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Esophageal carcinoma

Esophageal carcinoma. Dept. of thoracic and cardiovascular sir run run shaw hospital, collage of medicine zhejiang university xuheyun. 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。

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Esophageal carcinoma

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  1. Esophageal carcinoma Dept. of thoracic and cardiovascular sir run run shaw hospital, collage of medicine zhejiang university xuheyun

  2. 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》

  3. 关于食道解剖的几个特点 • 管状消化器官，有主动功能 • 全长28~30cm，起始于距门齿15cm处 • 分三段，位置不同，处理原则不同 • 血管供应：有三个来源，但没有很粗的固有动脉， • 粘膜、粘膜下、肌层淋巴管丰富 • 邻近重要器官比较多

  4. 病理类型与转移 • 鳞癌多见，腺癌少见（ Barrett's Esophagus），其他类型：神经内分泌癌、肉瘤等罕见 • 多中心型 • 大体类型不同，临床表现不同 • 以直接侵润、淋巴转移多见，晚期血行转移

  5. 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.

  6. 病理分期 • 中国分期（1976年） • 国际抗癌联盟食道癌TMN分期

  7. 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

  8. 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

  9. N: Regional Lymph Nodes N0 ：No regional lymph node metastasisN1： Regional lymph node metastasis M: Distant Metastasis M0 ：No distant metastasisM1 ：Distant metastasis

  10. Diagnosis

  11. Symptom Patients with Symptom (%) Dysphagia吞咽困难 87-95 Weight Loss 42-71 Vomiting orRegurgitation 29-45 Pain 20-46 Cough or Hoarseness嘶哑 7-26 Cachexia（恶病质） ~6 Dyspnea（呼吸困难） ~5

  12. 常用的检查手段 Barium swallow（吞钡造影） Esophagoscopy （食道镜） Chest radiograph Computed tomography (CT) scan. MRI Brush cytology毛刷细胞学检查

  13. 进一步的检查以明确是否能手术 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

  14. 鉴别诊断 • 食道炎 • 贲门失驰缓症 • 食道平滑肌瘤 • 食道憩室 • 食道静脉曲张

  15. Treatment Esophagectomy 食管切除术 Palliative treatment 姑息疗法 External beam radiation 外放疗 Intracavitary radiation 内放疗 Laser therapy 激光治疗 Photodynamic therapy 光动力治疗 Stents 支架

  16. 手术适应症： • 病人能否耐受手术？ • 肿瘤能否切除？ • 病人能否得利？ • 手术原则： • 根治性手术应尽量多切除食道，重建消化道（胃、空肠、结肠） • 姑息治疗应尽量选择创伤小的手术

  17. 三切口食道癌根治术

  18. 二切口食道癌根治术 Ivor Lewis

  19. 左剖胸食道癌根治术

  20. 不开胸食道癌切除术 食道床经路 胸骨后经路

  21. 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

  22. 食道支架

  23. 术后 术前

  24. Complication手术并发症 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

  25. 结果与预后

  26. (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

  27. 关于食道癌的几个常识性问题 • 在中国这是一个很重要的疾病 • 流行病学：呈区域性分布，发病率相差悬殊，男性多于女性。 • 致病因素：物理、化学、生物、遗传 • 治疗效果不令人满意。

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