肠系膜巨大未成熟畸胎瘤1例

肠系膜巨大未成熟畸胎瘤１例谭德银女性，２０岁，维吾尔族。于１９９０年６月始无原因出现腹胀，Ｂ超检查发现腹腔内肿块在当地医院手术切除，术中见肿瘤位于横结肠下方与肠系膜相连。术后半年肿瘤复发呈进行性增大，１９９１年１０月在当地医院再次行肿瘤切除术。术后４...     

非开胸食管内翻剥脱术治疗高位食管癌

１９９０年１月至１９９５年１２月作者采用非开胸食管内翻剥脱术治疗高位食管癌１１例。其中下咽癌２例，颈段食管癌１例，上胸段食管癌８例；病理诊断均为鳞癌。术后发生吻合口瘘３例，声音嘶哑２例，腹壁切口裂开１例。全组无手术死亡。术后随访１０个月～５年，除１例失访外，３例死于肿瘤复发，余７例均健在。本文仅就手术适应证及术后并发症的预防进行了讨论。     

胃癌术后吻合口复发19例临床治疗分析

自１９６５年～１９９１年，我院共收治１９例胃癌术后吻合口复发病人，占同期手术病人的２．１％。再次根治切除２例，１例生存２年４个月，１例生存４年１０个月均健在。６例开腹探查胃空肠吻合，均在半年内死亡。未手术行化疗９例，４例生存不满１年，５例生存不满６个月。２例行吻合口区放疗４个月内死亡。胃癌术后吻合口复发关键在于早期发现复发征象，争取及早再次行根治性切除。     

59例复发乳腺癌的疗效分析

１９９０年１２月—１９９７年１２月共收治复发乳腺癌５９例，我科用ＣＭＦ－Ｐ方案、ＣＡＰ方案、ＣＡＦ方案加６０Ｃｏ体外照射疗效满意，现报告如下。１资料与方法１．１临床资料本组５９例病人均为根治术后复发的Ⅳ期病例。全部患者均为女性，年龄最小２５岁，最大６...     

晚期直肠癌的术后放疗

目的 评价放疗对晚期直肠癌术后病人的作用。方法 从１９９０年１月－１９９３年１２月，我科共收治晚期直肠癌术后放疗病人３２例，年龄最小２８岁，最大６５岁，中位年龄４５岁。所有病例均病理证实，腺癌３１例，腺鳞癌１例。放疗剂量为４０－５５ＧＹ／４－６周。结果 术后与放疗间隔时间１－３个月１５例，复发率２６．７％，３－５人有７例，复发率４３．７％，１、３年生存率分别为９０．３％、１９．４％。结论晚期直肠癌     

食管癌根治性放疗后复发或纤维狭窄的外科治疗

根治性放疗是治疗食管癌的重要方法之一，但效果并不理想。６个月复发为６５－６％，１年复发为９０－１％。１９６０年初～１９９７年底，我科对２６８例食管癌根治性放疗后未控或复发的患者进行了手术治疗，现将结果报告如下。本组男性２２０例，女性４８例。上段６３例（２３－５％），中段１８２例（６７－９％），下段２３例（８－６％）。放疗前病变＜５ｃｍ４１例（１５－３％），５～８ｃｍ１７５例（６５－３％），＞８ｃｍ５２例（１９－４％）。放疗剂量均＞６０Ｇｙ以上。复发时间：＜６个月１６０例（５９－７％），６～１２月…     

前颅底沟通瘤的外科治疗

目的 探讨前颅底沟通瘤的诊断，手术方式和疗效。方法 对２１例前颅底沟通瘤患者进行了手术治疗，并对其疗效进行了随访。结果 肿瘤全切１７例，大部或部分切除４例。３例出现并发症，其中脑脊液漏１例，单眼运动障碍加重１例，糖尿病昏迷１例。除糖尿病昏迷患者术后６天死亡外，余２０例均痊愈。术后随访３个月－４年，１０例资料完整者恢复良好，无肿瘤复发。     

上皮性卵巢癌二次手术14例临床分析

目的：探讨上皮性卵巢癌二次手术的临床意义。方法：对１４例上皮性卵巢癌二次手术病人进行临床分析。１４例初次手术时为Ⅲ￣Ⅳ期，均行瘤细胞减灭术，术后时间６月￣１年。４例经过规律化疗后行ＳＬＬ以了解治疗效果及判断预后，１０例为病灶复发欲行ＳＣＲ。结果：ＳＬＬ阳性１例，显微观阳性２例，阴性１例，手术后４￣１８个月复发；ＳＣＲ理想减灭２例，非理想减灭６例，姑息手术３例，术后平均存活时间６．５月，术后生活质量     

卵巢上皮性癌综合治疗89例

探讨卵巢上皮性癌在手术，化疗及热疗等综合治疗中，临床分期，术后残留癌灶大小，术后化疗及热疗因素与生存率的关系。方法回顾分析１９９０年元月至１９９５年１２月６年间收治的卵巢上皮性癌８９例的临床资料。结论临床分期愈早，手术后无或残留癌灶〈２ｃｍ，常规化疗８－１０个疗程以及加热疗者疗效较好。     

肌层浸润性膀胱癌保留膀胱手术的临床观察

目的　探讨肌层浸润性膀胱尿路上皮癌保留膀胱手术的有效性及安全性。方法　收集２００３年６月至２００７年６月行保留膀胱手术的４１例肌层浸润性膀胱癌患者的临床资料,其中行膀胱部分切除术（ＰＣ）２９例,行根治性经尿道膀胱肿瘤电切术（ＴＵＲＢＴ）１２例。采用吡柔比星３０ｍｇ／次膀胱灌注化疗,每周１次,共８次,继而每月１次,共持续１年。每３个月行膀胱镜检查１次,持续２年。结果　ＰＣ组术后１、３年无瘤生存率分别为８２８％（２４／２９）和５５.２％（１６／２９）,ＴＵＲＢＴ组分别为７５％（９／１２）和５０％（６／１２）,两组差异均无统计学意义（Ｐ＞０.０５）。ＰＣ组术后肿瘤复发率为３４.５％（１０／２９）,首次肿瘤中位复发时间为９.５个月;ＴＵＲＢＴ组术后肿瘤复发率为４１.７％（５／１２）,首次肿瘤中位复发时间为８.０个月,两组差异均无统计学意义（Ｐ＞０.０５）。结论　对于身体条件不能耐受或不愿接受根治性膀胱全切术的肌层浸润性膀胱癌患者,行保留膀胱手术联合术后化疗是一种可行的治疗方案。     

Jaw involvement in American Burkitt's Lymphoma

A total of 100 patients with American Burkitt's lymphoma (AMBL) (mean age, 15 years; M:F ratio 3:1; 3% black) have been treated at the National Cancer Institute since 1964. Eighteen of these had jaw involvement, 16 at presentation and 2 at relapse (mean age, 16 years; M:F ratio 1.6:1). None of these 18 patients was black. Of the 16 patients presenting initially with jaw tumors, 14 were first evaluated by their dentist; 8 were 16 years of age or older (adults) and 6 were younger than 16 years of age (children). Toothache and perioral numbness were the most frequent findings in adults, whereas toothache, loose teeth, intra-oral and extra-oral swelling were the most common complaints in children. Ten patients were treated with antibiotic therapy and/or dental extractions for presumed tooth infection. The distribution of jaw lesions was: unilateral mandibular (7), unilateral maxillary (4), bilateral mandibular (5), and four quadrants (2). Radiologic evaluation was abnormal in all 17 cases evaluated. Only three patients (all children) had disease limited to the jaw. Four of eight children and 3 of 10 adults are long-term survivors with a median follow-up of seven years (range, 2-15 years). American Burkitt's lymphoma with jaw involvement differs from African Burkitt's lymphoma (AFBL) with jaw involvement in a number of ways: (1) the incidence of jaw tumors in adults is similar to that in children; (2) the incidence of jaw tumors is not greater in males; (3) tumor is considerably more limited in extent with a single quadrant mandibular lesion being the most common presentation; and (4) clinical presentation also differs, with toothache and perioral numbness, uncommon in AFBL, being the most frequent complaints. These marked differences in the frequency and clinical characteristics of jaw tumor of AMBL and AFBL are consistent with other findings indicating that these diseases may differ phenotypically.     

后路I期全脊椎整块切除治疗胸腰椎原发和转移性肿瘤的疗效分析

目的探讨后路I期全脊椎整块切除（totalenblocspondylectomy,TES）治疗胸腰椎原发和转移性肿瘤的疗效。方法回顾性分析2007年1月至2012年7月,我科行TES的21例,男11例,女10例,年龄21～66（平均47.8）岁。原发肿瘤8例,孤立性转移瘤13例。原发肿瘤分别为骨巨细胞瘤3例,浆细胞瘤2例,骨肉瘤、软骨肉瘤及上皮样血管内皮瘤各1例;转移性肿瘤原发肿瘤分别为乳腺癌4例,肺癌3例,肾癌2例,甲状腺癌、前列腺癌、膀胱癌和原发灶不明转移性腺癌各1例。肿瘤节段分布于T3～L3,其中胸椎12例、腰椎9例,单一椎体19例、多椎体2例（均位于3个相邻胸椎）。根据Tomita脊柱肿瘤外科分期进行评估：Ⅰ型5例、Ⅱ型10例、Ⅲ型1例、Ⅴ型2例、Ⅵ型3例。术前均有顽固性腰背痛或神经功能损害。切除椎体的骨缺损用钛网＋自体骨或异体骨＋钉棒系统进行固定和重建。手术均经后路I期完成。结果手术时间4.0～8.5h,平均6.4h;出血量1300～11600ml,平均4500ml。本组21例均获12～80个月的随访,平均40个月,术后腰背部局部疼痛均达到缓解。脊髓功能损伤的患者术后Frankel分级均有一级以上恢复,和术前Frankel分级比较,差异有统计学意义（Z＝-2.232,P＜0.05）。3例死亡,平均死亡时间为术后16个月,4例带瘤生存,14例无瘤存活,总生存率为85.7%。局部复发3例,复发率为14.3%,复发时间为平均术后22个月。本组除1例胸腔积液伴肺部感染、1例气胸伴双肺感染、1例左侧L3神经根一过性麻痹外,未出现严重并发症,并发症发生率14.3%。所有病例均无术中由于大血管或节段血管引起的大出血发生,植骨均完全愈合,无内固定失败或钛网移位。结论后路I期TES治疗脊柱原发恶性肿瘤、侵袭性良性肿瘤和孤立性转移瘤能有效降低局部复发率,无严重的并发症,是一种有效的手术方式。     

Gnathic osteoblastoma: clinicopathologic review of seven cases with long-term follow-up

The clinical, radiographic and histopathologic features of seven cases of osteoblastoma of the jaw bones were analyzed. The mandible was involved in six cases and a periosteal presentation of the tumor was noted in three cases. Six tumors were symptomatic with pain being the common presentation. The radiographic appearance of the intraosseous tumors varied from well-defined radiolucencies to poorly-defined mixed lesions. A small periosteal tumor was undetectable radiographically. Histopathologically, the tumors exhibited variation in woven bone formation, osteoblastic rimming, lesional maturation as well as interaction of the tumor with surrounding host tissue. Intraosseous tumors were managed with aggressive surgical curettage and periosteal tumors were resected and the underlying bone was curetted down to normal host bone. Follow-up of cases ranged from 2 years to 18 years with no recorded recurrences. Gnathic osteoblastomas offer a unique diagnostic challenge as they resemble other tumors of the jaws including the cementoblastoma, cemento-ossifying fibroma, cemento-osseous dysplasia and most importantly the gnathic osteosarcoma. We stress on the need to correlate the histopathologic findings with clinical and radiographic features to reach an accurate diagnosis.     

腮腺内面神经鞘瘤12例临床病理分析

目的 :分析腮腺内面神经鞘瘤的临床、病理特点 ,以免误诊、误治。方法 :对山东省莱阳中心医院 2 0年间收治的 12例腮腺内面神经鞘瘤的临床、病理特点 ,进行回顾性分析。结果 :6例术前误诊为混合瘤 ,1例误诊为腺样囊性癌 ,1例误诊为淋巴瘤。 2例做了穿刺活检 ,3例做了术中快速病检 ,皆得以确诊。术中保留面神经的 10例 ,虽然术后出现面瘫 ,但于术后 6～ 12月恢复 ,切除面神经颅外段 2例 ,面瘫未见恢复。本组 5例肿瘤来源于面神经总干 ,3例来源于上、下颊支 ,2例来源于颧支 ,2例来源于下颌缘支。肿瘤镜下分型 :囊状型 9例 ,网状型 3例。术后随访 5～ 10年 ,无 1例复发。结论 :此瘤极易误诊 ,确诊有赖于术前 (或术后 )病理检查。术中应尽力保留面神经 ,虽然术中刺激、牵拉面神经等致术后面瘫 ,但大多数患者可自然恢复     

原发骶骨肿瘤手术治疗应注意的有关问题

目的探讨原发骶骨肿瘤手术治疗的相关问题。方法回顾分析10年间,我院收治的29例原发骶骨肿瘤的临床资料。男16例,女13例。平均32.6岁。病程1年4个月～3年。低位14例,高位15例。偏位17例,中央12例。骨巨细胞瘤13例,脊索瘤8例,软骨肉瘤4例,神经纤维瘤2例,副神经节瘤和黑色素瘤各1例。单纯后入路骶骨肿瘤切除或刮除术19例,前后联合入路骶骨肿瘤切除或刮除术10例;同期行腰骶椎骨盆内固定11例。结果所有患者均在全麻下顺利完成手术,无术中死亡。术中出血平均为1800ml。14例低位肿瘤,13例术后神经功能正常,1例神经功能恢复不理想。15例高位肿瘤中,术后1例失访,12例神经功能恢复,2例神经功能异常。21例患者获得平均4年10个月的随访,5例复发,2例死亡,余14例正常。结论应根据肿瘤的位置高低选择恰当的手术入路;采用前入路时同时结扎髂内血管,可减少术中出血;在不影响肿瘤切除的前提下,尽可能保留双侧S1～2及至少一侧S3神经根,或一侧S1～3神经根,可获得较理想的神经功能恢复;高位骶骨肿瘤应根据情况采取不同的固定方式重建腰骶髂稳定性。     

全脊椎切除治疗原发性、侵袭性和恶性腰椎肿瘤30例报告

目的探讨原发性恶性腰椎肿瘤全脊椎切除手术入路、肿瘤切除术式、重建策略及预后。方法回顾性分析1998年1月至2004年12月收治的30例原发性恶性腰椎肿瘤患者的病理类型、临床表现、手术途径、术式及其预后。本组30例中,肿瘤病灶涉及WBB分区3～9区/1～12区和L1～L5椎节。采用后方入路14例,前后联合入路16例。1个椎节切除28例,2个椎节切除1例,3椎节切除1例。根据手术入路的不同而行后路或前后路行全椎节切除与重建术。根据肿瘤的病理类型,术后给予相应的全身/局部化疗或放疗。结果术后随访1～6年,1例神经症状无改善,其余术后近期疗效均较满意,神经功能均有不同程度改善。6例患者分别于术后12～48个月局部复发,1例恶性纤维组织细胞瘤患者于术后36个月因多处转移、全身衰竭死亡。结论肿瘤的性质、切除方式和术后的相关综合治疗对预后具有重要影响,应根据肿瘤的性质、浸润范围选择相应的手术途径及肿瘤切除与重建方式。     

Aspects diagnostiques et résultats du traitement chirurgical des tumeurs maxillomandibulaires : à propos de 23 cas

Tumors of the maxilla and mandible are common and diverse in nature. Their treatment is based primarily on the large surgical resection. We report in this study our experience in the surgical management of these tumors at the Military Hospital Ouakam. This was a retrospective study of 23 cases diagnosed in the Military Hospital Ouakam (HMO, Dakar, Senegal) from 2004 to 2012. There were 18 cases of benign tumors (78.3%) and 5 cases of malignant tumors (21.7%). We had 7 cases of maxillary tumors (30.4%) including 5 cases of cancer (71.4%of tumors of the jaw) and 16 cases of tumors of themandible (69.6%), all benign. The circumstances of discovery in cases of malignant tumors were mainly marked by the oral ulcerative lesions (80%). Themean duration of symptoms was 5.8 months. The circumstances of discovery for benign tumors were dominated by facial swelling (100%) with a mean duration of 3.5 years. Panoramic dental radiography showed picture of osteolysis in 23 cases (100%). The ameloblastoma was the first maxillo-mandibular tumor with 14 cases, 60.9% of all tumors and 77.8% of benign tumors. Squamous cell carcinoma was the second tumor with 4 cases, 17.4% of all tumors and 80%of cancers. Surgical treatment had consistedmainly of a large resection of the tumor (69.6%). The evolution was good for benign tumors and bad for malignant tumors after a mean follow-up of 9.8 months.     

食管间质瘤的诊断和治疗

目的：探讨食管间质瘤临床特征及诊治方法。方法：回顾分析我院诊治的1例及国内1994年-2010年报道的23例食管间质瘤的临床资料。结果：共24例,男14例,女10例;12-74岁,平均50.30岁;以食管梗阻为主要临床表现。恶性间质瘤16例,良性间质瘤7例,交界性1例;手术切除21例。平均随访14个月,死亡1例,无复发。结论：食管间质瘤较少见,确诊依赖病理免疫组化,手术是首选治疗方法。     

26例原发性纵隔恶性生殖细胞瘤的诊治

目的:探讨原发性纵隔恶性生殖细胞瘤的诊治及外科手术的作用.方法:对26例收治的原发性纵隔恶性生殖细胞瘤的临床资料进行回顾性分析.结果:22例手术治疗患者中,11例根治性切除,10例姑息性切除,1例探查,手术并发症发生率及死亡率分别为18.2%和9.1%,其中12例术后给予以顺铂为主的联合化疗,4例予以放疗.手术治疗患者术后病理为无性生殖细胞瘤12例,精原细胞瘤5例,未成熟畸胎瘤5例.3例未成熟畸胎瘤及1例胚胎癌患者明确诊断后未手术而给予放疗或放、化疗.本组26例患者中仅2例精原细胞瘤生存满5年,17例已证实死亡,除2例手术死亡外均死于肿瘤复发转移.结论:原发性纵隔恶性生殖细胞瘤的治疗应强调以化疗为主的综合治疗,外科切除只宜做为阶段性的辅助手段,手术时机把握应以具体患者情况而定.     

Treatment and Prognosis of Primary Adrenalcortical Adenocarcinoma-Report of 21 Cases

OBJECTIVE To analysize the treatment and prognosis of primary a-drenalcortical adenocarcinoma. METHODS Clinical data from 21 cases of patients with primary adreno-cortical adenocarcinoma were reviewed. There were 14 males and 7 females, ranging in age from 2 to 67 years (mean 45.6). The tumors were unilateral, and on the right side in 16 and on the left in 5. The sizes of the tumors ranged from 4 to 28 cm (mean 12 cm). There were 13 functional tumors with excess hormone production and 8 nonfunctional. Six cases showed evidence of adjacent tissue or lymph node invasion, and 3 cases had developed metastases. Radical curative resection was employed for 15 cases, 4 received a palliative operation and 2 only a biopsy. RESULTS All the cases were followed-up for 1 to 5 years. Overall 2 and 5-year survival rates were 52.4% (11/21) and 23.8% (5/21), respectively. CONCLUSION Adrenocortical adenocarcinoma appears to have a poor prognosis. Early diagnosis and curative surgery were the most effective treatments.