Download - Esophageal carcinoma
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Esophageal carcinoma
Dept. of thoracic and cardiovascular sir run run shaw hospital, collage of medicine
zhejiang university
xuheyun
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中国奇人倒立 照样大吃大喝 (葫芦岛讯)中国东北葫芦
岛有一个奇人,能倒立吃饭喝水和唱歌。
这个奇人为 41 岁的张凤民,是兴城市公安局碱厂乡派出所干警,身高 1.72 米,体重约 80 公斤,身强体壮。
他说,他小时爱看武打小说和录像,受到其影响,学着练习倒立。高中期间练过武术,久而久之,倒立时间越来越长,有时感觉口渴了,就让家人拿过来一瓶啤酒,打开后就一口气喝了下去;有时饿了,随手拿过吃的东西就往嘴里塞。
张凤民还可以变换三种不同的姿势,即 10 指倒立,手掌倒立和头顶倒立。
《联合晚报》
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•管状消化器官,有主动功能管状消化器官,有主动功能•全长全长 28~30cm28~30cm ,起始于距门齿,起始于距门齿 15cm15cm 处处•分三段,位置不同,处理原则不同分三段,位置不同,处理原则不同•血管供应:有三个来源,但没有很粗的固血管供应:有三个来源,但没有很粗的固有动脉,有动脉,•粘膜、粘膜下、肌层淋巴管丰富粘膜、粘膜下、肌层淋巴管丰富•邻近重要器官比较多邻近重要器官比较多
关于食道解剖的几个特点关于食道解剖的几个特点
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病理类型与转移病理类型与转移
•鳞癌多见,腺癌少见( 鳞癌多见,腺癌少见( Barrett's Esophagus ),其他类型:神经内分泌癌、),其他类型:神经内分泌癌、肉瘤等罕见肉瘤等罕见•多中心型多中心型•大体类型不同,临床表现不同大体类型不同,临床表现不同•以直接侵润、淋巴转移多见,晚期血以直接侵润、淋巴转移多见,晚期血行转移行转移
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Barrett's EsophagusIt is a condition where metaplastic化生的 columnar epithelium replaces the distal squamous mucosa due to prolonged exposure of the distal esophageal mucosa to gastroesophageal reflux. Recurrent long-term reflux results in inflammation and ulceration of the squamous mucosa. Increased exposure to alkaline secretions from the duodenum and acidic secretions from the stomach act to convert the mucosa.
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病理分期病理分期
•中国分期(中国分期( 19761976 年)年)•国际抗癌联盟食道癌国际抗癌联盟食道癌 TMNTMN 分期分期
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TNM Classification of Esophageal Carcinomas
T: Primary Tumor
T0 : No evidence of a primary tumorTis : Carcinoma-in-situ (High-grade dysplasia)T1 : The tumor invades the lamina propria, muscularis mucosae, or submucosa but does not breach the boundary between the submucosa and muscularis propria
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T2 : The tumor invades the muscularis propria but does not breach the boundary between the muscularis propria and periesophageal tissueT3 : The tumor invades the periesophageal tissue but does not invade adjacent structuresT4 : The tumor invades adjacent structures
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N: Regional Lymph Nodes N0 : No regional lymph node metastasisN1 : Regional lymph node metastasis M: Distant Metastasis M0 : No distant metastasisM1 : Distant metastasis
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Diagnosis
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Symptom Patients with Symptom (%)
Dysphagia吞咽困难 87-95
Weight Loss 42-71Vomiting or Regurgitation
29-45
Pain 20-46Cough or Hoarseness嘶哑 7-26
Cachexia (恶病质) ~6Dyspnea (呼吸困难)
~5
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Barium swallow (吞钡造影)Esophagoscopy (食道镜)Chest radiograph Computed tomography (CT) scan.MRIBrush cytology 毛刷细胞学检查
常用的检查手段
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Endoscopic ultrasound (EUS) 超声内镜
Laryngoscopy 喉镜检查
Bronchoscopy 支气管镜检查
Bone and upper abdomen for metastasizing tumors
进一步的检查以明确是否能手术
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鉴别诊断鉴别诊断
•食道炎食道炎•贲门失驰缓症贲门失驰缓症•食道平滑肌瘤食道平滑肌瘤•食道憩室食道憩室•食道静脉曲张食道静脉曲张
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Esophagectomy Esophagectomy 食管切除术食管切除术Palliative treatment Palliative treatment 姑息疗法姑息疗法External beam radiation External beam radiation 外放疗外放疗Intracavitary radiation Intracavitary radiation 内放疗内放疗Laser therapy Laser therapy 激光治疗激光治疗Photodynamic therapy Photodynamic therapy 光动力治疗光动力治疗Stents Stents 支架支架
TreatmentTreatment
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手术适应症:手术适应症:
病人能否耐受手术?病人能否耐受手术?
肿瘤能否切除?肿瘤能否切除?
病人能否得利?病人能否得利?
手术原则:手术原则:
根治性手术应尽量多切除食道,重建根治性手术应尽量多切除食道,重建消化道(胃、空肠、结肠)消化道(胃、空肠、结肠)
姑息治疗应尽量选择创伤小的手术姑息治疗应尽量选择创伤小的手术
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三切口食道癌根治术三切口食道癌根治术
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二切口食道二切口食道癌根治术癌根治术
Ivor LewisIvor Lewis
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左剖胸食道癌左剖胸食道癌根治术根治术
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不开胸食道癌切除术 食道床经路 胸骨后经路 不开胸食道癌切除术 食道床经路 胸骨后经路
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胸腔镜在食管癌治疗中的应用
游离胃 + 开胸手术全腔镜食管癌根治术
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食道支架食道支架
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术前术前
术后术后
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Anastomotic leak吻合口漏Chylothorax(chylopleura)乳糜胸Constriction of stoma吻合口狭窄Reflux 返流Respiratory complication呼吸系并发症
Complication 手术并发症手术并发症
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结果与预后结果与预后
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(1996) (1994) (1986) (1997) (1993)
I 50% 18% 55% 50.3% 50.8%
IIA 38% 14% 15% 22.5% 37.5%
IIB 6% 27% 22.5% 16.2%
III 10% 4% 6% 16.7% 13.6%
IV 2% 0% 0%
Correlation of 5 Year Survival and
Stage of Esophageal Cancer
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•在中国这是一个很重要的疾病在中国这是一个很重要的疾病•流行病学:呈区域性分布,发病率相流行病学:呈区域性分布,发病率相差悬殊,男性多于女性。差悬殊,男性多于女性。•致病因素:物理、化学、生物、遗传致病因素:物理、化学、生物、遗传•治疗效果不令人满意。治疗效果不令人满意。
关于食道癌的几个常识性问题关于食道癌的几个常识性问题
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