胸腺类癌外科治疗的长期结果

目的探讨胸腺类癌的临床表现,分类与预后的关系,以及手术方式及术后辅助治疗特点,以提高对该病的认识。方法回顾性分析北京协和医院1980年1月至2006年1月18例胸腺类癌的外科治疗和随诊结果。开胸探查活检2例,姑息性切除2例,完整切除14例,包括2例上腔静脉系统切除移植人工血管。采用寿命表法计算生存率,用Cox单因素回归模型分析胸腺类癌预后的影响因素。结果2例行开胸探查患者分别于术后1年和2年死亡;2例姑息性切除术后患者症状暂时缓解;完整切除患者除1例合并柯兴综合征术后2周死于败血症,其余13例术后完全恢复,随诊5个月至15年良好。全组3年、5年、10年生存率分别为72.6%、60.5%和40.3%。经Cox单因素分析结果:纵隔淋巴结转移(P=0.047)、病理类型(P=0.000)、手术方式(P=0.000)和术后综合治疗(P=0.018)是影响预后的因素。结论胸腺类癌不同于胸腺瘤、胸腺癌,临床诊断困难;病理学分典型和不典型胸腺类癌,两者临床表现和预后明显不同。不典型类癌恶性程度高,切除后容易复发和转移,预后较差。彻底切除肿瘤以及受侵的组织和器官,可以明显提高长期生存率。术后放疗、化疗有一定辅助作用。     

薄层斜轴位T2WI扫描在判断子宫恶性肿瘤宫颈浸润范围中的价值

目的 探讨薄层斜轴位扫描在判断子宫恶性肿瘤宫颈浸润范围中的价值. 资料与方法 回顾性分析53例经手术病理证实的子宫恶性肿瘤患者的MRI资料,比较普通轴位、旁矢状位及薄层斜轴位T2WI 3种扫描方法对判断子宫恶性肿瘤宫颈浸润范围的准确性. 结果 普通轴位、旁矢状位和薄层斜轴位T2WI判断宫颈病变浸润范围的准确性分别为77.36%、60.38%和92.45%.普通轴位与旁矢状位相比（χ2=3.56,P＞0.05）,两者之间差异无统计学意义;薄层斜轴位与旁矢状位比较（χ2=15.13,P＜0.05）,两者之间差异有统计学意义.薄层斜轴位与普通轴位比较（χ2=4.71,P＜0.05）,两者之间差异有统计学意义. 结论 对于宫颈病变浸润程度和范围的准确评价,薄层斜轴位扫描是一种非常必要而且有用的方法,应在常规轴位扫描的基础上加扫薄层斜轴位,提高宫颈病变浸润程度和范围判断的准确性.     

CT灌注成像在乳腺肿瘤中的临床应用价值

CT灌注成像作为功能成像技术之一,将组织学功能与解剖学结构完美地结合在一起,在血管性病变及肿瘤性病变中有着很高的临床应用价值,在乳腺肿瘤中的应用尚处于起步阶段。此技术可用于乳腺肿瘤的临床诊断、鉴别诊断及治疗监测等几个方面,因而有着广阔的应用前景。本文就CT灌注成像技术的基本原理及其在乳腺肿瘤中的临床应用予以综述。     

Risk factors for capillary leakage syndrome after bone marrow transplantation

 Age, hematopoietic growth factors, cyclosporin A, mode of bone marrow transplantation (BMT) (autologous, allogeneic-related, unrelated), and underlying disease were assessed as potential risk factors for capillary leakage syndrome (CLS) in 96 patients after BMT. CLS was defined as unexplained weight gain of >3% within 24 h and nonresponsiveness to furosemide. CLS occurred in 9/21 patients after unrelated compared with 2/33 after allogeneic-related BMT (p=0.0017) for hematopoietic disorders (n=54) and in 6/7 patients after allogeneic-related compared with 3/35 after autologous BMT (p=0.0001) for solid tumors (n=42). Hematopoietic growth factors and cyclosporin A were no signficant risk factors on their own. We conclude that unrelated BMTs or high-intensity conditioning regimens used in combination with allogeneic-related BMT are the main risk factors for CLS. Received: 6 January 1997 / Accepted: 10 March 1997     

Chemotherapy in intracerebrally transplanted tumors induced with transplacental administration of ethylnitrosourea in rats

Summary Four tumors of the spinal cord were induced with ethylnitrosourea in rats by transplacental administration and transplanted into the brains of animals of the same strain. One of these intracerebrally grafted tumor lines (G-XIII) was followed up over the first 10 passages and treated with CCNU and other alkylating drugs. The results were compared with findings in an earlier established line (G-XII) in passage 12 and 59, which in the first instance was sensitive to CCNU. The CCNU application prolonged survival in treated animals in various treatment schedules in the first 10 intracerebrally grafted generations of the tumor up to 59%. Induction times of tumors became increasingly shorter. The susceptibility of early passages was similar in both lines. Its loss in late passages went together with diffuse growth of the tumor and reticulin fiber production. In addition, glial fibrillary acid protein expression and formation of intermediate filaments in perivascular tumor cells was lost.     

The chemotherapy of posterior Fossa tumors in childhood

Conventional therapy for brain tumors, consisting of neurosurgical intervention and radiotherapy, has not resulted in the successes achievable in other childhood malignancies. The role of adjuvant chemotherapy, well defined in many childhood cancers, has not yet contributed significantly to the treatment of children with brain tumors. Chemotherapy of recurrent tumors has produced regressions but no cures. The most active agents identified to date in the treatment of recurrent posterior fossa tumors include cisplatinum, cyclophosphamide and methotrexate. Future efforts will need to focus on the rational selection of drugs for study in limited agent histology-stratified phase II trials, with advancement of active agents into large randomized phase III adjuvant therapy trials.     

Primary breast lymphoma.

Primary breast lymphoma (PBL) is a rare tumor of the breast. Three cases of PBL are being described. All three cases achieved remission following biopsy, chemotherapy, and/or radiotherapy. The literature is extensively reviewed with emphasis on true incidence of PBL and survival rates.     

卵巢浆液性肿瘤几种形态测量指标的比较

应用体视学方法对卵巢浆液性肿瘤进行研究，从定量的角度对卵巢良性、交界性及恶性肿瘤的五项指标进行比较，包括（１）细胞核长短轴之比；（２）结缔组织间质与上皮细胞体积密度之比；（３）细胞核与细胞浆体积密度之比（核浆比）；（４）细胞核平均直径；（５）乳头的上皮厚度。结果表明恶性肿瘤核浆体积密度比明显高于交界性及良性肿瘤（ｐ＜０．０１）；恶性肿瘤结缔组织间质与上皮细胞体积密度之比明显小于交界性及良性肿瘤（Ｐ＜０．０１）。     

Perioperative tumor localization for laparoscopic colorectal surgery

Background: Because of the inability to palpate colonic tumors during laparoscopy, their location must be precisely identified before resection is undertaken. Method: A retrospective study was performed of 58 patients in order to be able to describe our methods of tumor localization for laparoscopic colorectal operations and to review their effectiveness. Results: In all patients, the entire colon was examined preoperatively by colonoscopy. In one patient, preoperative colonoscopic localization was inaccurate. In 31 patients, tumors were easily detectable at surgery. In five patients with the tumor in the right colon, even though the lesion was not detectable at surgery, right colectomy was performed without marking because preoperative colonoscopy reliably identified the lesion adjacent to the ileocecal valve. Twenty-two patients required some type of procedure to localize the tumor. The procedures and their problems were as follows: preoperative tattoo (five)—tattoo not visualized (one); intraoperative colonoscopy alone (six), combined with intraoperative tattoo (four) or clip (three)—poor operative exposure due to bowel distension (nine), hard to see the clip (three), dislodged clip (two), inadequate resection margin (one); intraoperative proctoscopy alone (two), combined with laparoscopic stitch (two)—no problems. In no patient was tumor present at a resection line and in no patient was the wrong segment resected. Conclusions: Reliable preoperative identification of the tumor adjacent to the ileocecal valve can permit right colectomy without marking. Lesions in the upper rectum can be approached via intraoperative proctoscopy ± suture placement. If the surgeon anticipates intraoperative localization may be difficult, lesions other than rectal or cecal ones should probably be marked by preoperative tattooing. Further studies regarding the technique of tattooing are warranted. Received: 18 July 1996/Accepted: 10 March 1997     

恶性胃肠道间质瘤34例临床分析

目的探讨恶性胃肠道间质瘤临床、病理特点。方法回顾性分析2002—2004年收治的34例恶性胃肠道间质瘤的临床和病理资料。结果病人临床表现中腹痛与消化道出血较常见，发生部位最常见为小肠和胃；肿块平均直径10．2cm；术后均经病理学诊断为恶性。术后12例复发，4例死亡。结论肿瘤大小、位置、核分裂像、免疫组化指标是判断胃肠道间质瘤良、恶性的重要指标，对病人诊断为恶性或潜在恶性的胃肠道间质瘤必须进行包括手术治疗在内的综合治疗。