日本気管食道科学会会報
Online ISSN : 1880-6848
Print ISSN : 0029-0645
ISSN-L : 0029-0645
31 巻, 3 号
選択された号の論文の11件中1~11を表示しています
  • 遠藤 光夫, 木下 祐宏, 山田 明義, 鈴木 茂, 井手 博子, 吉田 操, 林 恒男
    1980 年 31 巻 3 号 p. 199-205
    発行日: 1980/06/10
    公開日: 2010/02/22
    ジャーナル フリー
    One thousand, six hundred and twenty-seven cases of the esophageal cancer have been admitted to our hospital for these fourteen years. The resection of the esophagus was performed in 846 cases (52%). Another surgical procedures were performed in 490 cases and no surgical treatment was carried out in the remaining cases. Considering the long-term-survival rate, 5-year-survival rate of the resected cases was 22%, otherwise, that of the non-resected cases was 1% even if the radical irradiation was performed. Till the end of last year, the thoracic esophageal cancers have been resected in 868 cases in our hospital. The operative mortality rate was 4.5%.
    The operation of the thoracic esophageal cancer is usually constituted of the subtotal resection of the thoracic esophagus with the systemic cleaning of the lymphnodes and the reconstruction of the esophagus using stomach, colon and small intestine. As the reconstruction of the esophagus, ante-thoracic esophagogastrostomy (Nakayama's method) was performed most frequently in our hospital. This had many advantages, otherwise to improve the sole disadvantage, high incidence of suture insufficiency, some modified operative techniques have been applied.
    The 10-year-survival rate after operation was 13%. From the analysis of the 10-year-survival rate, the patients with cancers less than 6cm in size on X-ray film, of which invasion revealed within the muscular layer, with no lymphnode involvement, being resected curatively and of histologically well differentiated type, had superiority in long-term survival.
    To obtain better results in the long-term survival, it is important to find out early cancer of the esophagus. The early esophageal cancer was defined as the cancer of which infiltration was limited in the submucosa without any metastasis. Twenty-eight cases of early esophageal cancer was operated in our hospital for these fourteen years. These were 3.5% of the cancer cases of total esophageal resections. The 5-year-survival rate of the early esophageal cancer was 64%. As for the diagnostic procedures, esophagoscopy was more advisable for discovery of the erosive type of cancer. Mucosal cancer was seen in 3 of 28 cases. All mucosal cancers revealed endoscopically erosive types. So X-ray examination and esophagoscopy are necessary to find out tiny and erosive lesions of the esophagus in screening examination. The endoscopic dye method using 2% toluidine blue solution and 3% Lugol solution, was advisable to detect the mucosal and intraepithelial cancer. The extent of the intraepithelial invasion of cancer and the tiny accessory lesions could be clearly demarcated by this method.
    In this report the present state of surgical treatment of the thoracic esophageal cancer and the diagnosis of early cancer are presented. The purpose of the surgery of thoracic esophageal cancer is placed not only for decrease of the mortality rate, but also for improvement of the long-term-survival rate after operation.
  • 熊谷 義也, 幕内 博康, 藤田 博正
    1980 年 31 巻 3 号 p. 206-212
    発行日: 1980/06/10
    公開日: 2010/02/22
    ジャーナル フリー
    Since 1964, 597 patients with esophageal cancer have been examined by the fiberoptic esophagoscope at our center.
    Since 1973, as a result of recent advance in fiberoptic esophagoscopy, some new diagnostic techniques have been elaborated, which are as follows; Lugol solution spreading method, clipmarking method, tattooing method, intraluminal U-turn technique, and boring biopsy.
    Since 1973, 240 cases have been examined by these new endoscopical techniques for the diagnosis of esophageal cancer.
    Lugol solution spreading method is an application of Shiller's method which had first been used in the field of gynecology. This method is very useful for discerning the existance of intraepithelial cancer. Iodine stains normal epithelium into a brownish colour, but the epithelium replaced by cancer cells is not stained because it lacks glycogen.
    Nowadays using these new techniques, a-factor (depth of cancer invasion) and n-factor (tendency of metastasis or malignancy) are able to be determined before treatment.
    A-factor is determined by calculation of length of the tumor, degree of circular invasion and “submerging rate”.
    The clinical characteristics of malignancy of esophageal cancer are obtained by integrating the following five factors; the form of the margin, intraepithelial invasion, diffuse invasion into lamina propria or submucosal layer, skipping metastasis, and type of invasion.
    The malignancy of esophageal cancer is expressed as the diagnostic malignant point. The relationship between the diagnostic malignant point and survival period after successful treatment of esophageal cancer was discussed in our patients. These were divided into three groups; the highly malignant group, the intermediate group, and the least malignant group. In the highly malignant group, no patient survived more than one year after treatment. A new treatment needs to be developed for patients in this group.
    All of those who survived more than one year belonged to the least malignant group.
  • 植松 貞夫, 磯野 可一, 竜 崇正, 渡辺 義二, 古川 隆男, 石川 達雄, 今園 修, 菊地 俊之, 佐藤 博
    1980 年 31 巻 3 号 p. 213-218
    発行日: 1980/06/10
    公開日: 2010/02/22
    ジャーナル フリー
    In this paper, clinical investigations of A3 esophageal cancer are discussed with regard to the radiological findings, surgical findings, effects of the preoperative combined chemo-and radiotherapy and prognosis.
    Radiological findings of the A3 esophageal cancer were recognized by irregularity, roughness, penetration and perforation of the esophageal wall, stenosis, bending and elevation of the esophagus at and around the lesions. Surgical exploration proved that A3 esophageal cancer invaded into the neighboring organs such as aorta, lung, trachea, diaphragm and pericardium. Among them the aorta was most frequently involved. The effects of preoperative combined therapy on the A3 esophageal cancer could not be expected. The prognosis of the A3 esophageal cancer was not good compared with A0-2 cancer. In order to improve the prognosis, preoperative and postoperative combined chemo-and radiotherapy and complete resection of esophageal lesions with invaded neighboring structures should be performed.
  • 福田 敬宏, 田島 昭三, 松本 満臣, 境野 宏治, 牧野 総太郎, 松浦 鎮
    1980 年 31 巻 3 号 p. 219-222
    発行日: 1980/06/10
    公開日: 2010/02/22
    ジャーナル フリー
    A case is presented of carcinoma of esophagus which developed in the site of chronic stricture caused by ingestion of a hydrochloric acid twenty-nine years previously. Esophagectomy was performed while carcinoma was still confined to the submucosal layer of the strictured esophagus. Twelve months after the operation, the patient has no evidence of recurrence. Carcinoma of the esophagus engrafted on corrosive stricture has rarely been noted. The incidence of carcinoma of the esophagus among patients with chronic esophageal strictures due to ingestion of corrosive is significantly higher than that in the general population. Diagnosis of carcinoma in these patients is often delayed, since the symptoms are blamed on corrosive stricture. However, our case revealed that carcinoma developed at the site of corrosive strictore was more apt to induce luminal obstruction before development of extrinsic spread. Therefore, some changes of dysphagia in patients with corrosive stricture should lead to thorough esophagoscopic and esophagographic examination. Histopathological examination of resected specimens from the present case revealed that a dense scar tissue in the corrosive stricture prevented early invasion of carcinoma into adjacent muscular layer of the esophageal wall. The incidence of malignant transformation of corrosive stricture does not warrant esophageal resection. However, in cases where some surgical intervention to relieve the stricture should need. resection of the esophagus with reconstruction seems to be a wiser choice than a by-pass procedure for preventing the later development of carcinoma.
  • 谷島 貴志子, 岩村 忍
    1980 年 31 巻 3 号 p. 223-227
    発行日: 1980/06/10
    公開日: 2010/02/22
    ジャーナル フリー
    It is strongly emphasized in this paper that every laryngologist should suspect presence of esophageal carcinoma whenever clinical diagnosis of recurrent laryngeal nerve paralysis was made. One hundred and thirty-eight cases with chief complaints of hoarseness were diagnosed as unilateral recurrent laryngeal nerve paralysis at the Department of Otolaryngology, Mitsui Memorial Hospital. Those investigations were carried out over the periods of recent 6 years. Among them, 4 cases with unilateral recurrent laryngeal nerve paralysis were found to present esophageal carcinoma of either cervical or thoracic portion. Those 4 cases commonly did not show any type of dysphagic problem throughout their clinical courses. Only problem they disclosed at the time of initial visiting our clinic was hoarseness rather than dysphagia.
    The recurrent laryngeal nerve is located anatomically close to the esophagus so that if carcinoma of the esophagus develops externally outside the esophagus to involve the recurrent laryngeal nerve, hoarseness may be the earliest symptom to suggest presence of esophageal carcinoma. On the contrary, if carcinoma of the esophagus grows internally inside the esophageal tract, dysphagia may be a starting symptom. All 4 cases we experienced in our institution revealed carcinoma of the esophagus extending outside it to paralyze the recurrent laryngeal nerve. Cobalt therapy was provided for 3 cases of them. Complete recovery of paralyzed vocal cord was noted in 1 case whose carcinoma was located in the limited area of pyriformis sinus. However, other 1 case resulted in no recovery of paralyzed vocal cord even on the process of radiotherapy. Among remaining two cases, one was lost for follow-up and the other was surgically treated in terms of total laryngoesophagectomy with permanent creation of tracheostoma.
  • 村上 泰, 原口 茂徳, 岡田 康司, 安藤 真姿子, 丸山 毅, 小堀 正
    1980 年 31 巻 3 号 p. 228-237
    発行日: 1980/06/10
    公開日: 2010/02/22
    ジャーナル フリー
    Technical details of a primary reconstruction of the cervical esophagus using pectoralis major myocutaneous island flap were discussed with some clinical case reports. Versatility of this flap was stressed along with some shortcomings, being compared with DP skin flap. Conclusions are as follows;
    1. Pectoralis major myocutaneous island flap is good enough to reconstruct the cervical esophagus after removing extensive cancer in the hypopharynx.
    2. Patients can begin to swallow in 19th postoperative day on the average, which is much shorter than 53rd in patients with DP skin flap.
    3. Delay procedure is unnecessary in every case.
    4. Thoracoacromial artery runs down on the anterior chest wall so in constant position that the designing of the flap is technically easy.
    5. Postoperative care is extremely simple.
    6. There may be no danger of flap necrosis and resultant stenosis.
    7. The flap may not be indicated for a woman with a buxom breast.
    8. The flap may not be indicated for a woman with a thick subdermal adipose tissue.
  • 自験例2例と本邦報告例の集計
    幕内 博康, 中崎 久雄, 三富 利夫, 熊谷 義也, 山崎 栄龍, 掛川 暉夫, 田中 幸房, 笠原 正男
    1980 年 31 巻 3 号 p. 238-245
    発行日: 1980/06/10
    公開日: 2010/02/22
    ジャーナル フリー
    There are 250 cases of double cancer of the esophagus and the stomach reported in Japan by 1978. However, few have reported carcinoma arising from the reconstructed stomach tube after radical operation for esophageal cancers.
    We have come across two such cases. One was a IIa type early stomach cancer, 1.0×0.6cm in diameter, discovered by follow-up endoscopic examination 2 years and 2 months after radical operation for esophageal cancer. The other was a Borrmann III type stomach cancer discovered 11 years after esophageal resection and was treated by resection of the stomach tube and esophago-colo-duodenostomy using midsternotomy.
    Sixteen such cases reported in Japan, including our two, are reviewed and summarized.
  • 平出 文久, 井上 鉄三, 都川 紀正, 椿 康喜代, 沢田 政道, 田中 英一
    1980 年 31 巻 3 号 p. 246-252
    発行日: 1980/06/10
    公開日: 2010/02/22
    ジャーナル フリー
    Cryosurgery is gaining more and more importance as a therapeutic modality within the field of head and neck surgery.
    Cryosurgery was performed in two patients with hemangioma arising from the entrance of the esophagus.
    Case 1: A 41-year-old woman was referred for the diagnosis of hemangioma in the entrance of the esophagus which had been present for approximately five years. The patient felt slight pain on deglutition and sometimes noticed hemoptysis. The lesion was treated with cryoapplication of -60°C on its surface through the direct laryngoscope under general anesthesia. Cryoapplications were repeated by overlapping frozen areas during treatment. The duration of the individual freezing cycles ranged from one and half to three minutes. Over a period of 3 weeks the patient received 2 cryosurgical treatments. Postoperative healing was uneventful. After 3 weeks following 2nd cryosurgery the lesion disappeared without leaving a remarkable scar. No recurrence was noted after one-year follow-up.
    Case 2: A 54-year-old man was admitted to the hospital with a history of foreign body sensation in the throat. Endoscopic examination revealed a dark, blue swelling in the entrance of the esophagus, suggesting a hemangioma. The lesion was frozen in three applications of -60°C each time. The frozen region was overlapped to compass the entire tumor. After thawing the frozen areas began to swell. In 24 hours it was almost twice of its original size. Then the necrotic tissue was well demarcated from vital tissue and on the seventh postoperative day the brownish lump exfoliated and showed a persistent smaller tumor. Total regression of the hemangioma and overgrowth of normal mucosa followed with a satisfactory functional result. No further growth was observed after six-month follow-up.
    The general treatment of the hemangioma in the larynx, hypopharynx and esophagus was briefly discussed.
  • 田中 隆, 虎渓 邦孝, 武谷 克重, 安広 矩明, 河口 忠彦, 村山 公, 坂部 孝
    1980 年 31 巻 3 号 p. 253-258
    発行日: 1980/06/10
    公開日: 2010/02/22
    ジャーナル フリー
    We have encountered 74 cases of esophageal achalasia in the past 15 years at our clinic.
    From X-ray findings, esophageal internal pressure curves and clinical symptoms, 5 cases were diagnosed as vigorous achalasia.
    According to the X-ray classification, 3 cases belonged to the spindle type grade II, one case the flask type grade II and one case the flask type grade III.
    On the internal pressure curves, all cases were of the spasmus type (type A).
    All these cases complained of esophageal pain as spasmodic symptom in addition to the difficulty in swallowing and had received various treatments as other diseases not related to the esophagus.
    As for the treatment, cardioplasty modified of Girard's method was performed on four cases, and additionally high truncal vagotomy was performed on two of them to obtain satisfactory results.
  • 桑原 英眞
    1980 年 31 巻 3 号 p. 259-267
    発行日: 1980/06/10
    公開日: 2010/02/22
    ジャーナル フリー
    The distribution and localization of endogenous peroxidase activity in the tracheobronchial epithelium of guinea pigs were investigated with both light and electron microscopes using a cytochemical procedure of the diaminobenzidine-H2O2 method after Graham and Karnovsky. Male guinea pigs were used at the following time-intervals after birth; 2 days, 4 days, 2 weeks, 1 month, 2 months and 6 months to 2 years
    The following results are obtained;
    1) Goblet cells in the tracheobronchial epithelium were cytochemically subdivided into two types of cells, that is, the peroxidase-positive cells and the peroxidase-negative cells. Both types of cells were provided with mucous granules. They independently possess the complete secretory function.
    2) The peroxidase-positive goblet cells were characterized by the presence of reaction product in the r-ER, perinuclear space and some of the Golgi complexes. However, no reaction product was discernible in the entire cytoplasm of the peroxidase-negative cells.
    3) The peroxidase-positive goblet cells increased with an inverse relation to the peroxidase-negative goblet cells as the animals grew older. Most of the goblet cells in the main bronchi of 2 to 4-day-old guinea pigs were peroxidase-negative, whereas nearly all of the goblet cells of 6 month to 2-year-old guinea pigs were positive.
    4) The peroxidase-positive goblet cells appeared to be more dominant in the upper trachea than in the main bronchi.
    5) Reaction product localized in the r-ER, s-ER, perinuclear space and the Golgi complex was also noted in the ciliated cells. Ciliated cells with cytochemical reaction product were consistently distributed throughout the epithelium of the lower respiratory tract.
    6) The peroxidase activity in the goblet cells and ciliated cells was clearly inhibited with 0.02M 3-amino-1, 2, 4-triazole or 0.02M potassium cyanide.
  • 橋本 紘治, 山地 誠一, 寺山 吉彦
    1980 年 31 巻 3 号 p. 269-276
    発行日: 1980/06/10
    公開日: 2010/02/22
    ジャーナル フリー
    The long-term use of a conventional tracheal cannula for patients with stenosis of the upper respiratory tract carries many problems; injury to the tracheal wall. inducement of the cough reflex, difficulty in keeping it clean and necessity for regular exchanges, etc.
    On the other hand, a permanent tracheal fenestration sometimes ends in unsatisfactory result because of dyspnea due to stenosis of the stoma.
    The authors developed a new simple device, a cuff button-like cannula, to secure the tracheal stoma for a long time. This device made of the bridged dimethylpolysiloxan (DMPS) is harmless for human tissues and shaped like a cuff button.
    As this cuff button-like cannula is flexible and elastic, it is easy to insert and also to remove. When patients keeping vocal function a speech valve can be attached to this cannula.
    Up to now we used this device in 9 cases without any troubles; one of them could go to school again and some have been back to their jobs.
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