胃肠道神经内分泌肿瘤诊治的研究进展

胃肠道神经内分泌肿瘤是一组异质性肿瘤,曾被认为是一种罕见的肿瘤.根据近几年的数据,其发病率已明显升高.胃肠道神经内分泌肿瘤临床表现多样,嗜铬蛋白A是其最重要的生化标志物.传统的影像学检查以及生长抑素受体显影有利于诊断.治疗方法包括手术切除、生物治疗、放射性核素治疗以及化学疗法.本文对其诊断方法和治疗方法的研究进展进行综述.     

胃肠道肿瘤的微创治疗进展

胃肠道肿瘤是我国常见的肿瘤之一,微创治疗的目的是在确保胃肠道肿瘤外科根治性治疗的前提下,将手术创伤最小化及术后生活质量最大化.虽然胃肠道肿瘤微创治疗在我国总体起步稍晚、地域发展不平衡,但近年发展速度、应用水平已得到国际同行的广泛认可,现就胃肠道肿瘤的微创治疗进展进行综述.     

胃肠道肿瘤的分子标志物与个体化治疗

胃肠道肿瘤是我国的常见恶性肿瘤．严重影响中国人的健康。随着肿瘤分子标志物研究的深入和新型抗肿瘤药物的开发应用,胃肠道肿瘤的治疗模式正在不断发生着变化．越来越多的分子靶向药物如曲妥珠单抗、西妥昔单抗和贝伐单抗等开始应用于临床。基于肿瘤分子分型制定适合患者的个体化治疗策略必将使更多的患者从治疗中获得益处,是未来胃肠道肿瘤治疗的必然趋势。     

精确放疗在胃肠道肿瘤综合治疗中的应用

中晚期胃肠道肿瘤单一治疗手段效果不理想,放疗作为胃肠道肿瘤综合治疗的重要组成部分．具有明确的临床价值。放疗可使肿瘤降期、提高手术切除率并保留器官功能．同时还能降低局部复发率和提高生存率。精确放疗适形度好,能最大限度地提高放疗的准确性．使胃肠道肿瘤获得治疗剂量的同时保护正常组织、增加肿瘤控制率并减少并发症的发生。精确放疗在胃肠道肿瘤综合治疗中发挥着越来越重要的作用。     

消化道恶性肿瘤的生物治疗

随着现代分子生物学和基因工程技术的飞速发展,以免疫治疗为基础发展而来的生物治疗日益受到重视,并显示出良好的应用前景,已成为肿瘤治疗的第四模式。一、生物治疗的概念与分类生物治疗也称为生物应答调节剂( biologicalresponse modifier,BRM)治疗。用于肿瘤生物治疗的生物制剂,即生物应答调节剂(BRM)的基本定义为:能够直接或间接地修饰宿主 肿瘤的相互关系,从而改变宿主对肿瘤的生物应答,产生有利于宿主,不利于肿瘤的治疗效应的物质或措施。(一)生物治疗的抗肿瘤作用包括以下几个方面:1.增强机体的防御能力,包括增强机体的天然(主…     

肝癌的生物治疗

生物治疗作为肿瘤治疗的新概念备受关注,已成为继手术、放疗、化疗后肿瘤治疗的第4种模式。随着现代分子生物学技术和基因工程技术的迅速发展,为原发性肝癌的生物治疗开辟了全新的领域,并已取得了越来越多可喜的成果,分子靶向治疗、免疫治疗、基因治疗、内分泌治疗、干细胞治疗等显示出了良好的应用前景。就生物治疗在肝癌治疗中的研究和应用作一概述。     

胃肠道肿瘤新辅助治疗疗效的影像学评价

新辅助治疗可使局部进展期胃肠道肿瘤患者增加根治切除的机会并从中获益。影像学是评价新辅助治疗疗效的重要手段．对于胃肠道肿瘤患者实现个体化诊疗意义重大。胃肠道肿瘤新辅助治疗评效的影像学手段主要包括CT、MRI和PET。RECIST形态学标准是目前国际通用的实体肿瘤评效准则,但其在胃肠道癌新辅助化疗的应用却遭遇瓶颈,陷入多数肿瘤无可测量靶病灶的困境。针对上述缺陷,近年来相关研究热点多集中于功能影像学领域,围绕PET和磁共振扩散加权成像的诸多影像学研究已经初步得到振奋人心的成果．有望为胃肠道肿瘤新辅助治疗的疗效评价提供有潜力的新指标。各种影像模式性能的稳定发挥,有赖于影像模式使用过程中的流程标准化、规范化,以保障治疗前后影像学资料较高的可重复性和可对比性。     

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目前,手术仍是治疗胃肠道肿瘤的最佳选择。但是,随着化疗、放疗、生物靶向治疗等逐步介入到外科治疗领域,使胃肠道肿瘤的治疗模式向着以手术为主的综合治疗方向发展。其中,包括肠内营养治疗的术前治疗及在此领域里发挥的作用已被人们所认识。本期重点讨论这方面的问题。1胃肠道     

胃肠道肿瘤的多学科综合治疗——一个不老的话题

如今的外科医生已普遍大方承认，手术仅仅是综合治疗方式“之一”，而非“唯一”。尽管多学科综合治疗听上去是“老生常谈”的老旧话题，但每次谈及胃肠道肿瘤，其仍然是一个热点议题；而且国内外相关指南每次修订时，化疗和放疗总是修订的一个重点。要进一步提高胃肠道肿瘤的治疗效果，需要胃肠外科医生加强学习以完成自身转型，更好地掌握整体治疗诊治的理念，运用以手术为主并辅以新辅助和辅助化疗、放疗及生物靶向治疗等的综合模式，在“规范化”的基础上真正做到“个体化”治疗每例患者。本期重点内容再次聚焦“综合治疗”，以期巩固和加深胃肠外科医生对综合治疗的认识。     

恶性肿瘤的免疫和基因治疗

肿瘤的生物治疗是在肿瘤免疫治疗的基础上发展起来的,已有一个世纪的历史。近 10 年来,在现代分子生物学和基因工程技术飞速发展的推动下,生物治疗日益受到重视,并显示出良好的应用前景,成为继肿瘤手术治疗、放射治疗和化学治疗三大常规治疗后的第四种治疗模式。肿瘤的生物治疗是指通过肿瘤宿主防御机制或生物制剂的作用以调节机体自身的生物学反应,从而抑制或消除肿瘤的治疗方法。它主要包括免疫治疗和基因治疗。本文就目前腹部恶性肿瘤生物治疗的主要方法和研究热点作一概述。一、免疫治疗肿瘤的形成是肿瘤抗原免疫逃逸的结果,机体的…     

人工关节置换术后感染的生物治疗方法及前景

人工关节假体术后感染是骨科临床治疗的难点、热点。目前假体周围感染(PJI)的治疗方法包括保守治疗和手术治疗,但总的治疗效果不理想。PJI生物治疗是指利用新型杀菌/抑菌剂、生物工程、组织工程等方法,通过破坏生物膜、靶向杀灭致病菌、被动免疫以及局部缓释杀菌剂等方式对PJI进行治疗的新方法。它的出现有望解决PJI治疗存在的一系列难题。本文就近年来PJI生物治疗的研究进展及应用前景进行综述。     

胃癌生物治疗现状与展望

目的 探讨胃癌生物治疗的现状与研究进展。方法 采用文献回顾的方法对胃癌生物治疗现状及其研究进展进行综述。结果 胃癌生物治疗的研究内容及主要方法包括：免疫调节剂治疗。单克隆抗体及其交联物导向治疗，细胞因子治疗，过继免疫治疗，基因治疗等。结论 生物治疗作为手术和放／化疗的有益补充，在胃癌综合治疗中发挥着重要的辅助作用。     

胃肠道多原发癌33例治疗体会

目的 探讨胃肠道多原发癌的诊断、治疗及再次手术效果.方法 回顾性分析1990～2004年间我院收治的胃肠道多原发癌33例的临床资料.结果 本组无手术死亡病例.生存时间10年以上者2例,5年以上者9例,3年以上者17例.另有5例仍在随访中.结论 对胃肠道多原发癌既应注重同时性癌的发现与诊断,也应注重新原发病灶的早期发现与诊断.通过根治性手术,辅以放、化疗,可获得较高的生存率.     

Radiofrequency Ablation of Invasive Breast Carcinomas: A Phase II Trial

Background Local ablative therapy of breast cancer represents the next frontier in the minimally invasive breast-conservation treatment. We conducted a phase II trial to evaluate radiofrequency ablation (RFA) of invasive breast carcinomas. Methods Consecutive patients from two Mexican Institutions with invasive breast cancers < 4 cm, with no multicentric tumors and no previous chemotherapy were included in this trial. Under ultrasound guidance, the tumor and a 5 mm margin of surrounding breast tissue were ablated with saline-cooled RFA electrode followed by surgical resection. Routine pathologic analysis and viability evaluation with NADPH-diaphorase stain were performed to assess tumor ablation. Procedure-associated morbidity was recorded. Results Twenty-five patients were included. Mean patient age was 55.3 years (range 42–89 years). Mean tumor size was 2.08 cm (range 0.9–3.8 cm). Fourteen tumors (56%) were <2 cm. The mean ablation time was 11 minutes using a mean power of 35 W. During ablation, the tumors become progressively echogenic that corresponded with the region of severe RFA injury at pathologic examination. Of the 25 patients treated, NADPH stain showed no evidence of viable malignant cells in 19 patients (76%), with significant difference between tumors <2 cm (complete necrosis in 13 of 14 cases, 92.8%) vs. those >2 cm (complete necrosis 6 of 11 cases, 54.5%) (P < .05). No significant morbidity was recorded. Conclusions RFA is a promising minimally invasive treatment of small breast carcinomas, as it can achieve effective cell killing with a low complication rate. Further studies are necessary to optimize the technique and evaluate its future role as local therapy for breast cancer.     

抗血管生成靶向药物在胰腺神经内分泌肿瘤治疗中的应用及研究进展

胰腺神经内分泌肿瘤(p NENs)是一类具有高度异质性的肿瘤,内科药物治疗是局部不可切除或发生远处转移肿瘤患者的主要治疗方式,包括生物治疗、分子靶向治疗、细胞毒药物治疗。近年来,抗血管生成靶向药物用于p NENs的研究越来越多,为其治疗提供了新思路。     

The invasion-MTT assay as a predictor of liver metastasis using human gastrointestinal carcinomas transplanted in nude mice

The invasion-3-(4,5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide (MTT) assay, which evaluates invasive potential into the reconstituted basement membrane, Matrigel, was performed on 49 human gastrointestinal carcinomas transplanted in nude mice. There were 19 colorectal carcinomas, 10 pancreatic carcinomas, 10 gastric carcinomas, 8 esophageal carcinomas, and 2 bile duct carcinomas. The percent invasion (PI) value of each tumor by the invasion-MTT assay expresses the invasive rate of tumor cells into the Matrigel as a percentage. There were no significant differences in correlations between the PI values and primary tumor site, clinicopathological findings, tumor doubling time, or DNA index; however, the PI values of primary tumors and lymph nodes with liver metastases were significantly higher than those of primary tumors without liver metastasis (P<0.05). Furthermore, the primary tumors with synchronous (P <0.05) or asynchronous (P<0.01) liver metastases showed significantly higher PI values compared with the primary tumors without liver metastases. These results suggest that PI is not only an independent factor to predict liver metastasis, but it also correlates closely with liver metastasis. Thus, the invasion-MTT assay for primary tumors might be clinically useful to predict liver metastasis in patients following surgery for gastrointestinal carcinomas. This study was supported in part by a Grant-in-Aid (no. 08407032) for scientific research and for cancer research from the ministry of Education, Science and Culture of Japan.     

Analysis of protein expression and gene mutation of c-kit in colorectal neuroendocrine carcinomas

Primary neuroendocrine carcinomas of the colon are rare but highly aggressive malignancies. The recent observations that c-kit protooncogene, a tyrosine kinase, is overexpressed in a subset of small cell lung cancer and that selective kinase inhibitors block the in vitro growth of small cell lung cancer cell lines prompted us to investigate the expression and mutation status of the c-kit gene in colorectal neuroendocrine carcinomas. Sixty-six cases of primary colorectal neuroendocrine carcinoma were collected from 13 institutions, including 36 small cell carcinomas and 30 moderately differentiated neuroendocrine carcinomas. Immunohistochemical studies using a polyclonal antibody against c-kit protein (CD117) demonstrated a strong and diffuse cytoplasmic staining in 15 cases (23%), which were relatively equally distributed in the small cell and moderately differentiated subgroups. As controls, 25 conventional colorectal adenocarcinomas, 26 colorectal adenomas and 19 colorectal carcinoid tumors were all negative, whereas 15 gastrointestinal stromal tumors were all positive, for kit expression. In contrast to gastrointestinal stromal tumors, kit-overexpressing neuroendocrine carcinomas showed no mutations in the juxtamembrane domain (exon 11) of the c-kit gene as determined by mutational analysis. Kaplan-Meier analysis with the log-rank test revealed that the patients with kit-positive tumors did not differ significantly in survival from those with kit-negative tumors (P = 0.77). These results indicate that c-kit overexpression observed in a subset of colorectal neuroendocrine carcinomas may not be mediated via activating mutations, and does not appear to be an initiating event during tumorigenesis because of lack of c-kit expression in other types of colorectal epithelial neoplasms. More importantly, our observations may have potential therapeutic implications since specific tyrosine kinase inhibitors have shown promise in the management of patients with kit-expressing malignancies.     

胃肠道恶性肿瘤术后肠梗阻64例原因分析

为探讨胃肠道恶性肿瘤根治性手术后肠梗阻的原因,对1997年6月至2007年4月手术治疗64例胃肠道恶性肿瘤术后发生肠梗阻的临床资料进行回顾性分析,并分析发生肠梗阻的时间及性质与梗阻原因的关系。结果显示,64例肠梗阻中,肿瘤复发原因占60．9％,良性原因占39．1％。72．0％的良性原因所致肠梗阻发生在术后6个月之内,肿·瘤复发所致的肠梗阻全部出现在术后6个月后。肿瘤局部复发是胃癌和直肠癌术后肠梗阻的主要原因,小肠坠入盆腔粘连成团也是直肠癌术后肠梗阻的重要原因。结果表明,根据初次手术时间结合肿瘤原发部位可大致判断肠梗阻的原因。