高强度超声联合阿霉素治疗兔门静脉癌栓

目的探讨高强度超声(HI U)联合抗癌药物治疗兔门静脉癌栓的有效性和安全性。方法45只实验兔分为4组,VX2肿瘤种植于门静脉腔内5d,15只接受HI U治疗(HI U组);10只接受阿霉素治疗(ADM组);10只接受HI U ADM联合治疗(HI U ADM组);10只接受假照治疗(对照组)。从HI U组中随机取5只兔于治疗后7d测量门静脉压,处死后对其进行病理学及电镜检查,并观察记录各组兔生存时间。结果治疗后门静脉压无明显降低(P>0.05)。靶区组织发生凝固性坏死,靶区内门静脉无破裂及出血,HI U组、HI U ADM组较ADM组、对照组生存时间明显延长(P<0.05);ADM组、对照组两组间生存时间比较差异无统计学意义(P>0.05)。结论HI U联合抗癌药物能够较为安全有效地治疗兔门静脉癌栓。     

肝细胞癌门静脉癌栓中肝细胞生长因子及其受体的表达

目的研究肝细胞生长因子（HGF）及其受体C-Met在肝细胞癌门静脉癌栓中的表达，探讨HGF及C-Met的表达与门静脉癌栓形成与发展的关系。方法用半定量逆转录-聚合酶链反应（RT-PCR）技术检测HGFmRNA及C-MetmRNA在20例肝细胞癌门静脉癌栓及其癌旁组织、10例无门静脉癌栓形成的肝细胞癌和癌旁组织及10例正常肝组织中的表达。结果HGF及C-Met在肝癌及癌栓中的阳性表达率均显著高于正常肝组织及癌旁组织，差异有统计学意义（P〈0．05），HGF及C—Met在癌栓中及肝癌中表达的阳性率比较差异无统计学意义（P〉0．05），HGF与C—Met在各组织中的表达阳性率高低差异无统计学意义（P〉0．05）。HGF及C—Met在肝癌及癌栓中的表达量均显著高于正常肝组织及癌旁组织，差异有统计学意义（P〈0．05），HGF及C-Met在癌栓中表达量显著高于其在肝癌中表达量（P〈0．05），HGF与C-Met在各组织中的表达量差异无统计学意义（P〉0．05）。结论HGF及C-Met参与了肝癌的形成，而肝癌患者HGF及C-Met量的升高可能是肝癌发展形成门静脉癌栓的原因之一，HGF及C—Met可作为门静脉癌栓形成的监测指标。     

粉防己碱联合阿霉素对人膀胱癌BIU-87／ADM细胞裸鼠移植瘤抑瘤率影响的研究

目的观察粉防己碱（tetrandrine,Tet）联合阿霉素（adriamycin,ADM）对人膀胱癌BIU87／ADM细胞裸鼠移植瘤抑制率的影响。方法30只裸鼠腋部皮下接种BIU87／ADM移植瘤细胞,第22天扪及一小结节,随机分为对照组（生理盐水;6只）、ADM组（1．0mg／kgADM;6只）、Tet低剂量联合ADM组（1．0μg／mlTet＋1．0mg／kgADM;6只）、Tet中剂量联合ADM组（3．0ptg／m{Tet＋1．0mg／kgADM;6只）和Tet高剂量联合ADM组（5．0~g／mlTet＋1．0mg／kgADM;6只）,每4天于肿瘤局部注射生理盐水、ADM以及不同剂量的Tet＋1．0mg／kgADM,每4天测量肿瘤大小,并绘制肿瘤生长曲线;药物处理结束后取瘤并称取重量,依据公式计算抑瘤率。结果Tet各剂量联合ADM组肿瘤的体积、瘤重与对照组比较,差异有统计学意义（P％0．05）;Tet中、高剂量联合ADM组肿瘤体积、瘤重与ADM组比较,差异有统计学意义（P〈O．05）。结论Tet联合ADM能够明显增加ADM对膀胱癌细胞B1U一87／ADM移植瘤杀伤的敏感性,Tet剂量越高,抑制作用越明显。     

门静脉灌注化学治疗药物治疗肝癌伴门静脉癌栓的临床价值

目的：探讨肝细胞肝癌伴门静脉癌栓（portal vein tumor thrombi,PVTT)外科手术后，门静脉灌注化学药物治疗的价值。方法：本组45例伴门静脉主干或I级分支癌栓的肝癌患者，在行手术切除后随机分为两组，一组行肝动脉化疗，同时行门静脉置泵灌注化疗（治疗组），另一组行肝动脉化疗（对照组）。结果：治疗组6个月，12个月，18个月的生存率分别为86％（18例），76％（16例），48％（10例）；对照组为75％（18例），58％（14例），33％（8例）。两组比较差异有显著意义（P＜0．05）。结论：肝癌伴PVTT手术切除术后，为防治门静脉癌栓导致肝内转移，复发，术中除应尽量取净癌栓组织外，门静脉灌注化疗是有效的措施之一。     

氯沙坦联合红景天治疗早期糖尿病肾病的临床研究

目的探讨氯沙坦联合红景天治疗早期糖尿病肾病的疗效。方法将64例早期糖尿病肾病（DN）患者随机分为氯沙坦对照组（对照组）和氯沙坦联合红景天治疗组（联合治疗组），每组32例。疗程均为6个月。结果①与治疗前比较，治疗组治疗后血清总胆固醇（TC）、甘油三酯（TG）明显下降（P〈0．05），高密度脂蛋白（HDL）明显上升（P〈0．05），对照组上述指标变化不明显（P〉0．05）；②两组均能显著改善早期DN患者尿微量白蛋白排泄率（UAER）（P〈0．05），而联合治疗组较对照组疗效显著（P〈0．05）；联合治疗组治疗后血肌酐（SCr）明显下降（P〈0．05），而对照组指标变化不明显（P〉0．05）；③两组治疗后空腹血糖（FBG）、血尿素氮（BUN）、血白蛋白（Alb）均无明显变化（P〉0．05）。结论氯沙坦联合红景天治疗早期DN疗效确切。     

肝癌常用介入治疗方法疗效比较的实验研究

目的评价四种常用介入方法治疗兔VX-2肝癌的效果及不良作用。方法50只荷瘤兔随机分5组，表柔比星＋超液化碘油乳化剂注入组（EPI＋LP）；无水酒精组（PEI）；肝动脉化疗栓塞组（TACE）；射频消融组（RFA）；生理盐水治疗组（NS）。术前、术后2周行MRI扫描，比较肿瘤平均增长率；检测术前、术后肝肾功能指标；2周后取出肿瘤，比较坏死率，并行病理检查。结果除EPI＋LP组与TACE组外，各组两两间肿瘤平均增长率均有显著性差异（P〈0．05），RFA组肿瘤平均增长率最小。5组实验兔肿瘤坏死率均有显著性差异（P〈0．05），RFA组坏死率最大，达（98．43±2．76）％。除NS组外，各组肝肾功能指标术前、术后均有统计学差异（P〈0．05），RFA组及TACE组变化最明显。病理上，RFA组肿瘤呈重度坏死，有多核巨细胞反应，肉芽肿形成；其他各组呈轻-中度坏死，PEI组出现空泡变性（脂肪变性），部分血管有癌栓；各组胆管未受破坏。结论RFA的疗效最佳，PEI最差，EPI＋LP及TACE居中。临床上，应在兼顾肝肾功能情况下，选择适当的介入治疗方法。     

分断流联合术与断流术治疗门静脉高压症的前瞻性对比研究

目的前瞻性观察对比脾肾分流加贲门周围血管离断术与单纯门奇断流术的特点和临床疗效。方法将1984～2004年入院的门静脉高压症360例患者随机分为两组：分断流联合术（250例）和门奇断流术（110例）。通过临床疗效观察、彩色多普勒（DCFI）检查、术中动态观察自由门静脉压（FPP）和数字减影血管造影（DSA），观察手术前后门静脉血流动力学的变化并进行对比研究。结果（1）术后出血：分断流联合术组近期无1例出血，远期出血率为8．0％，断流术组近期再出血率为5．5％，远期再出血率为17．6％（P〈0．05），（2）肝性脑病发生率：分断流组为5．6％，断流组为4．4％（P〉0．05）。（3）门静脉血流动力学变化：分断流术后的FPP降低较断流术后明显（P〈0．05）；分断流术后门静脉直径（DPV）缩小较断流术后明显（P〈0．05）；分断流术后门静脉血流量（PVF）减少与断流术后无明显差异（P〉0．05）。结论分断流联合术降低FPP，较断流术明显，可较为有效的缓解了门静脉学高动力血流状态，且其临床疗效优于断流术。     

RFA联合ＴＡＣＥ和HFH对兔肝VX2肿瘤的作用

目的探讨射频消融（RFA）联合高频热疗（HFH），经动脉化疗栓塞（TACE）治疗兔肝VX2肿瘤的作用。方法将兔肝VX2肿瘤模型分为：RFA＋TACE＋HFH治疗组（A组），RFA＋HFH治疗组（B组），RFA＋TACE治疗组（c组）和TACE＋HFH治疗组（D组）。观察各组治疗前后的血清谷丙酸转氨酶（ALT），肝脏热休克蛋白（HSP70）及脾脏树突状细胞（DCs）表达。结果（1）ALT：在治疗组第1天均明显升高，A组升高幅度最大，14d内恢复最慢；B组上升幅度最小，恢复最快（P〈0．05）。（2）HSP70表达：A组治疗后明显上升，14d时仍为最高；D组上升幅度最小，14d时夷达值最低（P〈0．05）。（3）DCs表达：A，B组无明显差异（P〉0．05），并且组内14d和7d时两者差异无显著性。C，D组明显低于其余两组，且下降较快（P〈0．05）。结论RFA＋TACE＋HFH能更好地激活HSP70和树突状细胞的表达，增加机体抗肿瘤免疫的能力，但同时损害肝功能最明显。联合运用时须综合考虑。     

经肝动脉化疗栓塞联合门静脉化疗对肝癌伴门静脉瘤栓的治疗价值

目的 探讨肝癌伴门静脉瘤栓患者术后经肝动脉化疗栓塞联合门静脉化疗对患者生存率的影响。方法 111例肝癌伴门静脉瘤栓患者随机分成3组，分别行单纯手术（A组）、术后肝动脉化疗栓塞（B组）和术后肝动脉化疗栓塞联合门静脉化疗（C组），分析各组患者复发率和生存率的差别。结果 ①B组的0．5和1年的复发率低于A组，其0．5年的生存率高于A组（均P〈0．05）；②C组的0．5、1、2和3年复发率均低于A组，生存率均高于A组（均P〈0．05）；③C组在第2年的复发率低于B组，在1和2年的生存率高于B组（均P〈0．05）；④3个组术后5年的复发率和生存率比较差异无统计学意义；⑤治疗方式、肿瘤大小和瘤栓位置是影响患者预后的独立因素（x2^=20．43，P〈0．01），结论 肝癌伴门静脉瘤栓患者，术后辅以肝动脉化疗栓塞联合门静脉化疗有助于提高近期疗效，但远期效果尚不肯定。     

手术切除及经门静脉免疫化疗治疗肝细胞癌合并门静脉癌栓

目的 评估对肝癌合并门静脉癌栓患者实施手术切除联合术后门静脉化疗加免疫治疗的临床效果.方法 采用随机化前瞻性临床试验方案,选取术后确诊为肝癌合并门静脉主干及第一级分支癌栓患者随机纳入研究组和对照组,行肿瘤切除＋癌栓取出术,研究组术后经门静脉途径行PIAF（5-FU、阿霉素、顺铂,α-IFN）方案化疗,对照组术后仅行常规治疗.随访观察复发或转移情况,进行统计分析.结果 研究组与对照组比较,研究组中位生存时间较对照组明显延长（12.5个月vs.7.0个月,P=0.0073）;Cox多因素分析显示治疗方法选择（是否化疗）是影响患者生存率的独立预后因素.研究组肿瘤中位复发时间较对照组延长（7.0个月vs.3.0个月,P=0.0089）;Cox多因素分析表明仅治疗方案的不同（手术后化疗与否）和AFP值对患者的复发有显著影响（P＜0.05）.结论 HCC合并PVTT患者,行肿瘤切除＋癌栓取出术,手术后辅以经门静脉＋皮下的PIAF免疫化疗是有效治疗HCC合并PVTT患者的综合疗法.     

Intracerebral hemorrhage in a patient with isolated abdominal stop-flow infusion chemotherapy

A case of unresectable liver metastases in a patient with breast cancer is reported. Isolated abdominal perfusion chemotherapy was performed in the patient, a 48-year old woman who complained of severe abdominal pain despite receiving analgetic treatment. The perfusion was uneventful, but 3h later the patient showed dilated and light-fixed pupils. A cranial computed tomography scan revealed a massive intracerebral hemorrhage and intracerebral metastasis. Brain death developed and the patient died 26h after stop-flow perfusion. Based on this experience, any intracerebral metastasis should be considered as a contraindication for abdominal and pelvic stop-flow chemoperfusion.     

22例小儿肝脏肿物的治疗体会

【摘要】〓目的〓探讨小儿肿物的临床特征、治疗方法及效果。方法〓回顾性分析我科在2011年1月~2013年6月收治22例小儿肝脏肿物的临床资料,17例患儿行手术治疗,8例肝母细胞瘤患儿术前进行了介入栓塞治疗,10例患儿手术过程中未阻断肝门,7例患儿手术应用了CUSA和(或)Ligasure能量平台。结果〓病理证实肝母细胞瘤14例,未分化胚胎性肉瘤1例,局灶性结节性增生3例,婴儿型血管内皮瘤2例,纤维性错构瘤1例,单纯性囊肿1例。肝切除手术应用CUSA和Ligasure的有8例,平均失血量为121 mL;钳夹法肝切除手术9例,平均失血量为248 mL;两组失血量间的差异有统计学意义(P<0.05)。术中阻断肝门的有7例,平均失血量为170 mL;未阻断肝门的有10例,平均失血量为198.64 mL;两组失血量间的差异无统计学意义。手术7例良性肿瘤术后均无病生存。1例未分化肝胚胎性肉瘤手术后6个月死亡。14例肝母细胞瘤中,9例行手术切除患儿至今仍存活;5例未手术患儿4例死亡,1例存活。结论〓利用精准肝切除的方法治疗小儿肝脏占位性病变,不论良恶性,都是安全有效的,但对于侵犯肝门或超过3个肝叶以上的肿瘤还需进一步的提高治疗手段。     

Leiomyosarcoma of the urinary bladder in a patient with bilateral retinoblastoma

Abstract:   We report a case of bladder leiomyosarcoma in a 27-year-old woman who had previously been treated with surgery and radiation for bilateral retinoblastoma. The patient was admitted to hospital with discomfort on micturition. Cystoscopy revealed a bladder tumor covered by normal urothelium. Transurethral resection of the bladder tumor was performed, and the histopathological diagnosis was leiomyosarcoma. Partial cystectomy was performed. The leiomyosarcoma of the bladder did not invade the muscle layer. However, bladder tumors recurred at new intravesical locations repeatedly. After transurethral resection of the bladder tumor had been performed twice, total cystectomy and creation of an ileal conduit were performed.     

Inflammatory myofibroblastic tumor of the urinary bladder in a 27-year-old woman with systemic lupus erythematosus

Abstract:   Spindle cell lesions of the urinary bladder are uncommon tumors, and are most often spindle cell (sarcomatoid) carcinomas, non-neoplastic reactive mesenchymal proliferations, or soft tissue sarcomas. Inflammatory myofibroblastic tumors (IMTs) may also occur in this location. Herein, we report an unusual case of an IMT arising in a previously uninstrumented bladder of a 27-year-old African American female with systemic lupus erythematosus. To our knowledge, IMT has not been reported in the clinical setting of rheumatologic disease.     

后腹腔镜肾输尿管全长与膀胱袖状切除术的三种术式比较（附110例报告）

目的：探讨后腹腔镜肾输尿管全长与膀胱袖状切除的最佳手术方式.方法：对110例肾盂或输尿管癌伴膀胱癌患者采用三种不同术式行肾输尿管全长及膀胱袖状切除术：A术式即后腹腔镜肾输尿管全长切除＋下腹部切口膀胱壁内段袖状切除术,共行32例 B术式即后腹腔镜肾输尿管全长切除＋经尿道电切膀胱袖状切除＋经腹部切口取肾术,共行19例 C术式即经尿道电切膀胱袖状切除＋后腹腔镜肾输尿管全长切除＋经腹部切口取肾术,共行59例.结果：手术经过均顺利.三种术式的手术时间、术中出血量、平均住院时间差异无统计学意义.围手术期死亡3例.出院后获定期随访58例,随访8～85个月,平均38.3个月,46例失访.因肿瘤转移死亡4例,因气胸、脑血管病死亡各1例.三种术式术后早期并发症、对侧病变、膀胱痛复发情况差异无统计学意义 但C术式术后死亡及转移例数较少.结论：肾盂或输尿管癌伴膀胱癌者可优先选择经尿道电切膀胱袖状切除＋后腹腔镜肾输尿管全长切除＋经腹部切口取肾术,而仅有肾盂或输尿管癌者可考虑行后腹腔镜肾输尿管全长切除＋下腹部切口膀胱壁内段袖状切除术.     

Lower urinary tract dysfunctions in patients with spinal cord tumors

AIMS: The objective of this study was to elucidate the incidence and pathophysiology of lower urinary tract dysfunctions (LUTS) in patients with spinal cord tumors. METHODS: Urinary questionnaire and urodynamic studies were done in 76 patients with spinal cord tumors. RESULTS: The patients included 56 with cervical-thoracic (C1 to T11) and 20 with lumbosacral tumors. The lumbosacral tumors consisted of 12 epiconus/conus medullaris (below T11) and 8 cauda equina tumors. These tumors were further subdivided into intramedullary, intradural extramedullary, and dumbbell-type. More than 83% of the patients had urinary symptoms. Patients with cervical-thoracic tumors commonly had voiding symptoms (75%). Detrusor hyperreflexia (39%), and detrusor areflexia on voiding (21%) were the main urodynamic features. Patients with epiconus/conus medullaris tumors commonly had voiding symptoms as well (58%), but decreased urge to void (50%), detrusor-sphincter dyssynergia (42%), and detrusor areflexia on voiding (32%) were the main features. Patients with cauda equina tumors commonly had storage symptoms (88%), of which sensory urgency was most common (63%). Severe LUTS occurred in the epiconus/conus medullaris tumors and in the intramedullary tumors. These dysfunctions tended to appear late and rarely appeared as the initial symptom in the course of the disease. There was no significant relationship between neurologic abnormalities and LUTS. Urodynamics showed that spinal cord tumors cause a variety of LUTS, depending on the location and the type of the tumor. CONCLUSION: Spinal cord tumors are commonly accompanied by LUTS. Clinical and urodynamic evaluation is crucial to diagnosis and management since there is little relationship between symptoms and findings.     

Surgically treated dumbbell schwannoma arising in the brachial plexus with intrathoracic extension

We report excision of a brachial plexus dumbbell tumor in the superior mediastinum in single-stage surgery via an anterior approach. A 40-year-old man found in the chest radiography to have a 3.5 cm mass in the right superior mediastinum was confirmed by chest computed tomography and cervical and chest magnetic resonance imaging to have a mass in the C-7 vertebral body and pedicle. The lesion was found to be a dumbbell schwannoma extending through the vertebral foramen. We attempted to resect the tumor via an anterior approach without changing the position. The methods appears to be safe and enabled us to avoid injuring adjacent nerves and vessels.     

Retroperitoneal extragonadal germ cell tumor in a patient with Klinefelter''s syndrome

A 22-year-old man was diagnosed with retroperitoneal seminoma associated with Klinefelter's syndrome. The tumor was 14 x 12 cm in size and surrounded the superior mesenteric artery. He received induction chemotherapy with bleomycin, etoposide and cisplatin (BEP) followed by salvage chemotherapy with paclitaxel, ifosfamide and cisplatin (TIP). The tumor considerably decreased in size and remains as a poorly defined plaque. At the time of writing, he is being followed closely and is free from progression.     

Plexiform fibrohistiocytic tumor of the hand: a case with late recurrence

A case of a rare and recently described neoplasm of the superficial soft tissue that occurs mainly in children and young adults is described. The lesion demonstrates morphological features reminiscent of both fibrous histiocytoma and fibromatosis. Microscopically, this tumor is characterized as a multinodular or plexiform proliferation of histiocyte- and fibroblast-like cells associated with multinuclear giant cells. Because of its unpredictable biological behavior, high recurrence rate, and potential for regional lymphatic metastasis, the diagnosis of plexiform fibrohistiocytic tumor raises important treatment considerations.