肝癌肝移植术后复发的危险因素分析

目的探讨原发性肝癌(HCC)肝移植术后肿瘤复发或转移的危险因素。方法回顾性我院2003年4月至2007年11月期间76例HCC患者行肝移植的临床资料,根据随访期间是否有复发分为复发组(n=23)和未复发组(n=53),总结肿瘤复发的特点。结果 76例患者中23例(30.3%)术后复发。单因素分析显示患者性别(P=0.449)、年龄(P=0.091)、术前是否治疗(P=0.958)、肿瘤数目(P=0.212)和是否伴有HBV/HCV感染(P=0.220)与肿瘤的复发无关,而肿瘤包膜完整性(P=0.009)、肿瘤分期(P=0.002)、肿瘤直径(P<0.001)、血管侵犯(P<0.001)以及术前AFP水平(P=0.044)与肿瘤的复发有关,其中肿瘤直径<5.0 cm(P=0.001)和术后2个月AFP水平恢复正常者(P<0.001)1年复发率更低。多因素分析显示肿瘤直径(P=0.001,OR=6.456,95%CI为2.356～17.680)、血管侵犯(P=0.030,OR=10.653,95%CI为1.248～90.910)以及术前AFP水平(P=0.017,OR=2.601,95%CI为2.196～5.658)是肝移植术后肿瘤复发的独立危险因素。结论对于肿瘤直径>5.0 cm、伴有血管侵犯以及术前AFP水平≥400μg/L尤其术后2个月AFP水平仍高于正常者术后需加强监测,必要时尽早给予抗肿瘤治疗。     

脊柱肿瘤的外科治疗现状与进展

脊柱原发骨肿瘤相对少见,约占全身骨肿瘤的6.6％～8.8％,其中良性肿瘤的发病率约占原发骨肿瘤的1％,恶性肿瘤约占5％,而脊柱是骨转移瘤最好发生的部位,约占全身骨转移瘤的50％.原发肿瘤中以血管瘤、骨巨细胞瘤、骨髓瘤、软骨肉瘤等常见[1-2].绝大多数(80％)脊柱肿瘤发生于椎体并向椎弓侵袭,而发生于后方附件的肿瘤少见.由于脊柱具有特殊的解剖结构,前方紧邻大血管及内脏,两侧有神经根走行,椎管内是脊髓,这就使得脊柱肿瘤不能像四肢肿瘤那样进行分期,也不能像四肢长骨肿瘤那样行瘤段骨整块切除,并且脊柱肿瘤复发后再次手术切除的机会很小,因此脊柱肿瘤手术难度大,复发率高,疗效差,一直是骨肿瘤治疗中的难点.     

脊柱骨巨细胞瘤手术治疗2年内复发情况及危险因素分析

目的探讨脊柱骨巨细胞瘤(giant celltumor of bone,GCTB)行手术治疗后的2年内复发情况及其危险因素。方法纳入2013年3月～2016年3月手术治疗的86例脊柱GCTB患者,随访2年以上,根据2年内是否复发设为复发组与未复发组。调查两组患者患病节段、手术方式等病历资料,采用单因素与多因素分析调查脊柱GCTB手术治疗2年内复发的独立危险因素。结果 86例患者2年复发20例,复发率23.26%,平均复发时间(14.33±2.81)个月;两组患病节段、双膦酸盐使用情况、术后放疗、手术方式、胰岛素样生长因子ⅡmRNA结合蛋白3(IMP3)表达、胰岛素样生长因子2(iIGF2)表达、侵袭范围、累及节段数量、手术史、年龄等差异有统计学意义(P0.05),术前Frankel分级、肿瘤最大直径、性别、Enneking分期、手术入路等差异无统计学意义(P0.05);多因素logistic回归分析显示,腰椎患病(OR=2.676)、未使用双膦酸盐(OR=3.032)、次全椎节切除(OR=3.214)、IMP3阳性(OR=4.126)术后2年内复发的独立危险因素。结论脊柱GCTB手术治疗短期内具有较高的复发率,腰椎患病、未使用双膦酸盐、次全椎节切除、IMP3阳性均可能增加其复发风险。     

椎管内肿瘤切除术后切口并发症的相关因素分析

目的分析导致椎管内肿瘤切除术后切口并发症发生的危险因素。方法回顾性分析自2010-01—2013-12手术切除治疗的椎管内肿瘤88例,分为2组,无切口并发症组(70例)和有切口并发症组(18例)。统计分析2组相关因素:性别、年龄、肿瘤性质、有无糖尿病、有无肥胖、有无吸烟、有无激素应用史、有无手术史、术前是否放疗、术前是否化疗、手术时间、术中出血量、有无脑脊液漏、有无术后肢体及大小便功能障碍。结果单因素分析显示2组性别、年龄、肿瘤性质、有无糖尿病、有无肥胖、有无吸烟、有无激素应用史、有无手术史、术前是否放疗、术前是否化疗、术中出血量、有无术后肢体及大小便功能障碍这12项相关因素差异无统计学意义(P0.05);2组手术时间、有无脑脊液漏2项相关因素差异有统计学意义(P0.05)。将手术时间、脑脊液漏2项进一步行Logistic回归分析显示,脑脊液漏(P=0.012,OR=10.579)及手术时间3 h(P=0.020,OR=6.593)是椎管内肿瘤术后切口并发症发生的危险因素。结论椎管内肿瘤切除术后切口并发症与术后脑脊液漏、手术时间3 h明显相关,应引起足够重视。     

脊柱原发恶性外周神经鞘膜瘤的诊断与治疗

目的:探讨脊柱原发恶性外周神经鞘膜瘤(malignant peripheral nerve sheat tumor,MPNST)的诊断和治疗方法。方法:1998年1月~2008年1月我科收治3例表现为椎体内病变的脊柱MPNST患者,均为女性,年龄分别为24、41、42岁。从出现症状到临床确诊的时间1～12个月,平均5个月。累及胸椎1例,腰椎2例。术前均行CT引导下病灶穿刺活检明确诊断为MPNST。均采用肿瘤包膜外分离、分块切除术。结果:3例患者术中平均出血4000ml,平均手术时间482min,2例患者肿物完全切除,1例患者肿物次全切除。术后症状均缓解。分别于术后3、4、30个月复发,2例复发后未再行手术治疗,其中1例行序贯放疗,分别于术后5个月、11个月死亡;1例复发后3次行肿瘤刮除术,末次术后行肿瘤疫苗治疗,末次术后随访20个月无复发。结论:脊柱原发MPNST罕见,影像学表现缺乏特异性,病灶穿刺取活组织行组织学及免疫组化检查是术前诊断的主要方法。手术可以缓解症状,但易复发,放疗对控制肿瘤复发效果不确切。     

乳腺癌术后胸壁局部复发相关因素回顾性分析

目的探讨乳腺癌术后胸壁局部复发的相关因素。方法回顾性分析705例手术治疗的乳腺癌患者的临床资料,采集患者的肿瘤TNM分期,手术方式,肿瘤生物学特性,放化疗情况,雌孕激素受体等,单因素和多因素分析,比较术后复发病例和无复发病例的因素差异。结果单因素分析显示:局部复发率随着TNM分期增高而增高;术后放疗者复发率较低(χ2=4.875,P=0.027),雌孕激素受体阴性者复发率低于阳性者(χ2=5.064,P=0.024)。多因素分析显示:原发肿瘤大小(T分期)、腋窝淋巴结状态(N分期)、远处转移情况(M分期)是局部复发的显著危险因素,术后放疗可降低局部复发率。结论肿瘤TNM分期和术后放疗是乳腺癌术后胸壁局部复发的独立相关因素,对有高危险复发因素的患者,应常规术后放疗,并定期追踪随访。     

老年脊柱转移瘤患者手术预后的影响因素回归模型分析

目的探讨老年脊柱转移瘤患者术后预后的影响因素。方法 137例经临床和病理学诊断为脊柱转移瘤老年患者作为研究对象。采用COX回归模型分析影响老年脊柱转移瘤术后预后危险因素,调查因素包括性别、原发肿瘤类型、累及椎体数、脊柱外骨转移、合并基础疾病、内脏转移、转移时间、吸烟、原发肿瘤性质、术后局部放疗。结果患者均随访24个月,根据预后情况分为存活组(n=34)与死亡组(n=103)。经单因素分析表明,性别、原发肿瘤类型、累及椎体数、合并基础疾病及吸烟两组比较差异无统计学意义(P 0. 05);脊柱外骨转移、内脏转移、转移时间≤20个月、原发肿瘤性质迅速、术后无局部放疗死亡组多于存活组,差异均有统计学意义(P 0. 05)。将上述单因素分析差异有统计学意义的因素纳入COX回归模型分析,显示脊柱外骨转移、内脏转移、转移时间≤20个月、原发肿瘤进展迅速及术后无局部放疗为影响老年脊柱转移瘤患者术后预后危险因素。结论老年脊柱转移瘤患者术后预后受多种因素影响,为改善患者预后,需采取针对性预防措施。     

中晚期原发性肝癌患者TACE术后早期复发危险因素

目的观察中晚期原发性肝癌(HCC)患者TACE术后早期复发危险因素。方法对42例中晚期原发性HCC患者行TACE治疗,术后随访6个月,对比分析早期复发与未复发患者之间的差异。结果术后6个月中,23例HCC早期复发(复发组),19例未复发(无复发组)。复发组白蛋白35 g/L者占比低于未复发组(P0.05),甲胎蛋白(AFP)400 ng/ml者占比及谷氨酰基转移酶(ALT)水平均高于未复发组(P均0.05)。未复发组肿瘤病理分化程度较高(P0.05),复发组瘤灶相对较多、肿瘤最大径较大,ADC值和包膜完整比例低于未复发组(P均0.05)。多因素Logistic回归分析结果显示,AFP400 ng/ml者占比(OR=3.313,P=0.041)、肿瘤分化程度(OR=1.463,P=0.038)、瘤灶数量(OR=2.216,P=0.028)及肿瘤ADC值(OR=0.025,P=0.003)是TACE术后HCC早期复发的独立危险因素。结论 TACE术后中晚期HCC早期复发与AFP、肿瘤分化程度、瘤灶数量及ADC值独立相关。     

Ⅳ期直肠癌的外科治疗及预后分析

目的 探讨Ⅳ期直肠癌患者原发病灶切除的价值和适应证.方法 回顾性分析1988年1月至2005年12月在外科治疗的118例Ⅳ期直肠癌患者的临床资料,将118例分为二组,手术切除原发病灶组(105例)和仅行造瘘术组(13例).采用Kaplan-Meier法进行生存分析,Log-rank检验进行统计学比较,应用Cox比例风险模型进行多因素分析. 结果 118例中105例行直肠原发病灶切除,同期行转移瘤切除16例;13例行造瘘术.手术切除原发病灶组总的5年生存率为8.5%.其中同期行转移瘤切除者5年生存率31.2%,行辅助化疗者5年生存率20%.手术切除原发病灶组与造瘘组中位生存期分别为15个月、13个月(X2=0.736,P=0.778).手术切除原发病灶组中转移灶切除和转移灶未切除中位生存期分别为20个月、14个月(X2=5.382,P:0.020).手术切除原发病灶加术后全身化疗为主者中位生存期为21个月.多因素分析显示原发肿瘤分化程度、肝转移瘤最大径和全身化疗是影响直肠原发肿瘤切除预后的最主要因素. 结论 对于Ⅳ期直肠癌能同时切除原发及转移病灶的患者,外科手术治疗可延长生存时间.     

长骨骨转移癌外科治疗的随访分析

目的：为有效地提高长骨骨转移癌患者的生存质量,探讨外科治疗的意义及手术方案的选择。方法：对1990年10月-1999年10月52例长骨骨折转移癌患者的临床外科治疗资料回顾分析。患者男27例,女25例;年龄33-74岁,平均56.8岁,60岁以上的患者30例;16例有多发转移灶,行外科手术55个部位。采用病灶切刮骨水泥填充3例;病灶切刮骨水泥填充髓内针内固定29例;瘤骨截除人工关节置换18例;瘤骨截除临时假体植入1例;截肢4例。结果：全部患者均有随访,术后存活时间2-122个月,平均28.2个月,存活6个月以上的患者36例（69.0％）,存活1年以上的患者30例（57.6％）。术后疼痛缓解率为75％;下肢36个手术部位,术后完全负重或扶单拐负重率为69％;术后复发11例,复发时间为2-69个月,平均17.2个月;术后病理证实为转移癌,未知原发肿瘤15例。结论：（1）长骨骨转移癌的病理骨折内固定或预防病理骨折内固定,有效缓解患者的局部疼痛,恢复肢体负重功能或连续性,为术后放、化疗提供便利;有利于晚期骨转移癌患者的护理,从而提高骨转移癌患者的生存质量。（2）随着原发肿瘤治愈率的提高,单发骨转移癌病灶应行边缘性或广泛性切除,重建肢体功能,降低复发率,尤其适应于存活期较长的乳腺癌、肾癌患者。     

The Efficacy of Radiofrequency Ablation for Bone Tumors Unsuitable for Radical Excision

BackgroundBone tumors can cause severe pain and poor quality of life due to recurrence and non-achievement of complete remission after surgery, chemotherapy, or radiotherapy. Radiofrequency ablation (RFA) can be considered for minimally invasive treatment of bone tumors that are difficult to radically excise. In this study, RFA was performed for bone tumors that were difficult to radically excise and did not respond to surgery, chemotherapy, or radiotherapy due to their large sizes and/or locations. The purpose of this study was to retrospectively analyze the clinical characteristics and survival rates of bone tumors after RFA and provide one more treatment option for the future.MethodsThere were 43 patients with bone tumors who underwent percutaneous RFA at our hospital from April 2007 to October 2017. The median age of the patients was 59 years (range, 31–75 years), and the median follow-up duration was 67.2 months (range, 10.2–130.5 months). Of the 43 patients, 26 were male and 17 were female. Thirty-four cases were metastatic bone tumors, 5 were chordomas, 3 were osteosarcomas, and 1 was a giant cell tumor. Pain and functional ability of the patients were evaluated using a visual analog scale (VAS) and the Musculoskeletal Tumor Society (MSTS) functional scoring system, respectively. Scores were recorded preoperatively, 1 week postoperatively, and 4 weeks postoperatively. The 1-year, 2-year, and 5-year survival rates were evaluated using the Kaplan-Meier method.ResultsThe mean VAS score was 8.21 preoperatively. The mean VAS score at 1 week, 4 weeks, 12 weeks, and 24 weeks postoperatively were 3.91, 3.67, 3.31, and 3.12, respectively. The mean preoperative MSTS score was 64.0% (range, 32%–87%). The mean postoperative MSTS score was 71.0% (range, 40%–90%). The 1-year, 2-year, and 5-year survival rates were 95.3%, 69.8%, and 30.2%, respectively.ConclusionsAs per our study findings, RFA was effective in reducing pain and improving functional ability of patients with bone tumors that were difficult to radically excise.     

Predictors of Recurrence After Local Excision and Postoperative Chemoradiation Therapy of Adenocarcinoma of the Rectum

Background: Local excision of rectal cancer preserves anal continence, bladder function, and normal sexual function. However, local recurrence after excision remains a significant problem. To further define the indications for local excision, we analyzed possible factors predictive of recurrence after local excision of rectal cancer.Methods: The charts of all patients undergoing local excision of adenocarcinoma of the rectum between 1985 and 1995 at a single institution were reviewed. Patients with metastatic disease at the time of excision and patients treated preoperatively with chemoradiation therapy were excluded. All available slides were reviewed by a single pathologist, who assessed the depth of invasion; the presence or absence of vascular invasion, lymphatic invasion, perineural invasion, and lymphocytic infiltrate; the mucinous status; and the degree of differentiation. Using the log-rank test and Cox proportional hazards model, univariate and multivariate analyses were performed to identify predictors of recurrence.Results: Ninety patients underwent local excision, 46 transanally and 44 using a Kraske approach. The breakdown of patients by tumor stage was as follows: Tis, 13%; T1, 41%; T2, 30%; T3, 15%; and Tx, 1%. Sixty-eight percent of patients with T1 tumors were treated with postoperative radiotherapy; all patients with T2 or T3 tumors were treated postoperatively with or without 5-fluorouracil. The median duration of follow-up was 51 months. The median tumor diameter was 2.5 cm (range, 0.4 to 7 cm), and the median distance of the tumor from the anal verge was 4.5 cm (range, 1 to 10 cm). The 4-year actuarial local disease-free survival rate broken down by tumor stage was as follows: Tis, 100%; T1, 95%; T2, 80%; and T3, 73%. The median time to local recurrence was 23 months (range, 7 to 61 months). Multivariate analysis showed that only tumor stage and margin status were predictors of local recurrence.Conclusions: Local excision and postoperative radiotherapy result in adequate local control of early stage (Tis and T1) adenocarcinoma of the rectum. Higher rates of recurrence were seen in patients with T2 and T3 tumors, especially in those with positive margins.Presented at the 51st Annual Meeting of The Society of Surgical Oncology, San Diego, California, March 26–29, 1998.     

软组织恶性纤维组织细胞瘤的治疗策略和预后分析

目的 分析软组织恶性纤维组织细胞瘤的治疗策略及预后相关因素.方法 回顾性分析1999年12月至2010年10月收治的78例软组织恶性纤维组织细胞瘤患者的临床资料,并对性别、年龄、肿瘤部位、肿瘤大小等9项可能影响预后的因素进行统计学分析.结果 60例患者获得随访,随访时间6～131个月,平均35.5个月.l、3、5年总体生存率分别为84.9％、72.9％和56.9％.术后局部复发20例(33.3％),中位局部复发时间为11.5个月(1～72个月).术后转移9例(15.0％),中位转移时间为7个月(1～26个月).单因素分析表明,就诊情况(初治组或复发治疗组)、肿瘤大小和外科边界与生存率有相关性(均P ＜0.05),外科边界、放疗与局部复发有相关性(P =0.000、0.039),外科边界与远处转移有相关性;多因素分析显示,外科边界是影响生存率(P =0.002,OR=5.753,95％CI1.904～17.386)和局部复发(P=0.000,RR =0.044,95％CI0.010 ～0.188)的独立危险因素.结论 外科边界是影响生存率和局部复发的独立危险因素.采取以手术为主联合放疗的综合治疗,方能减少复发、提高生存率.     

Surgical treatment of malignant thoracic schwannomas

The objective of this study is to evaluate the results after surgical treatment of malignant tumors arising from the peripheral nerves of the thorax under consideration of adjuvant therapy modalities. PATIENTS AND METHODS: Between 1988 and 1998, 9 patients (6 males, 3 females) underwent surgical treatment for MTNSO and 35 pts. for benign neurogenic tumors. The mean age in patients with malignant tumors was 45 years (range, 25 to 73 years). 3 pts. with MTNSO (33.3%) had neurofibromatosis (von Recklinghausen's syndrome) compared to 8.6% (3/35) in patients with benign neurogenic tumors. RESULTS: In patients with MTNSO partial chest wall resections (n = 4) including sternectomy (n = 1), lung resections (n = 2), paravertebral (n = 1) and mediastinal tumor resection (n = 1) and palliative resection of pleural recurrence (n = 1) were performed. Radical resection was achieved in 5 pts. (55.5%). There was no postoperative mortality. 3 patients (33.3%) had postoperative complications: wound infection (n = 2) and wound dehiscence due to fall with consequent pleural infection (n = 1). Adjuvant therapy was performed in two pts. (adjuvant radiotherapy/chemotherapy for metastatic disease n = 1; adjuvant chemotherapy/adjuvant radiotherapy after resection of recurrent tumor n = 1). Early recurrence is documented in 2 pts. (after 3 and 6 months). Two pts. are alive and free of disease at three years, and the patient after sternectomy with recurrent disease at 20 months. Three pts. died 8, 9 and 26 months after the primary surgical procedure. The first postoperative examination (at three months) in the remaining patient showed no evidence for recurrent disease. CONCLUSION: Patients with MTNSO have an unfavourable prognosis and local recurrence is frequent even after radical surgical therapy. Therefore an adjuvant treatment in these patients may be justified, even if the value of these therapy modalities is not proved yet. A tumor-free long-term survival especially after complete surgical resection is possible in selected cases.     

肝脏恶性肿瘤肝移植术后肿瘤复发的临床研究

目的 总结肝脏恶性肿瘤患者行肝移植术后肿瘤复发的临床特点,探讨术后复查的规范方法和治疗复发肿瘤的措施.方法 回顾性分析215例原位肝移植患者的临床资料,分析其中81例复发患者的肿瘤复发时间、复发部位和治疗效果.结果 81例患者的随访时间为6～108个月.首次发现肿瘤复发的时间为肝移植术后3～20个月,常见的复发部位为肺、腹腔种植或淋巴结转移、移植肝内复发和骨转移.复发肿瘤的治疗以局部治疗为主,包括肺转移瘤切除术6例次、伽马刀治疗74例次;腹盆腔转移癌切除术10例次,腹腔淋巴结伽马刀治疗8例次;肝转移癌切除术6例次、消融治疗5例次、伽马刀治疗15例次、TACE 33例次,二次肝移植3例次;骨转移瘤切除术15例、伽马刀治疗16例次以及病理性骨折内固定术3例;脑转移瘤伽马刀治疗4例次.本组患者治愈3例,带瘤生存6例,已存活21～56个月,中位生存时间为39个月.死亡72例,中位生存时间为15个月.结论 肝移植术后对恶性肿瘤患者要进行有针对性的规范检查、积极治疗复发肿瘤,尽量延长患者的生存时间.     

术前放疗联合全直肠系膜切除术治疗可切除性直肠癌临床疗效的系统评价

目的评价术前放疗联合全直肠系膜切除术（TME）治疗局部可切除直肠癌的临床疗效。方法全面检索1982年1月至2009年4月间发表的评价术前放疗的前瞻性临床随机对照试验研究,按纳入和排除标准筛选,提取人选试验的基本特征和临床疗效数据。对研究目的相同的多项随机对照试验的临床数据采用RevMan4．2软件进行定量合并．对不符合定量合并要求的数据作统计描述。结果符合选择标准的临床随机对照试验9项。短程术前放疗联合规范的TME手术组治疗直肠癌的2年局部复发率为2．4％,低于单纯TME手术组的8．2％（P〈0．01）。术前放疗患者的4年总生存率和无病生存率与术前常规分割放化疗患者相比,差异无统计学意义（P〉0．05）：两组患者的局部复发率差异也无统计学意义（RR=1．16,95％C10．37～3．61,P=0．80）。术前高剂量放疗组完全缓解率显著高于低剂量组（16．0％比2．0％,P〈0．05）．保肛手术率提高3．9％。结论TME术前放疗可降低直肠癌术后局部复发的风险。     

A Prospective, Multi-Institutional Study of Adjuvant Radiotherapy After Resection of Malignant Phyllodes Tumors

Background  Malignant phyllodes tumors of the breast are unusual neoplasms, with an incidence of approximately 500 cases annually in the United States. Published local recurrence rates after margin-negative breast-conserving resections of borderline malignant and malignant phyllodes tumors are unacceptably high, at 24 and 20%, respectively. It is uncertain whether radiotherapy after resection of phyllodes tumors is beneficial. Methods  We prospectively enrolled patients who were treated with a margin-negative breast-conserving resection of borderline malignant or malignant phyllodes tumors to adjuvant radiotherapy. The primary endpoint was local recurrence. Results  Forty-six women were treated at 30 different institutions. The mean patient age was 49 years (range, 18–76 years). Thirty patients (65%) had malignant phyllodes tumors; the rest were borderline malignant. The mean tumor diameter was 3.7 cm (range, .8–11 cm). Eighteen patients had a negative margin on the first excision. The median size of the negative margin was .35 cm (range, <.1–2 cm). Twenty-eight patients underwent a re-excision because of positive margins in the initial resection. Two patients died of metastatic phyllodes tumor. During a median follow-up of 56 months (range, 12–129 months), none of the 46 patients developed a local recurrence (local recurrence rate, 0%; 95% confidence interval, 0–8). Conclusions  Margin-negative resection combined with adjuvant radiotherapy is very effective therapy for local control of borderline and malignant phyllodes tumors. The local recurrence rate with adjuvant radiotherapy was significantly less than that observed in reported patients treated with margin-negative resection alone.     

甲状腺癌骨转移的外科治疗及预后因素分析

 目的 探讨甲状腺癌骨转移的临床特点、外科治疗策略及影响预后的因素。方法 回顾性分析1999年1月至2011年7月间接受外科治疗且有完整随访资料的46例甲状腺癌骨转移患者的临床资料,男20例,女26例;年龄40~87岁,平均56.87岁。中轴骨转移占91.3%,四肢骨转移占8.7%。分化型甲状腺癌占76.1%,低分化型占23.9%。19例为单发骨转移,27例为多发骨转移。应用Kaplan-Meier生存分析和COX回归对性别、年龄、病理类型、骨转移病灶数目、转移部位、内脏转移、骨科并发症、转移时长、首诊时已发生骨转移、原发病灶手术、接受131I治疗、原发病灶接受放化疗、术前一般情况、手术方式、病灶性质、术中出血量、应用预防出血措施、围手术期并发症、远期并发症19项因素进行分析。结果 78.3%的患者接受了切除性手术,平均出血量为2603.26 ml,术后5年生存率为37.3%,10年生存率为12.4%。分化型甲状腺癌、单发骨转移、接受131I治疗、术前一般情况良好为预后良好因素,其中单发骨转移和接受131I治疗为独立影响因素。结论 明确甲状腺骨转移患者的预后因素有助于确定手术适应证,从而进一步提高甲状腺癌骨转移患者的治疗效果和生存期。     

Radical resection of rectal cancer primary tumor provides effective local therapy in patients with stage IV disease

Background The optimal use of radical surgery to palliate primary rectal cancers presenting with synchronous distant metastases is poorly defined. We have reviewed stage IV rectal cancer patients to evaluate the effectiveness of radical surgery without radiation as local therapy. Methods Eighty stage IV patients with resectable primary rectal tumors treated with radical rectal surgery without radiotherapy were identified. Sixty-one (76%) patients received chemotherapy; response information was available for 34 patients. Results Radical resection was accomplished by low anterior resection (n=65), abdominoperineal resection (n=11), and Hartmann’s resection (n=4). Surgical complications were seen in 12 patients (15%), with 1 death and 4 reoperations. The local recurrence rate was 6% (n=5), with a median time to local recurrence of 14 months. Only one patient received pelvic radiotherapy as salvage treatment. One patient required subsequent diverting colostomy. Median survival was 25 months. On multivariate analysis, the extent of metastasis and response to chemotherapy were determinants of prolonged survival. Conclusions For patients who present with distant metastases and resectable primary rectal cancers, radical surgery without radiotherapy can provide durable local control with acceptable morbidity. The extent of metastatic disease and the response to chemotherapy are the major determinants of survival. Effective systemic chemotherapy should be given high priority in the treatment of stage IV rectal cancer.     

前、后联合入路全脊椎切除附加内固定治疗颈椎骨肿瘤39例报告

目的探讨对颈椎骨肿瘤采用前后联合入路全脊椎切除、内固定重建技术的疗效及其预后。方法1998年10月至2003年10月,对39例颈椎(C3-7)骨肿瘤患者实施全脊柱切除术。其中原发性骨肿瘤34例,包括骨巨细胞瘤14例,浆细胞瘤6例,神经鞘瘤(侵及椎体)1例,软骨肉瘤4例,骨母细胞瘤4例,恶性神经鞘瘤2例,动脉瘤样骨囊肿2例,脊索瘤1例;转移性肿瘤5例,原发灶来源于甲状腺癌、前列腺癌各2例,肺癌1例。经前后联合入路行单椎节切除29例、双椎节切除7例、3个椎节切除3例。经一期或二期前后联合入路行肿瘤切除与内固定重建。前路采用钛网植骨加AO、Orion、Zephir或者Codman等带锁钢板内固定,后路Cervifix、AXIS内固定重建。结果术后随访6个月至5年,绝大多数患者术后近期疗效较满意,局部疼痛和神经症状均有不同程度改善或缓解,19例脊髓神经功能完全恢复。1例术后出现一过性瘫痪加重,1例恶性神经鞘瘤术后1年局部复发,1例转移癌患者于术后25个月因全身衰竭死亡。结论全脊椎切除能显著降低颈椎原发性骨肿瘤局部复发率,改善脊髓神经功能,提高手术疗效。