消化學-- 食道疾病
 
 

Diseases of the Esohagus

                                Clinical manifestication: ( 略 )
                                Diagnostic aid:               ( 略 )
                               Causal factors: hot food ( 辣 ), alcohol beverage, poor dental hygiene etc.

Malignant Tumor - Upper Part  : more often in woman, an etiologic relationship between a carcinoma 

                                               of the mouth of esophagus and a chronic hypopharyngitis seems to
                                               exist, and Plummer-Vinson syndrome is also suggestive of some
                                               association. Dysphagia, hoarsness, otalgia and frequent choking.

Malignant Tumor - Midportion : More than 1/3 of esophageal cancer found here, 2 types
                                               predominante here ( exophytic or proliferative; & ulcerating or infiltrating )

                                               and stenosing mode of growth. The latter type is the
                                               most dangerous, though less clinical manifestations.  The tumor
                                               may convert the greater  part of esophagus into a rigid, constricted
                                               tube, fixing to the adjacent structures.  May direct extend to
                                               pericardium, the pleura, the mediastinum and into the
                                               tracheobronchial tree, causing a tracheo-esophageal fistula.

Malignant Tumor - Lower End : Most frequent site of esophageal carcinoma, usually scirrhous,
                                               infiltating or proliferative, resulted obstruction producing
                                               dysphagia, progressive dyspepsia and postmeal discomfort.
                                               Dilatation of proximal esophagus may mimic achalasia.  Many
                                               incidences the lower tumor presents an extension to gastric cardia
                                               and fundus.  Differential diagnosis between carcinoma and benign
                                               lesions, such as cicatrical strictures, peptic ulcers, cardiospasm
                                               and hiatal hernia may be decided by an adequate biopsy.

                                     Primary adenocarcinoma of the esophagus, probably araising from
                                               cardiac glands in the esophageal wall is a very rare finding.
                                                      Some relative with the condition of Barrett's columnar-lined
                                               esophagus or long-standing severe reflux.

Treatment
                               The recognized and most hopeful approach is surgical extirpation of
                           laryngo-esophagus ( upper ), total surgical resection ( middle ) and the
                               greatest hope of surgical extirepation at an early stage ( upper, middle,
                           lower ).  However, the reconstructive procedures are complex and rather
                             difficult, many techniques with various approach using different GI segment
                               or skin tube graft facing the complicated postoperative cares, surgical
                               intervention should be decided carefully.  Therefore  preoperative  staging
                                     become important.        Radiation therapy has been disappointing.
                              Chemo-immunotherapy is still developed.

                               Conservative handles such as                            

                               endoprothesis, intra-luminal Laser cauterization, enterostomy feeding etc.
                               some times become a kind of choice.
 

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