鼻咽部神经内分泌癌的病理特征和临床分析

目的 探讨鼻咽部神经内分泌癌（neuroendocrine carcinoma，NEC）的临床病理特征、免疫组化特点、治疗方法及预后。方法 回顾性分析12例NEC患者的临床和病理资料，并复习相关文献。 结果 12例患者中，男性10例，女性2例，平均年龄49.4岁，病理类型均为小细胞型NEC。光镜下可见较小瘤细胞，呈圆形、卵圆形和梭形，核深染，胞浆少，核浆比例高，伴有较明显的病理性核分裂象，染色质细腻。免疫表型：CgA、Syn、CD56和EBERs阳性或部分阳性者分别有6例、10例、9例和3例。临床分期Ⅰ期1例，Ⅱ期1例，Ⅲ期4例，Ⅳ期5例，分期不详1例。所有患者均接受放疗和（或）化疗，至随访结束存活者9例，死亡3例。结论 鼻咽部神经内分泌癌临床上较少见，好发于中老年男性，病理类型以小细胞型为主，易出现颈部淋巴转移，就诊时大部分已处中晚期，治疗以放化疗为主。     

Reduced regional homogeneity and neurocognitive impairment in patients with moderate-to-severe obstructive sleep apnea

BackgroundNeurocognitive dysfunction and abnormal regional homogeneity (ReHo) have been reported in patients with obstructive sleep apnea (OSA). However, little is known about whether brain functional alteration could be used to differentiate from healthy controls (HCs) and its correlation with neurocognitive impairment.MethodsThirty-three treatment-naive patients with moderate-to-severe OSA and 22 HCs with matched age, sex and education underwent the evaluation of Epworth sleepiness scale, neurocognitive function, full night polysomnography and resting-state functional magnetic resonance imaging scan. ReHo, support vector machine, and correlation with neurocognitive function were administrated to analyze the data.ResultsCompared with HCs, patients with OSA showed decreased ReHo in the bilateral superior frontal gyrus (FG), bilateral superior medial prefrontal cortex (PFC)/right supplementary motor area (SMA), left middle FG, and right precentral/postcentral gyrus. Negative correlations were observed between the ReHo values in the left superior FG/middle FG and apnea hypopnea index, oxygen desaturation index in the OSA group. The scores of Stroop word test, Stroop color-word test, symbol coding test were all negatively correlated with the ReHo values in the right precentral gyrus/postcentral gyrus in patients. Scores of the animal naming fluency test were positively correlated with the ReHo values in the left superior FG/middle FG in patients. Moreover, support vector machine analysis showed the ReHo values in the left superior FG/middle FG or bilateral superior medial PFC/right SMA both could discriminate patients from HCs with good accuracies, sensitivities, and specificities (85.45%, 87.88%, 81.82% and 81.82%, 84.85%, 77.27%, respectively).ConclusionDysfunction in the frontal lobe is a potentially pivotal neuro-pathophysiological mechanism of neurocognitive impairment in patients with moderate-to-severe OSA. And significantly lower ReHo values in the left superior FG/middle FG and/or superior medial PFC/SMA are promising imaging biomarkers to discriminate moderate-to-severe patients with OSA from HCs.     

微波治疗窦道的临床研究

目的:窦道是通达组织深部的盲管性创道,时发时愈,迁延日久.是临床工作者常见的问题,治疗十分困难;为探索窦道的新的治疗途径,开展了微波治疗窦道的临床研究.方法:微波组:采用微波热机局部照射 外科常规换药治疗;根据病变部位分别选择直径为10cm或16cm的辐射器,辐射器距窦道口距离为3cm～5cm,隔1d或隔2d治疗1次,每次30 min,10次为1个疗程,微波治疗功率为70W,治疗结束观察治疗效果.对照组:按外科常规换药治疗.结果:微波组痊愈率98%,好转率2%,总有效率100%;对照组痊愈率37.5%,有效率37.5%,无效率25%,总有效率75%;结论:微波治疗窦道不愈患者具有简单、安全、方便、疗效独特等优点.     

进展期胃癌的淋巴结转移特点及其临床意义

目的探讨进展期胃癌的淋巴结转移特点及临床意义。方法对2002年4月至2003年7月期间进行胃癌根治淋巴结清扫手术的91例患者的手术切除标本进行解剖，收集切除的淋巴结，逐枚进行病理组织学和免疫组织化学检查，判断淋巴结是否转移并计算淋巴结转移率。分析淋巴结转移率与肿瘤大小、TNM分期、Borrmann分型、肿瘤部位和淋巴结清扫范围等方面的关系。结果91例胃癌患者中淋巴结转移阳性63例（69．2％）。共收获3149枚淋巴结，平均每例34．6枚。肿瘤直径小于3cm者淋巴结转移率较3cm以上者低（P〈0．05）。TNM分期中Ⅲa和Ⅳ期患者淋巴结转移率均为100％，其转移度在30．3％～58．4％之间，较Ⅰ、Ⅱ期者高（P〈0．001）；Borrmann分型中Ⅲ型病例的淋巴结转移率（79．6％）较其他型患者高，而Ⅳ型患者淋巴结转移度（35．3％）最高（P〈0．05）。施行D3淋巴结清扫手术患者的淋巴结转移率和转移度（88．2％、38．0％）均高于D1、D2术患者（P〈0．05）。17例（18．7％）患者常规病理检查发现有183枚淋巴结微转移，肿瘤各部位与淋巴结微转移的关系差异无统计学意义（P〉0．05）。近端胃癌淋巴结转移主要在第1、2、3、5、7、8、9、12、13和16组，以8组转移度为最高（68．1％）；中部胃癌淋巴结转移主要在第1、3、7、12、13和16组，其中最高转移度为第3组（47．6％）；远侧胃癌淋巴结转移主要见于1、2．3、5、6、12、13和16组，其中第16组转移度为最高（83．3％）。结论淋巴结转移率和转移度与胃癌的恶性程度密切相关，因此D3淋巴结清扫手术对某些进展期胃癌患者值得考虑使用。     

Easier node dissection after chemoradiotherapy for lung cancer with collagen insertion at mediastinoscopy

Objective: Induction chemoradiotherapy followed by anatomical resection is a current therapeutic strategy for non-small-cell lung cancer with mediastinal node involvement. Dense peritracheal fibrosis and sclerosis after chemoradiotherapy cause difficult mediastinal node dissection. We evaluated a novel technique to make the mediastinal node dissection easier after induction therapy. Methods: At the end of mediastinoscopic node biopsy for staging of lung cancer, cotton-type collagen was inserted anterior and lateral to the trachea in patients with pathologically confirmed mediastinal node involve-ment (n=45). The induction therapy consisted of concurrent use of platinum-based chemotherapy and hyperfractionated radiotherapy. After the chemoradiotherapy all patients underwent a pulmonary resection with complete mediastinal node dissection 7–12 weeks after the collagen insertion. Surgical findings of the mediastinum and the time for node dissection were compared with those without collagen insertion at mediastinoscopy after chemoradiotherapy (n=5). Results: All five patients without collagen insertion showed sclerotic and fibrotic change of mediastinal nodes with severe adhesion to the trachea. In 42 of 45 patients with collagen insertion (93.3%) the collagen remained unabsorbed and separated the mediastinal nodes from the trachea. Mediastinal node dissection was easily accomplished by removing mediastinal tissues lateral and anterior to the collagen. The rate of mediastinal node separation was significantly higher with collagen insertion than without (p< 0.0001). The times for node dissection in patients with and without collagen insertion showed no significant difference. Conclusion: Cotton-type collagen insertion at staging mediastinoscopy for lung cancer separates the mediastinal nodes from the trachea and makes the node dissection easier after induction chemoradiotherapy.     

多层螺旋CT灌注成像在颅脑系统疾病中的应用研究

随着多层螺旋CT的推广使用,使以脑血流动力学研究为目的的多层螺旋CT脑灌注成像(MSCT perfusion imaging)逐渐变为现实,为综合应用CT扫描技术提供了条件,为临床提供了一种全新的、极具潜力的、适用面广的影像检查新技术。一、CT脑灌注成像理论基础1.脑灌注成像理论的形成:在198     

NEW DEVICE TO PERFORM COAGULATION AND IRRIGATION SIMULTANEOUSLY DURING ENDOSCOPIC SUBMUCOSAL DISSECTION USING AN INSULATION‐TIPPED ELECTROSURGICAL KNIFE

Background: Although bleeding is an unavoidable complication of endoscopic submucosal dissection (ESD), endoscopic hemostasis using an insulation‐tipped electrosurgical knife (IT) knife is impossible because an insulator is mounted at the tip of the knife. We have developed a new type of hood which could perform both coagulation and irrigation simultaneously. Methods: Our new device was fabricated by drilling a side hole in the cap portion of a conventional transparent hood followed by attaching a machined papillotomy knife to the exterior surface of the hole. Results: Our new hood was useful for hemorrhage during ESD using IT knife. Conclusions: With this method, endoscopic hemostasis using IT knife is easy, as hemostatic procedure can be performed under irrigation and coagulation using conventional endoscopy.     

434例肺癌淋巴结转移及其廓清的临床研究

目的：研究肺癌淋巴结转移的方式与规律，以探讨肺癌淋巴结合理的手术廓清范围。方法：对434例肺癌患者施行手术并予淋巴结廓清，回顾性分析病理证实的转移淋巴结的分布情况。结果：手术共清除2198组淋巴结，病理证实有癌细胞转移的749组。淋巴结转移率T1期为16．5％，T2期33．5％，T3期35．6％，T4期52．3％，T1期和T4期的组间有显著性差异（P＜0．01）。上叶肺癌上纵膈与下纵膈淋巴结转移有显著差异。左上叶肺癌第5组淋巴结有30．6％转移，左下叶和右中、下叶肺癌第7组淋巴结有26．5％转移。结论：除T1期肺癌淋巴结转移仅限于区域性上纵膈或下纵膈外，总体上，上叶肺癌以上纵膈淋巴结转移居多，而中、下叶肺癌则上、下纵膈均可发生淋巴结转移。左上叶肺癌第5组淋巴结转移和中、下叶肺癌第7组淋巴结转移是上、下纵膈之间淋巴结扩大转移的信号。原发肺癌除T1期可仅行区域性上纵膈或下纵膈淋巴结清扫外，均应行系统性肺门和上下纵膈淋巴结廓清。