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The Role of Esophagus in Voice Rehabilitation of Laryngectomees 食道在喉切除术患者语音康复中的作用
Pub Date : 2018-11-07 DOI: 10.5772/INTECHOPEN.78594
Ljiljana Širić, M. Rosso, A. Včev
The total laryngectomy is a standard procedure of laryngeal carcinoma treatment which leaves multiple persistent consequences on a laryngectomized person. After laryngectomy, all of patients cannot speak loudly, and 10–58% patients have a dysphagia. In such changed anatomical condition, the esophagus has a key function in two of three primary approaches to voice—speech rehabilitation of laryngectomized patients: esophageal and tracheoesophageal speech therapy method because one of these is the only acceptable solution of substitute alaryngeal speech. In esophageal speech, the esophagus has the role of speech air reservoirs since the respiratory and digestive pathways are permanently separated after the procedure. In the production of tracheoesophageal speech, the tra- cheoesophageal fistula and the esophagus allow the recommunication of these pathways and the use of air from the lungs for speech. There are several prerequisites for successful esophageal and tracheoesophageal speech. After tracheoesophageal puncture and insertion, the tracheoesophageal prosthesis may occur different complications in the early or late postoperative period in 10–60% of patients. The quality of alaryngeal voice is very different from the quality of laryngeal voice, but allows communication to laryngectomees.
全喉切除术是喉癌治疗的一个标准程序,在喉切除的人留下多重持久的后果。喉切除术后,所有患者都不能大声说话,10-58%的患者出现吞咽困难。在这种改变的解剖条件下,食道在喉切除术患者语音康复的三种主要方法中的两种中起着关键作用:食道和气管食道言语治疗方法,因为其中一种是替代喉部言语的唯一可接受的解决方案。在食道言语中,由于手术后呼吸道和消化道永久分离,食道具有言语空气储存器的作用。在气管食道言语的产生过程中,气管食道瘘和食道允许这些通路的再交流,并使用来自肺部的空气进行言语。成功的食道和气管食道言语有几个先决条件。气管食管穿刺插入后,10-60%的患者在术后早期或后期可能出现不同的并发症。喉部声音的质量与喉部声音的质量有很大的不同,但可以与喉切除术者交流。
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引用次数: 0
Immunotherapy for Esophageal Cancer 食管癌的免疫治疗
Pub Date : 2018-11-05 DOI: 10.5772/INTECHOPEN.78644
Tianhong Wang, Yi Zhang
As the third most common cancer of the gastrointestinal tract, esophageal cancer has a rather worse prognosis treated with current therapy strategies, and a poor 5-year survival rate lower than 15%. Recent years, emerging immunotherapy has showed a gratifying effect in treating other solid tumors which illuminates its usage for esophageal cancers. Immunotherapy for esophageal cancer basically includes adoptive-cell-therapy-based, antibody-based and vaccine-based therapies, and all of which have shown preliminary favorable results in treating esophageal cancer. However, due to the rather lower muta- tion rate and a tough microenvironment inside the cancer, promising immunotherapies like immune checkpoint blockade drugs, gene-modified-T cell therapies are hindered by the immunosuppressive factors from microenvironment. Future endeavors will be focus-ing on targeting immunosuppressive factors, combining immunotherapies with classical treatments to create a satisfying effect. Immunotherapy has a broad application prospect in the treatment of malignant tumors. The high frequency of esophageal cancer mutations and the effective results of immunotherapy highlighted in other gastrointestinal cancers provide strong evidence for the study of esophageal cancer immunotherapy. Treatment strategies combined with existing or new treatment modes will be the direction of future esophageal cancer treatment.
食管癌是第三大常见的胃肠道肿瘤,目前的治疗策略治疗预后较差,5年生存率不足15%。近年来,新兴的免疫疗法在其他实体肿瘤的治疗中显示出令人满意的效果,这说明了其在食管癌中的应用。食管癌的免疫治疗主要包括过继细胞疗法、抗体疗法和疫苗疗法,这些疗法在食管癌的治疗中均显示出初步的良好效果。然而,由于较低的突变率和肿瘤内部艰难的微环境,免疫检查点阻断药物、基因修饰t细胞疗法等前景看好的免疫疗法受到微环境免疫抑制因子的阻碍。未来的努力将集中在针对免疫抑制因子,将免疫疗法与经典疗法相结合,以创造令人满意的效果。免疫疗法在恶性肿瘤的治疗中具有广阔的应用前景。食管癌突变的高频率和免疫治疗在其他胃肠道肿瘤中所突出的效果,为食管癌免疫治疗的研究提供了有力的证据。结合现有或新的治疗模式的治疗策略将是未来食管癌治疗的方向。
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引用次数: 1
The Clinical Relevance of Gastroesophageal Reflux Disease and Laryngopharyngeal Reflux in Clinical Practice 胃食管反流病与喉咽反流的临床意义
Pub Date : 2018-11-05 DOI: 10.5772/INTECHOPEN.78357
Aragona Salvatore Emanuele, Mereghetti Giada, G. Ciprandi
Gastric reflux may be considered a para-physiological event that may occur up to 50 times a day. It usually happens when gas (less commonly liquids) flow back from stomach into esophagus. However, when defense mechanisms leave, disease may progress. If the esophagus is the trigger, gastroesophageal reflux disease (GERD) emerges. The prevalence of GERD in the primary care setting seems to be even more evident when one considers that, in the United States, 4.6 million office encounters annually are primarily for GERD, whereas 9.1 million encounters include GERD in the top 3 diagnoses for the encounter. GERD constitutes also the most frequently first-listed gastrointestinal diagnosis in ambulatory care visits. In addition, the extraesophageal manifestations of reflux, including LPR, asthma, and chronic cough, have been estimated to cost $5438 per patient in direct medical expenses in the first year after presentation and $13,700 for 5 years. Presently, the newest alginate compounds renowned the interest in this attracting and stimulating area. In this regard, a new medical device (Marial®), unique still now possessing the indication for both GERD and LPR, has been recently launched in the Italian market, two large surveys were conducted in Italy: RELIEF, involving 86 otolaryngologists, and EMERGE, involving 56 gastroenterologists. The aims of these surveys were: (1) to define clinical characteristics, including previous treatment, of the patients referred to consultation; (2) to evaluate the reliability of RFS, GIS, and RSI questionnaires in real-world settings, such as specialist office; and (3) to investigate the patients’ perception of efficacy of the prescribed therapy, based on the best practice and considering also the new medical device Comparing the patients’ perception of treatment efficacy, reduction in RSI values for each single symptom before and after a 4 week-treatment with Marial® alone or with PPI in add-on in EMERGE and RELIEF patients are reported. Marial® alone treatment induced a statistically significant higher reduction in each single symptom in RELIEF patients than in EMERGE patients, with the exception of heartburn, chest pain, indigestion, or stomach © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. acid coming up. Similar results were obtained evaluating the reduction in RSI values in patients treated with PPI in add-on that was able to determine a higher statistically significant decrease in RELIEF than in EMERGE patients in each single symptom, with the exception of heartburn, chest pain, indigestion, or stomach acid coming up.
胃反流可被认为是一种非生理事件,每天可发生多达50次。它通常发生在气体(不太常见的液体)从胃回流到食道时。然而,当防御机制离开时,疾病可能会发展。如果食道是诱因,就会出现胃食管反流病(GERD)。当人们考虑到在美国,每年有460万的办公室就诊主要是因为GERD,而910万就诊的前3位诊断中包括GERD时,初级保健机构中GERD的患病率似乎更加明显。在门诊就诊中,胃食管反流也是最常见的胃肠道诊断。此外,食道外的反流表现,包括LPR、哮喘和慢性咳嗽,估计每位患者在发病后第一年的直接医疗费用为5438美元,5年内为13700美元。目前,最新的藻酸盐化合物在这一领域引起了人们的兴趣。在这方面,一种新的医疗器械(Marial®)最近在意大利市场推出,目前仍然是独一无二的,同时具有GERD和LPR的适应症,在意大利进行了两项大型调查:RELIEF,涉及86名耳鼻喉科医生,EMERGE,涉及56名胃肠科医生。这些调查的目的是:(1)确定就诊患者的临床特征,包括既往治疗;(2)评估RFS、GIS和RSI问卷在现实环境(如专家办公室)中的可靠性;(3)调查患者对处方治疗疗效的感知,在最佳实践的基础上,同时考虑到新的医疗器械。比较患者对治疗疗效的感知,报告了在EMERGE和RELIEF患者中,单独使用Marial®或加用PPI治疗4周前后,每个单一症状的RSI值的减少。除胃灼热、胸痛、消化不良或胃痛外,单独使用Marial®治疗的RELIEF患者的每一种症状的减轻程度均高于EMERGE患者,具有统计学意义©2018作者。被许可方IntechOpen。本章是在知识共享署名许可(http://creativecommons.org/licenses/by/3.0)的条款下发布的,该许可允许在任何媒体上不受限制地使用、分发和复制,只要原始作品被适当引用。酸来了。在评估附加PPI治疗的患者RSI值的减少时获得了类似的结果,能够确定除胃灼热、胸痛、消化不良或胃酸发作外,每个单一症状的缓解都比EMERGE患者具有更高的统计学意义。
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引用次数: 1
Introductory Chapter: Esophagus and Esophageal Cancer 导论章:食道与食管癌
Pub Date : 2018-11-05 DOI: 10.5772/INTECHOPEN.77995
Jianyuan Chai
Our body obtains nutritional supplies from the environment through two primary pipes: bronchus and esophagus, the two simplest organs in the respiratory and digestive systems, respectively. While the bronchus passes oxygen to the lung and expels carbon dioxide out of our biological system, the esophagus transports water and food into the stomach from where a sophisticated process of digestion and nutrient extraction begins.
我们的身体通过两条主要管道从环境中获取营养:支气管和食道,它们分别是呼吸系统和消化系统中最简单的两个器官。当支气管将氧气输送到肺部并将二氧化碳排出我们的生物系统时,食道将水和食物输送到胃中,从那里开始一个复杂的消化和营养提取过程。
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引用次数: 1
Prevention and Management of Complications from Esophagectomy 食管切除术并发症的预防和处理
Pub Date : 2018-11-05 DOI: 10.5772/INTECHOPEN.78757
J. Oxenberg
While surgery plays a major role in the treatment and potential cure of esophageal cancer, esophagectomy continues to have a significant amount of morbidity compared to other surgical oncology procedures. Efforts to improve morbidity and mortality from esopha - gectomy include the Consensus Guidelines for Complications from Esophagectomies, Enhanced Recovery after Surgery protocols as well as others. Although we strive to improve morbidity and mortality after these surgeries, adverse events still occur. They affect not only patient quality of life and increase cost of care for esophageal cancer but also have a negative impact on overall cancer survival. This chapter reviews the preven tion of adverse outcomes from esophagectomies as well as discusses the management of many complications that may occur more common to the operation.
虽然手术在食管癌的治疗和潜在治愈中发挥着重要作用,但与其他肿瘤外科手术相比,食管切除术的发病率仍然很高。为改善食管切除术的发病率和死亡率所做的努力包括《食管切除术并发症共识指南》、《术后恢复强化方案》等。尽管我们努力提高这些手术后的发病率和死亡率,但不良事件仍时有发生。这些不良事件不仅影响患者的生活质量,增加食管癌的治疗成本,而且对癌症的总体生存率也有负面影响。本章回顾了食管切除术不良后果的预防,并讨论了手术中可能出现的许多常见并发症的处理方法。
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引用次数: 3
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Esophageal Cancer and Beyond
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