目的 觀察內鏡黏膜剝離術（ESD）下治療早期食管癌的療效及安全性。 方法 以2009年1月－2012年6月在我院消化內鏡中心就診的患者為研究對象，以內鏡黏膜切除術（EMR）為對照，回顧性分析接受ESD和EMR治療的共75例早期食管癌患者的臨床資料，比較兩組患者病灶整塊切除率、組織學治愈切除率、手術時間及并發癥等。 結果 共納入75例患者，其中41例患者接受ESD治療，34例接受EMR治療。ESD和EMR組病灶整塊切除率分別為90.2%（37/41）和44.1%（15/34）；治愈切除率分別為78.0%（32/41）和50.0%（17/34），整塊切除率（P＜0.001）和治愈切除率（P=0.011）在兩組間的分布差異均有統計學意義。ESD組患者手術平均時間（39.5 ± 11.4）min，而EMR組手術平均時間（33.5 ± 18.6）min，但二者之間的差異無統計學意義（P=0.091）。此外，術后延長出血和穿孔等并發癥在兩組間的分布亦無明顯差異。 結論 早期食管癌患者接受ESD治療可獲得更高的整塊切除率和組織學治愈切除率。
Objective To explore the comprehensive treatment of synchronous double cancers of the esophagus and stomach. Methods The treatment procedures of 8 patients with synchronous double cancers of the esophagus andstomach admitted in the Department of Digestive Tumor Surgery of The Hospital of Traditional Chinese Medicine of Jiangsu Province between Oct. 2006 to Feb. 2013 were analyzed. Some experience of comprehensive treatment of synch-ronous double cancers of the esophagus and stomach was explored. Results Eight cases of synchronous double cancers of the esophagus and stomach were all diagnosed by endoscopic biopsy. According to the results of CT and endoscopic ultrasonography assessment， lesions which were staged earlier than T1a were cured by endoscopic mucosal resection（6 cases， including 4 cases of esophagus cancer and 2 cases of gastric cancer）， and resection operation （1 cases of esop-hagus cancer）. The lesions staged later than T2 were treated by preoperative neoadjuvant chemoradiation， surgery， and adjuvant chemoradiation after operation （8 cases， including 2 cases of esophagus cancer and 6 cases of gastric cancer）， and simple operation （1 case）. Eight patients had been followed-up for 10-76 months （averaged 41.3 months）. Six patients survived without recurrence and metastasis during the followed-up， 1 patient died in 7 months after operation， and 1 patient relapsed in 20 months after operation. Conclusions Individually designed comprehensive treatment using neo-chemotherapy， intervention chemotherapy， radio-chemotherapy， radical resction surgery， adjuvant chemotherapy， and endoscopic mucosal resection can treat synchronous double cancers of the esophagus and stomach effectively. Impr-actical pursuit for radical surgery will not result in good prognosis
Gastroesophageal reflux disease (GERD) is a common, chronic disease of the digestive system. In recent years, endoluminal therapy for GERD has become a research hotspot. The reduced anti-reflux barrier function plays an important role in the occurrence of GERD. Peroral endoscopic therapy can improve the defect of anti-reflux barrier function. According to the involved layers, the endoscopic therapy can be classified as transmural which represented by transoral incisionless and transoral incisionless fundoplication, and non-transmural which represented by peroral endoscopic cardia constriction and radiofrequency ablation. This article reviews the progress of endoscopic non-full-thickness therapy for GERD in recent years, and introduces the action mechanism of peroral endoscopic therapy of GERD, the therapy of the mucosal layer and muscle layer of anti-reflux barrier, and other treatments. The purpose is to provide a reference for further exploring suitable endoscopic treatment of GERD.
ObjectiveTo summarize the research progress of functional surgery in upper and middle gastric cancer.Method" functional gastric surgery” " pylorus-preserving gastrectomy” and " proximal gastrectomy” were used as search terms to retrieve the literatures, and various surgical methods and their application status were reviewed.ResultsFunctional gastric surgery can effectively improve the postoperative quality of life of patients with early gastric cancer in the upper and middle stomach.ConclusionFunctional gastric surgery is a feasible surgical method for early gastric cancer.
目的 探討內鏡反轉黏膜切除術治療超低位直腸大型側向發育型腫瘤的價值。 方法 回顧性分析四川大學華西醫院消化內鏡中心2010年1月－2011年12月間38例內鏡反轉黏膜切除術治療超低位直腸大型側向發育型腫瘤病變殘留、治療效果。 結果 38例患者，男18例，女20例，年齡8～80歲；病變下緣距肛門齒狀線1～4.0 cm24例，侵及齒狀線14例。病變大小（按病變最大徑分類）：1.5～3.0 cm 12例，3.1～4.0 cm 8例，4.1～5.0 cm4例，5.1～7.0 cm 10例，10 cm 4例。病變直徑在5.0 cm以下的24例患者，經首次手術治療腫瘤完整切除，術后2例灶性癌變，追加外科手術；其余22例2個月復查，病變無殘留，6個月復查，2例復發，經再次手術病變完整切除。隨訪1年，全部未見復發，治愈率為100%，無殘留。病變直徑5.1～7.0 cm的10例患者，經首次手術治療腫瘤分次切除，2個月復查，6例病變完整切除無殘留，6個月復查，其中2例復發，經再次內鏡下手術切完病變，隨訪1年，無復發；另4例有殘留，經再次內鏡下手術切完病變，6個月復查無復發，隨訪1年，4例均未見復發。病變直徑10 cm 的4例患者，經多次手術后復查均有病變殘留，無法完全切除，患者拒絕外科手術。5.1 cm以上病變治愈率71.43%，殘留率高達57.14%。本組術后出血16例，感染1例，直腸狹窄1例，肛門墜脹3例，無穿孔發生。 結論 內鏡反轉黏膜切除術治療超低位直腸大型側向發育型腫瘤有效，對5.0 cm以下病變能一次完整切除，5.1 cm以上病變殘留率高，需再次內鏡下手術，10 cm以上病變切除不完全。應慎重選擇病例，術后密切隨訪。
Objective To compare the clinical effect of tissue selecting therapy stapler (TST) and procedure for prolapse and hemorrhoids (PPH) in treatment of hemorrhoid in Ⅲ-Ⅳ degree. Methods Clinical data of 80 cases of hemorrhoid in Ⅲ-Ⅳ degree who treated in The First Affiliated Hospital of Harbin Medical University from May 2015 to July 2015 were retrospectively collected. All the 80 cases were divided into TST group (n=40) and PPH group (n=40) according to the surgical types. The comparison of the clinical effect of 2 groups was performed. Results The operative time, hospital stay, intraoperative blood loss, anal fall bilge feeling score, postoperative pain score at 3 time points, and the incidence of anal secretions of TST group were lower or shorter than those corresponding indexes of PPH group (P<0.05). But there was no significant difference in cure rate, the incidence of urinary retention, the incidence of anal stenosis, the incidence of intractable pain, and satisfaction situation between the 2 groups (P>0.05). All of the cases were followed up for 3 months, during the follow-up period, no one suffered from rectal vaginal fistula, fecal incontinence, and recurrence. Conclusion TST and PPH both have satisfactory effect in treatment of hemorrhoid in Ⅲ-Ⅳ degree, but TST has advan- tages of less blood loss, shorter operative time, rapid postoperative recovery, and less pain.