胰腺黏液性囊性肿瘤临床诊断及治疗

目的 探讨胰腺黏液性囊性肿瘤的诊断和治疗方法.方法 回顾性分析2000年5月至2009年5月经手术并病理证实为胰腺黏液性囊性肿瘤12例患者的临床特点和治疗结果.结果 术前查超声、CT和MRCP,确诊率分别为50.0%(5/10)、66.7%(6/9)和83.3%(5/6).完整手术切除率为91.7%(11/12),姑息切除1例.术后胰漏3例,2例治愈;1例术后1个月死亡,死亡原因为胰漏合并腹腔感染.1例术后25个月死于肿瘤复发转移.结论 胰腺黏液性囊性肿瘤缺乏特异性临床表现,联合应用影像手段可以提高确诊率;对于胰腺黏液性囊性肿瘤应积极手术,根据肿瘤的部位采取不同的手术方式.     

痔上黏膜环切术治疗重度环状混合痔的疗效评价

目的 评价痔上黏膜环切术(PPH)治疗重度环状混合痔的手术疗效.方法 2000年10月至2007年1月采用痔切除吻合器对100例重度环状混合痔患者进行PPH,分析手术效果,总结手术经验.结果 术后100例患者中治愈90例(90%),好转10例(10%),无未愈患者;Ⅰ级疼痛者85例(85%),Ⅱ级疼痛者15例(15%),无Ⅲ级疼痛患者;手术时间、创口愈合时间、住院时间分别为(15±5)min、(6.0±2.6)d、(6.0±1.9)d;术后并发症分别为尿潴留10例(10%),水肿10例(10%).随访2周至20个月,1例再行外痔切除术,其余未见复发,无肛管狭窄、大便失禁发生.结论 PPH大大减轻了传统手术后常见的肛周疼痛,术后并发症少,患者能够很快恢复正常的生活.改进PPH手术的方法 ,可使之容易推广,同时达到更好的治疗效果.     

腹腔镜治疗粘连性肠梗阻的疗效观察

目的比较腹腔镜与开腹肠粘连松解术的疗效.方法将用腹腔镜行肠粘连松解术的29例临床资料与同期行开腹肠粘连松解术的29例患者的治疗结果进行对比分析.结果腹腔镜组与开腹组的手术时间分别为(59.8±12.6)min和(135.8±28.0)min,两组比较差异有统计学意义(P＜0.01);术后使用镇痛药者分别为3.4%(1/29)和86.2%(25/29);术后胃肠功能恢复时间分别为(12.6±4.7)h和(43.6±11.5)h,差异有统计学意义(P＜0.01);住院时间分别为(6.6±1.4)d和(12.5±2.7)d,P＜0.01;两组均无脏器损伤等严重并发症.腹腔镜组术后随访28例,平均随访24个月(2～48个月),未见复发;开腹术后随访27例,平均随访25个月(2～48个月),5例患者出现肠梗阻复发的症状,再次手术治愈.结论腹腔镜肠粘连松解术与开腹手术相比,具有手术时间短、出血少、术后恢复快和并发症少等优点.     

经闭孔入路阴道无张力性尿道吊带术治疗女性压力性尿失禁

目的 评价经闭孔入路阴道无张力性尿道吊带术(TVT-O)治疗女性压力性尿失禁(SUI)的疗效及安全性.方法 女性SUI患者26例,其中Ⅱ型2例,Ⅱ/Ⅲ型23例,Ⅲ型1例.有盆腔手术史1例,伴有急迫性尿失禁2例.所有患者均进行TVT-O治疗.结果 手术时间15～20(18.0 4±2.3)min,术中出血10～40(20.0±3.4)ml.治愈24例(92.3%),改善2例(7.7%).术后发生排尿困难2例(7.7%),1例延长导尿时间后缓解,1例经尿道扩张后好转.大腿内侧疼痛4例(15.4%),经镇痛、消炎药物治疗后症状消失.1例(3.8%)术后尿频,药物治疗后缓解.26例患者术后随访8～16个月,无一例复发,亦未见感染等并发症发生.结论 TVT-O治疗女性SUI操作简单,治愈率高,并发症少且预后良好,是一种较为理想的方法,适合在临床推广.     

乳腺癌保乳手术300例报告

目的:探讨乳腺癌保乳手术的技巧和近期疗效。方法:临床Ⅰ～Ⅱ期女性乳腺癌300例行保乳手术,肿瘤直径<2 cm行区段切除,肿瘤直径≤3 cm行象限切除。标本切缘取标本作快速冰冻切片病理检查并行常规腋窝淋巴结清扫,切缘阴性时整形乳房,腺体拉拢间断缝合。术后残留乳房行全乳照射,剂量5 000 cGy,术后1周开始接受全身化疗。放疗后ER+者结合内分泌治疗5年,对300例患者进行复查随访。结果:300例手术全部成功,术后腋下积液30例,积液愈合后放疗。无残留乳腺术后并发症,因局部乳房缺损修复8例,余均整形乳房,腺体拉拢间断缝合。术后随访24～80个月,平均57月,随访率为85.0%(255/300)。局部复发率9.8%(25/255),行残乳切除术,现复查良好。对侧腋窝淋巴结转移发生率1.2%(3/255),时间平均为术后38个月。远处转移率2.0%(5/255),时间平均为术后48个月。死亡率2.0%(5/255),5年无病生存率85.1%(217/255),总生存率98.0%(250/255)。该组病例美容效果良好74.0%,一般17.0%,差9.0%。结论:保乳手术临床效果良好,应该大力推广。     

原发性纵隔肿瘤的诊断与外科治疗

目的 总结原发性纵隔肿瘤的诊断与外科治疗经验.方法 回顾性分析129例原发性纵隔肿瘤患者的临床资料,肿瘤全部切除108例,肿瘤大部分切除9例,单纯探查活检12例.结果 本组手术死亡3例.术后随访5个月至18年,4例良性纵隔肿瘤患者于术后5个月至3年肿瘤复发,余105例良性纵隔肿瘤患者术后预后良好.恶性纵隔肿瘤17例,1、3、5年生存率分别为76.5%(13/17)、58.8%(10/17)和29.4%(5/17).结论 原发性纵隔肿瘤的诊断主要依靠临床症状和X线、CT检查;治疗应以手术为首选,姑息切除术后配合放、化疗可提高疗效.     

长间隔全封闭单层石膏袜治疗50例下肢非动脉性溃疡

目的以“煨脓长肉”和“脓液抑菌作用”原理为理论依据,创立长间隔全封闭单层石膏袜愈合下肢溃疡的新方法。方法选择50例单肢非动脉性溃疡患者为治疗对象,包括静脉性溃疡40例,外伤性溃疡7例和糖尿病溃疡3例。用分段调节加压绷扎法,做第1层湿绷带自下而上的分段调节加压绷扎,外层做单层石膏袜加固包扎。结果平均随访时间为15个月(12~20个月),平均治疗时间为5个月(4~10个月)。40例(80%)患者溃疡愈合(溃疡创面完全闭合,无任何渗出液体,不需换药),10例(20%)患者溃疡好转(溃疡缩小,分泌脓腋减少)。溃疡复发5例(10%)。结论长间隔全封闭石膏袜治疗下肢溃疡简单而有效,脓液浸泡创口有协助加压绷扎的治疗效果。     

曲安奈德局部注射治疗初次发病泪腺炎45例分析

目的 探讨长效皮质类固醇激素曲安奈德局部注射治疗初次发病泪腺炎的效果.方法 自2007-06-2009-09对45例泪腺炎患者采取曲安奈德局部注射的方法进行治疗,45例患者(均为初次发病)单侧泪腺炎.取曲安奈德混悬液40 mg(1 ml)加2%利多卡因0.5 ml,注射于泪腺组织内,局部加压20 min,1个月后重复注射至病情稳定或局部肿块消失,最多注射4次.结果 本组35例注射1次后治愈,观察6个月～2 a未见复发;8例多次注射后治愈;2例局部注射4次无效,改为全身激素治疗,其中1例病情稳定,1例因反复发作最后接受手术摘除泪腺.结论 曲安奈德局部注射治疗初次发病泪腺炎是可行而有效的方法,效果显著.     

胸膜纤维板剥脱术治疗112例慢性结核包裹性脓胸的体会

目的 探讨在外科手术治疗慢性结核包裹性脓胸中,胸膜纤维板剥脱术的手术时机选择.方法 对112例慢性结核包裹性脓胸患者系统抗结核治疗3个月以上,术前体温平稳1个月,结核中毒症状基本缓解后,采用胸膜纤维板剥脱术治疗.结果 术后随访2～24个月,治愈106例(94.6%),好转4例(3.6%),未愈2例(1.8%),经再次手术治愈.病程6～12个月42例患者与其他70例患者比较,完全剥除脓胸纤维板包裹率最高.结论 胸膜纤维板剥脱术治疗慢性结核包裹性脓胸,病程在6～12个月者,纤维板易从胸膜上剥除,可有效缩短手术时间,手术创伤小,术后渗血量少及不易复发,是手术最好的时机.     

复发型脑血管病44例报告

本文报道自1980年8月至1982年10月两年多的期间内收治之复发型脑血管病44例。复发性质:缺血型卒中复发31例,混合型卒中复发8例,出血型卒中复发5例。其中同一侧的缺血型卒中复发21例,不同侧的缺血型卒中复发10例,同一侧的混合型卒中复发5例(皆为先缺后出型),不同侧的混合型卒中复发3例(先缺后出型1例,先出后缺型2例),同一侧的出血型卒中复发1例,不同侧的出血型卒中复发4例。累及双侧的复发型脑血管病合并假性延髓麻痹者11例。治疗结果:基本治愈7例,好转24例,无变化4例,转院1例,自动退院1例,死亡7例。复发次数及间隔时间:本组最少复发一次,最多复发三次。初发与第一次复发间隔最短者为8个月。最长者为14年。间隔一年复发者20例,间隔二年者8     

同步加速调强放疗在早期乳腺癌保乳术后放疗中的临床研究

目的：观察同步加速调强放疗在早期乳腺癌保乳术后放疗的临床疗效和不良反应。方法：选择本院45例于2010年1月-2012年12月接受保留乳房手术切除的早期乳腺癌患者,按照随机数字表法分成研究组和对照组,研究组23例采用全乳放疗并同期加量放疗,1.8~2.4 Gy/d,每周5次。全乳腺照射45 Gy/25F,瘤床区总剂量60 Gy/25 F;对照组22例采用全乳放疗后局部瘤床加量,2 Gy/d,每周5次,全乳腺照射50 Gy/25 F,瘤床区局部加量10 Gy/5 F,总剂量60 Gy/30 F。按RTOG标准评估放疗反应,复发转移率的比较采用χ2检验。结果：两组患者中位随访18个月,研究组23例患者中,1例患者出现同侧锁骨上淋巴结转移,1例出现骨转移,复发转移率为8.70%。患者的放疗反应为1~2级,中位住院放疗时间为30 d。对组照22例患者中1例肝转移,其余均未出现复发和远处转移,复发转移率为4.55%。放疗反应为1~2级,中位住院放疗时间37 d。两组复发转移率比较差异无统计学意义（P=0.968）。结论：同步加速调放疗治疗早期乳腺癌保乳术后患者,缩短了治疗时间,临床疗效良好,放疗反应轻微,值得进一步临床研究及应用。     

三阴性乳腺癌的临床病理学特征及其预后分析

目的 分析三阴性乳腺癌的临床病理学特征及其预后.方法 回顾性分析2005年1月至2007年6月570例乳腺癌患者的临床资料,其中雌激素受体(ER)、孕激素受体(PR)、HER-2均阴性(ER-/PR-/HER-2-)113例(观察组)和ER-/PR-/HER-2+48例(对照组).比较两组的临床病理学特征、复发和生存情况.结果 观察组中位年龄46岁,13.3%(15/113)的患者有乳腺癌或卵巢癌家族史,86.7%(98/113)的病理类型为浸润性导管癌,31.0%(35/113)的患者合并腋窝淋巴结转移,58.4%(66/113)的患者有p53表达,与对照组比较差异无统计学意义(P＞0.05).中位随访时间24个月,失访5例,10例(9.3%,10/108)出现复发转移(其中肝、肺转移6例,骨转移3例,脑转移1例),其中8例(7.4%,8/108)死于远处转移,2年生存率96.2%,与对照组比较差异无统计学意义(P＞0.05).结论 三阴性乳腺癌发病率较高,和ER-/PR-/HER-2+亚型乳腺癌的临床病理学特征相似,预后相仿.     

Comparison of acute skin reaction following morning versus late afternoon radiotherapy in patients with breast cancer who have undergone curative surgical resection

We investigated the relationship between the time of radiotherapy (RT) and treatment outcomes in breast cancer. Patients with pathologic T1–2N0–1 breast cancer who received adjuvant RT in the morning (before 10:00 AM) or late afternoon (after 3:00 PM) were eligible for inclusion in this study. We retrospectively compared the clinicopathologic characteristics, acute skin reaction, and survival outcomes according to the time of RT. The median follow-up duration was 83 months (range, 10–131 months). From the 395 eligible patients, 190 (48.1%) and 205 (51.9%) patients were classified into the morning RT group and the afternoon RT group, respectively. The clinicopathologic characteristics were relatively well balanced between the treatment groups, except for pathologic N-stage (P = 0.0409). Grade 2 or higher acute skin reaction according to the Radiation Therapy Oncology Group criteria was observed in 39 (9.9%) patients, with a higher frequency in the afternoon RT group than the morning RT group (13.7% vs 5.8%, respectively; P = 0.0088). There was no difference in the failure patterns or survival outcomes between the treatment groups. RT in late afternoon was associated with increased Grade 2 or more skin reaction after RT for breast cancer patients, but treatment outcomes did not differ according to the time of RT. Individualized considerations for treatment should be taken into account to reduce the risk of skin reactions.     

Low grade endometrial stromal sarcoma of uterine: review of 17 cases

Endometrial stromal sarcomas (ESS) are the second most common uterine sarcomas. Endometrial stromal sarcomas account for 0.25% of all uterine malignancies. Uterine sarcomas most often affect postmenopausal women. The aim of this retrospective study was to review the experience in the treatment and clinical outcome of low grade malignant endometrial stromal sarcoma. Seventeen patients with histologically proven low grade ESS in department of Gynecologic Oncology of the Vali-e-Asr Hospital, Tehran-Iran, between 1999 and 2008 were included in the analysis. Demographics, pathology, treatment, time to recurrence, salvage therapy and survival information was collected. The median age of our patients was 45.35 ± 6.8 (range 36-61). The median parity of the patients was 5 (range 0-8). Most patients were diagnosed at FIGO stage I. The mean survival for patients with stage I and II was 73.5 ± 35.09 and 57.6 ± 5.37 months, respectively, with mortality rate of 5.9% through a median follow-up time of 68.82 ± 30 months. Of 17 patients, seven cases (35.29%) were disease free at 6 years after hysterectomy. Radiotherapy was administered to four patients (23.53%). Only one patient recurred at 10th month after surgery. Surgeries not preserving ovarian function were helpful to decrease the risk of recurrence compared with those sparing ovarian function.     

Final results from a multicenter prospective study (?JROSG 05–5) on postoperative radiotherapy for patients with ductal carcinoma in situ with an involved surgical margin or close margin widths of 1 mm or less

This multicenter prospective study ( Japanese Radiation Oncology Study Group: JROSG 05-5) aimed to evaluate the effectiveness of postoperative radiotherapy (PORT) in patients with ductal carcinoma in situ (DCIS) with an involved surgical margin or close margin widths of ≤1 mm or less. PORT consisted of whole-breast irradiation (50 Gy in 25 fractions) followed by boost irradiation (10 Gy in 5 fractions). Eligibility criteria were as follows: (i) DCIS without an invasive carcinoma component, (ii) age between 20 and 80 years old, (iii) involved margin or close margin widths of ≤1 mm, (iv) refusal of re-resection, (v) performance status of 0–2, and (vi) written informed consent. The primary endpoint was ipsilateral breast tumor recurrence (IBTR), and secondary endpoints were overall survival (OS), relapse-free survival (RFS), recurrence patterns, and adverse events. A total of 37 patients from 12 institutions were enrolled from January 2007 to May 2009. The median follow-up time was 62 months (range, 28–85 months). The median pathological tumor size was 2.5 cm (range, 0.3–8.5 cm). Of the 37 patients, 21 had involved margins, and 16 had close margins. The 5-year IBTR, OS and RFS rates were 6% (95% confidence interval [CI]: 2–21), 97% (95% CI: 83–99) and 91% (95% CI: 77–97), respectively. Two patients developed local recurrence at the original site after 39 and 58 months. No severe adverse events were found. Our study suggests that this PORT regimen could be a treatment option for patients with DCIS with involved margin or close margin who don''t desire re-resection.     

体重指数对绝经前后Luminal型乳腺癌预后的 影响分析

摘要:目的　探讨体重指数（BMI）对绝经前后Luminal型乳腺癌预后的影响。方法　回顾性收集四川省肿瘤医院2005-2010年收治的298例女性原发Luminal型乳腺癌病例资料并进行随访,中位随访时间为39个月。将病例根据绝经状态分层,采用COX比例风险模型分析不同BMI（BMI＜23.0 kg/m2和BMI≥23.0 kg/m2）对乳腺癌病例无病生存期（DFS）的影响。结果　绝经前和绝经后Luminal型乳腺癌患者的平均BMI分别为（22.77±2.67）kg/m2和（24.47±3.63）kg/m2,差异有统计学意义（P＜0.001）,BMI＜23.0 kg/m2和BMI≥23.0 kg/m2的绝经前Luminal型乳腺癌患者的5年无病生存率分别为78.9%和60.7%（P＝0.036）,BMI≥23 kg/m2可显著增加绝经前Luminal型乳腺癌复发转移的风险（调整HR＝2.451,95%CI:1.100～5.459）,BMI对绝经后Luminal型乳腺癌DFS的影响无统计学意义。结论　高BMI是影响绝经前Luminal型乳腺癌预后的不良因素。     

Retrospective study of conservation surgery for breast cancer with or without axillary dissection

BACKGROUND: It is already known that for breast cancer patients, an axillary dissection or locoregional radiation has no major effect on survival with a simple mastectomy. We analyzed whether axillary dissection improved the prognosis for breast conservation surgery. METHODS: From 1982 to 1995, 31 patients underwent axillary dissection and 33 did not in association with breast conservation surgery performed at our institution. Median follow up was at 55 months, ranging from 3 to 210. Survival rates of patients were analyzed retrospectively. RESULTS: In the dissection group, 8 patients had recurrence and 5 died within 3 years, yielding a relapse-free survival rate of 71%. In the non-dissection group, 7 patients had recurrence, 3 died within 3 years, with a relapse-free survival rate of 79%. Figures for overall survival, relapse-free except breast and relapse-free for breast at 5 years were 93%, 73%, and 96% for the dissection group, and 93%, 89%, and 89% for the non-dissection group, respectively. No difference was found in survival rates between the two groups. Adjusted by Cox's regression analysis, survival rates of overall, relapse-free, relapse-free except breast and relapse-free for breast, at 5 years were 86%, 71%, 77%, and 90% for the dissection group, and 100%, 78%, 85%, and 95% for the non-dissection group, respectively. No survival benefit was found in axillary dissection. The first site of recurrence was in the affected breast in 3 patients and in other sites in 5 patients for the dissection group, while for the non-dissection group it was in the affected axilla in 1 patient, the skin of the affected breast in 1 patient, the affected breast in 3 patients, and other sites in 2 patients. In the non-dissection group, a patient who had recurrence on the skin of the affected breast, subsequently had an axillary recurrence on the same side with plexus paresis. CONCLUSION: In breast conservation, prophylactic axillary dissection seems to be omitted, but the axilla of the affected side should be examined for metastasis while treatment is possible.     

125Iodine monotherapy for Japanese men with low- and intermediate-risk prostate cancer: outcomes after 5 years of follow-up

Data from 305 Japanese men with low-risk (n = 175) or intermediate-risk (n = 130) prostate cancer who underwent ¹²⁵I monotherapy were retrospectively analyzed. Of the 305 patients, 93 received hormonal therapy for a median of 6 months (range, 1–33 months) before implantation. The prescribed dose to the prostate plus 3- to 5-mm margin was set at 145 Gy. The mean dose to 90% of the prostate volume at 1 month (D90) and the prostate volume receiving at least 100% dose at 1 month (V100) were 173.4 Gy and 95.8%, respectively. The median follow-up was 66 months (range, 12–94 months). The 5-year biochemical non-evidence of disease rate was 95.5% (low-risk, 94.2%; intermediate-risk, 97.3%). The 5-year freedom from clinical failure rate was 98.9% (low-risk, 98.9%; intermediate-risk, 99.2%).The initial prostate-specific antigen level was identified as a significant predictive factor for biochemical recurrence (P = 0.029). The late Grade 3 genitourinary toxicity rate was 2.0%. No patients displayed late gastrointestinal toxicity of Grade 3 or worse. Monotherapy with ¹²⁵I showed excellent outcomes with limited morbidity for Japanese men with low- and intermediate-risk prostate cancer after 5 years of follow-up.     

Definitive radiotherapy for primary vaginal cancer: correlation between treatment patterns and recurrence rate

The purpose of this study was to determine the outcomes and optimal practice patterns of definitive radiotherapy for primary vaginal cancer. Between 1993 and 2012, 49 patients were treated with definitive radiotherapy for primary vaginal cancer in three hospitals. Of these, 15 patients (31%) had clinically positive regional lymph node metastasis. A total of 34 patients (70%) received external beam radiotherapy with high-dose-rate brachytherapy (interstitial or intracavitary), and 8 (16%) (with small superficial Stage I tumors) were treated with local radiotherapy. The median follow-up was 33 months (range: 1–169 months). The 3-year overall survival (OS), disease-free survival (DFS), and loco-regional control (LRC) rates were 83%, 59% and 71%, respectively. In multivariate analysis, the histological type (P = 0.044) was significant risk factors for LRC. In Federation of Gynecology and Obstetrics (FIGO) Stage I cases, 3 of 8 patients (38%) who did not undergo prophylactic lymph node irradiation had lymph node recurrence, compared with 2 of 12 patients (17%) who underwent prophylactic pelvic irradiation. For Stage III–IV tumors, the local recurrence rate was 50% and the lymph node recurrence rate was 40%. Patients with FIGO Stage I/II or clinical Stage N1 had a higher recurrence rate with treatment using a single modality compared with the recurrence rate using combined modalities. In conclusion, our treatment outcomes for vaginal cancer were acceptable, but external beam radiotherapy with brachytherapy (interstitial or intracavitary) was needed regardless of FIGO stage. Improvement of treatment outcomes in cases of FIGO Stage III or IV remains a significant challenge.