【作者】 杨瑞森； 刘奇； 李敏； 张百江； 张利民； 李辉； 刘希斌； 杨靖；

【Author】 YANG Rui-sen, LIU Qi, LI Min, ZHANG Bai-Jiang, ZHANG Li-min, LI Hui, LIU Xi-bin, YANG Jing. Department of Thoracic Surgery , Shandong tumor Hospital & Institute , Jinan 250117, China

【机构】 山东省肿瘤医院胸外科；

【摘要】 目的为了改善食管癌、贲门癌患者的生存质量,提高食管癌的冷冻及手术切除后的5 年生存率。方法 1991年6月-1993年12月采用液氮做为致冷剂,用自行设计并制作的食管腔内软管冷冻探头,在内镜引导下进行25例食管腔内冷冻后行手术切除。2004年1月-2004年4 月采用CO2做为致冷剂,应用JT冷冻治疗机对30例原发性食管癌患者术前先行腔内冷冻治疗,手术切除后再行病理学检查。结果 JT冷冻治疗机组经术前冷冻后短期观察,进食缓解率63．3％ (19／30),术后病理学检查:部分癌细胞坏死,淋巴结呈滤泡增生反应。免疫功能检测CD8冷冻后为 30．92％,低于冷冻前的34．98％,差异有显著性(P<0．05)。食管腔内冷冻后行手术切除术后1、3、 5、10年生存率分别为92％、76％、56％和36％,而对照组1、3、5、10年生存率分别为80％、40％、 28％和12％,3、5、10年生存率比较具有统计学意义。结论冷冻治疗不仅可造成癌细胞或正常组织的坏死、脱落,从而达到缓解食管、贲门癌梗阻的目的,同时还可提高患者的免疫功能和5年和10 年生存率,治疗效果良好,为食管癌的综合治疗开辟了一条新的途径。更多还原

【Abstract】 Objective To improve the impact of palliative management of malignant dysphagia on quality of life(QOL) of the patients with esophageal carcinoma and five years survival rates of postoperative patients with esophageal cancer. Methods Group 1, with cryotherapeutic instrument using liquid nitrogen as cryogen and self-designed flexible cryoprobes, 25 cases were received en-doscopy- guided intracavity cryotherapy of esophagus. Group 2, with JT type cryotherapeutic instrument using carbon dioxide as cryogen, after receiving endoscopy- guided intracavity cryotherapy of esophagus plus surgical resection, light and electron microscopy were used to observe changes of pathologic configuration in 30 patients with primary esophageal carcinoma. Results the symptom of the dysphagia were attained immediate amelioration in 19 patients(63. 3%) of Group 2; Histological examination showed necrosis of cancer cells and tissue degeneration and follicular hyperplasia was the main manifestation in the regional lymph nodes. Immune function test showed the index of CD8 in the post - cryotherapy group were 30. 92% , statistically significant lower than 34. 98% of the pre-cryotherapy. The follow-up of treatment group in 25 cases receiving cryotherapy plus traditional surgery, 1-,3 - ,5 - ,10 - year survival rates of the treatment were 92%, 76%, 56% and 36%, respectively, and 1-,3-,5-,10 -year survival rates of the control were 80%, 40%, 28% and 12%, respectively, statistically significant difference in survival did exist between groups by the end of 3, 5 and 10 years after the combined therapy. Conclusions Cryotherapy performed by introducing flexible cryoprobes at upper GI endoscopy is a simple technique capable of inducing controlled necrosis of cancer cells and the sloughing of necrotic tissue to attain palliation of dysphagia and anastomotic stricture, and possibly associated development of an immune response, with the improvement of 5-,10 -year survival rates, demonstrated the feasibility and efficacy of promising methods for the treatment of esophageal cancer.更多还原