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肺结核合并重症肌无力误诊为肺癌合并重症肌无力一例

自发性食管破裂的诊断与治疗

摘要： 目的 总结自发性食管破裂的诊治经验, 提高对该病的诊治水平。 方法 回顾性分析我院2000年10月至2008年12月收治的21例自发性食管破裂患者的临床资料，男18例, 女3例；年龄24～59岁，平均年龄40.5岁。行开胸手术治疗19例，其中行食管裂口修补术13例,食管部分切除、食管胃吻合术4例，单纯胸腔清洗引流2例；11例加做空肠造瘘术，8例置放空肠营养管。未行手术而仅行抗感染对症支持治疗2例。 结果 19例开胸手术患者中,痊愈16例(84.21%)，死亡3例，分别因严重纵隔感染中毒性休克、吻合口瘘、纵隔感染各死亡1例；经保守治疗的2例患者均死于严重感染、多器官功能衰竭。随访16例，随访时间3个月～8年，随访期间无明显食管反流和食管狭窄等并发症发生。 结论 自发性食管破裂通过早期、积极、有效的外科治疗，预后良好；术后保证引流通畅、加强营养、预防和控制感染是治疗该病的关键。

肺软骨瘤一例

Diagnosis and Surgical Treatment of Multi-primary Esophageal Carcinoma

Objective To study the diagnosis and surgical treatment of multi-primary esophageal carcinoma. Methods The data of 29 patients of multi-primary esophageal carcinoma were collected .The diagnosis was made by dye-staining through gastroscopy and X-ray examination.Pathological examination after operation was analyzed.Three kinds of operations were used: 22 by radical resection, 5 by partial resection and 2 by surgical exploration. Results Twenty-one patients were diagnosed before operation,8 patients were diagnosed during and after operation. Sixty-seven foci and 6 early stage patients were found. The complications were found in 7 patients.No patient died during operation. Twenty-five patients were followed up. The follow up time was 7-36 months.1-year survival rate 77.8%,3-year survival rate 41.6%. Conclusion Routine X-ray examination of esophagus, and esophageal dye-staining and/or biopsy through endoscopy are important measures for early diagnosis of multi-primary esophageal carcinoma.Prompt surgery is advised.

Expression of CD105 Protein in Esophageal Squamous Cell Carcinoma and It＇s Relationship with P53 Protein

Objective To explore the expression of CD105 protein in esophageal squamous cell carcinoma and it＇s relationship with P53 protein. Methods Using streptavidin biotinperoxidase （SP） method, the expression of CD105 protein and P53 protein in esophageal squamous cell carcinoma were examined in normal esophageal tissues （n=10） and esophageal squamous cell carcinoma tissues（n=86）. Results The expression positive rate of CD105 protein was 74. 4%（64/86） in esophageal squamous cell carcinoma , 0% in normal esophageal epithelium. Expression positive rate of CD105 protein was 66. 1%（37/56） in early stage （stage Ⅰ-Ⅱ ）, 90.0% （27/30） in later stages （stage Ⅲ-Ⅳ ）. The expression of CD105 protein were bly associated with P53 protein（P〈0. 05）. Conclusion CD105 protein may participate in the onset and progression of esophageal squamous cell carcinoma. CD105 protein could he a new diagnostic /therapeutic target in esophageal squamous cell carcinoma.

The Comparative Analysis of Mechanical Suture and Manual Suture in Surgery of Esophageal Carcinoma

Objective To evaluate the effect of mechanical suture in surgery of esophageal carcinoma,Methods Five hundred and sixty-eight cases of esophagogastrostomy and esophagojejunostomy for esophageal and cardiac carcinoma were collected in our hospital between January, 1988 and December, 2002. They were devided into two groups according to the methods of anastomoses, the group by stapler and the group with hand. The incidence of postoperative complications in the two groups was compared. Results The time of esophagogastrostomy, the total operating time, and postoperative fasting time of group by stapler were shorter than those of group with hand （Plt;0. 01）, and there was no statistically difference in the median hospitalized time after operation for two groups. The anastomotic leakage, anastomotic stricture, anastomotic bleeding , incidence of postoperative complications in respiration and circulation and mortality rate of group by stapler were lowed than those of group with hand （2.1%, 1.4%,0%,2.8% and 0.7% vs.6.8%,4.3%,1.4%,16.5% and 2.9%）. There was no statistical difference in the postoperative gastro-esophageal reflux for two groups （P 〉 0.05 ）. Conclusion The median time of esophagogastrostomy and the median operating time by stapler are decreased and the incidence of postoperative complications is decreased.