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外科治疗Barrett食管一例

同种异体主动脉片修补犬食管缺损的实验研究

目的寻找临床中实用、安全有效、制作简便的食管修复材料或食管替代物。方法在无菌条件下手术切取犬降主动脉,制作成2cm×3cm的主动脉片低温保存;将3只成年健康杂种犬经手术制造颈段食管壁缺损,用预先低温保存的同种异体犬主动脉片修补缺损。结果动物全部存活,新生食管壁具有正常食管的各层结构和功能,局部管腔无狭窄,进食正常,术后无严重急性排斥反应。结论同种异体主动脉片可以诱导自体食管壁新生,用于食管壁缺损的修补。

血管内皮细胞生长因子在食管癌中的表达及意义

目的 探讨食管癌血管内皮细胞生长因子(VEGF) 表达及其与肿瘤血管新生和病理学特点的关系。方法 对40例手术切除的原发性食管癌标本进行免疫组织化学染色，确定其VEGF的表达及微血管密度。结果 40例食管癌患者中27例VEGF蛋白表达阳性，阳性率为67.5%，微血管密度在食管癌VEGF表达阴性、弱阳性和强阳性者间比较差别具有显著性意义(Plt;0.05)，有淋巴结转移者VEGF表达阳性率较无淋巴结转移者明显增高（Plt;0.01）。结论 食管癌VEGF表达水平与肿瘤血管新生强度、淋巴结转移有密切关系。

PRESERVATIVE MEASURES FOR BLOOD SUPPLY TO JEJUNAL SEGMENT IN RECONSTRUCTION OF ESOPHAGUS

OBJECTIVE: To study the effective protective measures to ensure sufficient blood supply to the jejunal segment in reconstruction of esophagus. METHODS: According to evidence based on medicine, we analyzed retrospectively 69 patients (48 cicatricial stenosis due to chemical burn, 21 defects due to excision of esophagus cancer), whose esophagus were reconstructed with free jejunal graft(in 28 cases) and with pedicle jejunal graft (in 41 cases) from 1980 to 2001. RESULTS: All patients were followed up for 1-21 years. Of 43 patients treated before 1996, 5 complicated by anastomotic leakage, 1 by strangulated intestinal obstruction; of 26 patients treated after 1996 (6 with free jejunal graft, 20 with pedicle jejunal graft), only one case complicated by anastomotic leakage. CONCLUSION: The preservative measures for good blood supply to the jejunal segment include the following aspects: (1) complete marginal vascular arcade without tension in the mesojejunum; (2) vessel anastomosis smooth; (3) 4-finger width pathway of jejunum; (4) the stable arterial blood pressure (more than 8 kPa); (5) a single-row anastomosis; and (6) the comprehensive preoperative management.