1、 一、食道癌早期癥狀1.咽下梗噎感最多見,可自行消失和復(fù)發(fā),不影響進(jìn)食。常在病人情緒波動時發(fā)生,故易被誤認(rèn)為功能性癥狀。2.胸骨后和劍突下疼痛較多見。咽下食物時有胸骨后或劍突下痛,其性質(zhì)可呈燒灼樣、針刺樣或牽拉樣,以咽下粗糙、灼熱或有刺激性食物為著。初時呈間歇性,當(dāng)癌腫侵及附近組織或有穿透時,就可有劇烈而持續(xù)的疼痛。疼痛部位常不完全與食管內(nèi)病變部位一致。疼痛多可被解痙劑暫時緩解。4.咽喉部干燥和緊縮感咽下干燥粗糙食物尤為明顯,此癥狀的發(fā)生也常與病人的情緒波動有關(guān)。5.其他癥狀少數(shù)病人可有胸骨后悶脹不適、前痛和喛氣等癥狀。二、食道癌中期癥狀1.咽下梗噎感最多見,可自選消失和復(fù)發(fā),不影響進(jìn)食。常在

2、病人情緒波動時發(fā)生,故易被誤認(rèn)為功能性癥狀。2.胸骨后和劍突下疼痛較多見。咽下食物時有胸骨后或劍突下痛,其性質(zhì)可呈灼熱樣、針刺樣或牽拉樣,以咽下粗糙、灼熱或有刺激性食物為著。初時呈間歇性,當(dāng)癌腫侵及附近組織或有穿透時,就可有劇烈而持續(xù)的疼痛。疼痛部位常不完全與食管內(nèi)病變部位一致。疼痛多可被解痙劑暫時緩解。4.咽喉部干燥和緊縮感咽下干燥粗糙食物尤為明顯,此癥狀的發(fā)生也常與病人的情緒波動有關(guān)。5.其他癥狀少數(shù)病人可有胸骨后悶脹不適、前痛和喛氣等癥狀。中期食道癌的典型癥狀:進(jìn)行性吞咽困難.可有吞咽時胸骨后疼痛和吐黏液樣痰。三、食道癌晚期癥狀1.咽下困難進(jìn)行性咽下困難是絕大多數(shù)患者就診時的主要癥狀,但

3、卻是本病的較晚期表現(xiàn)。因?yàn)槭彻鼙诟挥袕椥院蛿U(kuò)張能力,只有當(dāng)約2/3的食管周徑被癌腫浸潤時,才出現(xiàn)咽下困難。因此,在上述早期癥狀出現(xiàn)后,在數(shù)月內(nèi)病情逐漸加重,由不能咽下固體食物發(fā)展至液體食物亦不能咽下。如癌腫伴有食管壁炎癥、水腫、痙攣等,可加重咽下困難。阻塞感的位置往往符合手癌腫部位。2.食物反應(yīng)常在咽下困難加重時出現(xiàn),反流量不大,內(nèi)含食物與粘液,也可含血液與膿液。3.其他癥狀當(dāng)癌腫壓迫喉返神經(jīng)可致聲音嘶啞;侵犯膈神經(jīng)可引起呃逆或膈神經(jīng)麻痹;壓迫氣管或支氣管可出現(xiàn)氣急和干咳;侵蝕主動脈則可產(chǎn)生致命性出血。并發(fā)食管-氣管或食管-支氣管瘺或癌腫位于食管上段時,吞咽液體時?？僧a(chǎn)生頸交感神經(jīng)麻痹征群。四

4、、體征早期體征要缺如。晚期可出現(xiàn)打呃、吞咽困難。并且由于患者進(jìn)食困難可導(dǎo)致營養(yǎng)不良而出現(xiàn)消瘦、貧血、失水或惡病質(zhì)等體征。當(dāng)癌腫轉(zhuǎn)移時,可觸及腫大而堅(jiān)硬的淺表淋巴結(jié),或腫大而有結(jié)節(jié)的肝臟。還可出現(xiàn)黃疸、腹水等。其他少見的體征尚有皮膚、腹白線處結(jié)節(jié),腹股溝淋巴結(jié)腫大。 乙酰肝素酶-癌癥轉(zhuǎn)移治療的靶點(diǎn)作者:趙華軍, 章雄文, 丁健, ZHAO Hua-jun, ZHANG Xiong-wen, DING Jian作者單位:趙華軍,ZHAO Hua-jun(中國科學(xué)院,上海生命科學(xué)研究院,上海藥物研究所,國家新藥研究重點(diǎn)實(shí)驗(yàn)室,腫瘤藥理組,上海,201203;中國科學(xué)院,研究生院,上海,201203,

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