore, it can precisely analyze the anatomical structure of the abnormal heart valves and provide assessment of the change of heart volume. Relying on its unique imaging property, it can largely facilitate preoperative decision-making and provide realtime intraoperative guidance as well as accurate postoperative evaluation. It has now been successfully applied in various types of cardiac surgical procedures including valve repair surgery, congenital heart defect intervention, cardiac mass removal as well as heart function evaluation. In this article, we will review the applications of RT3D-TEE in cardiac surgery, and try to form a basis for its further clinical application.
ObjectiveTo systematically review the efficacy of early enteral nutrition (EN) versus parenteral nutrition (PN) for esophagus cancer patients after esophagectomy. MethodsThe following electronic databases as PubMed, EMbase, The Cochrane Library (Issue 6, 2016), Web of Science, CBM, WanFang Data and CNKI were searched from inception to June 2016 to collect randomized controlled trials (RCTs) on comparing early EN and PN for esophagus cancer patients after esophagectomy. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. ResultsA total of 14 RCTs involving 2 275 patients were included. The results of meta-analysis showed that, compared with the PN group, the early EN group could improve postoperative levels of albumin (MD=1.12, 95%CI 0.03 to 2.20, P=0.04) and transferrin (MD=10.08, 95%CI 5.41 to 14.76, P<0.000 1), decrease the incidences of pulmonary infection (OR=0.36, 95%CI 0.25 to 0.53, P<0.000 01) and anastomotic leakage (OR=0.57, 95%CI 0.36 to 0.92, P=0.02), but there was no significant difference in postoperative level of prealbumin between two groups (MD=10.04, 95%CI -0.31 to 20.39, P=0.06). ConclusionThe early EN could improve the postoperative levels of albumin and transferrin, decrease the incidences of pulmonary infection and anastomotic leakage, but could not improve the postoperative prealbumin level.
Objective To analyze the Podoplanin expression in patients with esophageal squamous cell carcinoma and to find out the relationship between Podoplanin expression and tumor embolus, lymph node metastasis, tumor differentiation as well as prognosis, and to provide clinical evidence for reducing the recurrence of esophageal squamous cell carcinoma and prolonging the disease-free survival and overall survival. Methods A retrospective analysis of 70 patients with esophageal squamous cell carcinoma in our hospital from June 2010 to June 2012 was conducted, including 39 males and 31 females, with a mean age of 63.6 years. Positive diagnosis of tumor thrombus was achieved in 35 patients and negative in 35 patients. Postoperative pathological specimens were examined and normal esophageal tissues (esophageal tissue more than 5 cm from the edge of the tumor) of patients were excised as a control group. Results The positive rate of Podoplanin was 34.2% in normal esophageal tissues and 62.8% in tumor tissues. The positive rate of Podoplanin expression was 77.1% and 48.6% in esophageal squamous cell carcinoma patients with or without tumor embolus, respectively. The positive rate of Podoplanin expression in tumor cells of patients with positive and negative lymph node metastasis was 71.9% and 23.1%, respectively (P<0.05). The mean disease-free survival of patients with Podoplanin expression-negative esophageal squamous cell carcinoma was 15.2 months, which was significantly longer than that of patients with Podoplanin expression-positive esophageal squamous cell carcinoma (P<0.05). Conclusion Podoplanin expression in the tumor cells and vessels can be an important reference index to the prognosis of patients with esophageal squamous cell carcinoma.
OBJECTIVE: To study the effective protective measures to ensure sufficient blood supply to the jejunal segment in reconstruction of esophagus. METHODS: According to evidence based on medicine, we analyzed retrospectively 69 patients (48 cicatricial stenosis due to chemical burn, 21 defects due to excision of esophagus cancer), whose esophagus were reconstructed with free jejunal graft(in 28 cases) and with pedicle jejunal graft (in 41 cases) from 1980 to 2001. RESULTS: All patients were followed up for 1-21 years. Of 43 patients treated before 1996, 5 complicated by anastomotic leakage, 1 by strangulated intestinal obstruction; of 26 patients treated after 1996 (6 with free jejunal graft, 20 with pedicle jejunal graft), only one case complicated by anastomotic leakage. CONCLUSION: The preservative measures for good blood supply to the jejunal segment include the following aspects: (1) complete marginal vascular arcade without tension in the mesojejunum; (2) vessel anastomosis smooth; (3) 4-finger width pathway of jejunum; (4) the stable arterial blood pressure (more than 8 kPa); (5) a single-row anastomosis; and (6) the comprehensive preoperative management.
ObjectiveTo investigate the feasibility of lung tissue flap repairing esophagus defect with an inner chitosan tube stentin in order to complete repairing and reconsruction of the esophagus defect.MethodsFifteen Japanese white rabbits were randomly divided into two groups， experiment group(n=10): esophagus defect was repaired with lung tissue flap having inner chitosan tube stent; control group(n=5): esophagus defect was repaired with lung tissue flap without inner chitosan tube stent; and then the gross and histological apearance in both groups were observed at 2, 4,8 weeks after operation, barium sulphate X-ray screen were observed at 10 weeks after operation.ResultsSix rabbits survived for over two weeks in experiment group, lung tissue flap healed with esophageal defect, squamous metaplasia were found on the surface of lung tissue flap in experiment group. At 10 weeks after operation, barium sulphate examination found that barium was fluent through the esophageal and no narrow or reversed peristalsis, the peristalsis was good in experiment group.Four rabbits survived for two weeks and the lung tissue flap healed with esophageal defect, fibrous tissue hyperplasy on the surface of the lung tissue flap in control group. At 10 weeks after operation, barium sulphate examination found that barium was fluent through the esophageal and slight narrow or reversed peristalsis, the peristalsis was not good in control group, otherwise.ConclusionIt is a feasible method to repair the esophageal defect with lung tissue flap with the inner chitosan stent.