目的 观察内镜黏膜剥离术（ESD）下治疗早期食管癌的疗效及安全性。 方法 以2009年1月－2012年6月在我院消化内镜中心就诊的患者为研究对象，以内镜黏膜切除术（EMR）为对照，回顾性分析接受ESD和EMR治疗的共75例早期食管癌患者的临床资料，比较两组患者病灶整块切除率、组织学治愈切除率、手术时间及并发症等。 结果 共纳入75例患者，其中41例患者接受ESD治疗，34例接受EMR治疗。ESD和EMR组病灶整块切除率分别为90.2%（37/41）和44.1%（15/34）；治愈切除率分别为78.0%（32/41）和50.0%（17/34），整块切除率（P＜0.001）和治愈切除率（P=0.011）在两组间的分布差异均有统计学意义。ESD组患者手术平均时间（39.5 ± 11.4）min，而EMR组手术平均时间（33.5 ± 18.6）min，但二者之间的差异无统计学意义（P=0.091）。此外，术后延长出血和穿孔等并发症在两组间的分布亦无明显差异。 结论 早期食管癌患者接受ESD治疗可获得更高的整块切除率和组织学治愈切除率。
目的 探讨内镜反转黏膜切除术治疗超低位直肠大型侧向发育型肿瘤的价值。 方法 回顾性分析四川大学华西医院消化内镜中心2010年1月－2011年12月间38例内镜反转黏膜切除术治疗超低位直肠大型侧向发育型肿瘤病变残留、治疗效果。 结果 38例患者，男18例，女20例，年龄8～80岁；病变下缘距肛门齿状线1～4.0 cm24例，侵及齿状线14例。病变大小（按病变最大径分类）：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。病变直径在5.0 cm以下的24例患者，经首次手术治疗肿瘤完整切除，术后2例灶性癌变，追加外科手术；其余22例2个月复查，病变无残留，6个月复查，2例复发，经再次手术病变完整切除。随访1年，全部未见复发，治愈率为100%，无残留。病变直径5.1～7.0 cm的10例患者，经首次手术治疗肿瘤分次切除，2个月复查，6例病变完整切除无残留，6个月复查，其中2例复发，经再次内镜下手术切完病变，随访1年，无复发；另4例有残留，经再次内镜下手术切完病变，6个月复查无复发，随访1年，4例均未见复发。病变直径10 cm 的4例患者，经多次手术后复查均有病变残留，无法完全切除，患者拒绝外科手术。5.1 cm以上病变治愈率71.43%，残留率高达57.14%。本组术后出血16例，感染1例，直肠狭窄1例，肛门坠胀3例，无穿孔发生。 结论 内镜反转黏膜切除术治疗超低位直肠大型侧向发育型肿瘤有效，对5.0 cm以下病变能一次完整切除，5.1 cm以上病变残留率高，需再次内镜下手术，10 cm以上病变切除不完全。应慎重选择病例，术后密切随访。
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
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.
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.
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.