结直肠癌肝转移的外科手术治疗

目的评价手术治疗对结直肠癌肝转移病人生存率的影响。方法回顾分析2000年1月1日至2004年12月31日复旦大学附属中山医院收治的363例结直肠癌肝转移病人，其中91例为手术病例，评价手术治疗对生存率的影响。结果160例同时性肝转移病人中手术切除肝转移灶22例（13．8％），203例延时性肝转移病人中手术切除肝转移灶69例（34．0％），两者相比差异具有统计学意义（P〈0．000）。同时性肝转移组手术死亡率（4．5％，1／22）高于延时性肝转移组（2．8％，2／69），两者相比差异有统计学意义（P〈0．05）。以2005年6月31日为随访终点，91例病人随访率100％，手术病人中同时性肝转移组1、3、5年生存率和中位生存时间与延时性肝转移组相似（P〉0．05），但术后复发率较高（36．4％vs21．7％，P=0．03）。363例病人中有36例具有手术指征而未手术病例，其1、3、5年生存率分别为47．9％、5．34％和0，明显低于91例手术病例（80．5％、33．0％和22．7％），（P=0．0034）。应用COX比例风险模型，对所有91例手术病人影响生存的因素进行多因素风险分析，得出手术切缘达1cm（β=-0．8351，P=0．0363）和复发后再次手术（β=-0．9428，P=0．0411）是生存的保护性因素，而术后复发（β=0．6471，P=0．0226）是生存的危险因素。结论手术治疗是结直肠癌肝转移的首选治疗措施，可以明显提高病人的术后生存。     

经尿道前列腺部分汽化电切术治疗高危前列腺增生

目的:探讨经尿道前列腺部分汽化电切术(TUVP)治疗高危前列腺增生(BPH)的疗效。方法:对86例平均年龄为75岁的高危BPH患者,采用TUVP治疗,随访10~40个月。结果:86例手术时间15~90min,失血量100~200 ml,无经尿道电切综合征发生。国际前列腺症状评分由术前(25.3±4.6)分,下降至术后(9.6±2.8)分;生活质量评分由术前(5.2±0.6)分,下降至术后(2.4±0.5)分;最大尿流率由术前(6.3±3.0)ml/s上升至术后(14.2±5.3 ml/s);剩余尿量由术前(88.8±13.4)ml,下降至术后(17.2±14.8)ml。手术前后比较,差异均有统计学意义(均P<0.01)。结论:TUVP是治疗高龄高危BPH有效、安全性好、并发症少的方法。     

小肠广泛切除术后高胃泌素血症与结肠代偿性变化的关系

观察大鼠小肠广泛切除术后血清胃泌素和结肠粘膜代偿性改变的动态变化规律,发现术后14天内血清胃泌素稍低于正常组,从第14天开始血清胃泌素升高加快,至21天时差异有显著性意义(P<0.05),第28天时差异有非常显著性意义(P<0.01).血清胃泌素变化与术后结肠粘膜DNA、RNA变化呈正相关关系(P<0.001),提示高胃泌素血症可能是引起小肠广泛切除术后结肠粘膜代偿性变化的主要因素之一.     

颅面联合入路切除颅眶鼻沟通瘤

本文报告了颅面联合入路成功切除颅眶鼻沟通瘤5例,包括上颌窦腺鳞癌及胚胎型横纹肌肉瘤各1例,嗅神经母细胞瘤2例,分化好的软骨肉瘤1例。重点讨论了手术方法,眼球保留及颅底修复等问题。     

Thoracoscopic wedge resection

Summary Thoracoscopic surgery is decidedly expanded by the ability to perform pulmonary wedge resections of the lung by using the Endo-GIA-stapler. In addition to thoracoscopic biopsies, since July 1991 we have carried out wedge resections in 12 patients suffering from spontaneous pneumothorax (nine) or peripheral bronchial carcinoma (three). Postoperatively one air fistula persisted over 9 days. The chest tube was removed within 48 h in all other patients. There was no other major complication. The postoperative hospitalization period lasted 4.6 days (1–9 days). Operating time was 44 min (30–70 min). The benefit for the patient consists in the little-impaired breathing mechanics, the short hospital stay, and the favorable cosmetic result.     

低功率电切治疗膀胱肿瘤疗效观察

目的 探讨经尿道膀胱肿瘤低功率电切术的适应症、手术方法及其疗效评估. 方法分析65例经尿道膀胱肿瘤切除术.手术时间10～90 min,平均时间41 min;膀胱穿孔1例,术后冲洗时间1～3 d,平均2 d;导尿管留置时间1～5 d,平均4 d.结果 随访0.5～3 a,48例中肿瘤复发15例,其中原位复发2例,异位多位复发13例.结论 经尿道膀胱肿瘤低功率电切可防止并明显减少闭孔神经反射的发生,具有操作简单,损伤小,出血少、恢复快等优点.     

吻合器痔上黏膜环切治疗直肠内脱垂的效果

①目的探讨直肠内脱垂的有效治疗方法。②方法对11例直肠内脱垂的病人行吻合器痔上黏膜环切术(PPH)，术后随访1～12个月。③结果全部病人术后均排便通畅，排便时间明显缩短，无明显手术并发症。④结论PPH治疗直肠内脱垂，手术操作简便、安全、疗效可靠，病人痛苦小、恢复快、并发症少，是一种值得推广的治疗方法。     

Resection of pulmonary metastases following chemotherapy for high stage testicular tumors

BACKGROUND: Our objective was to analyze retrospectively our experience with 19 patients who had metastatic germ cell testicular tumor and had undergone resection of pulmonary metastases following chemotherapy. We wished to determine the necessity of thoracic surgery on these patients. METHODS: Of 103 patients in need of postchemotherapeutic surgery for metastatic germ cell testicular tumors, 19 patients (mean age 31) underwent surgery for thoracic masses following cis-platin based chemotherapy. Resection of pulmonary metastases was performed on patients with normal tumor markers after chemotherapy, who did not achieve complete radiological remission. Histopathological findings, correlation with the pathology of abdominal surgery and probable prognostic factors for disease-free and overall survivals were evaluated. RESULTS: Disease-free and overall survival rates were 14/19 (73%) and 16/19 (84%), respectively, within a median follow-up time of 30 months (15-212 months). Patients with and without viable tumor cells in their thoracic histopathological specimen had 40% and 85% disease-free survival rates, respectively (P < 0.05). Eight patients had both abdominal and thoracic postchemotherapy surgery. Only two (25%) of these patients had the same histopathological features at both sites. CONCLUSIONS: All patients with residual thoracic masses must be considered candidates for surgery, because there are no predictive factors to determine the thoracic pathology without surgery. With the resection of the pulmonary metastases only, surgery can be performed without significant morbidity and is essential to select patients for further chemotherapy, to remove all visible masses and to provide histopathological confirmation. Patients with viable tumor cells in the thoracic surgical specimen have a poor prognosis.     

Evaluation of an aortic stent graft for use in surgery on esophageal cancer involving the thoracic aorta

Objective: The purpose of this experimental study was to investigate whether aortic stent grafting can be applied to the treatment of an esophageal cancer involving the thoracic aorta. Methods: The canine thoracic aorta was partially resected without aorta being clamped after emplacement of an endovascular stent graft. Study I; The aortic whole layer of 1 cm in length and 1/4 of the circumference was resected and was covered by a free fascia patch of the abdominal rectal muscle immediately after stent graft placement. Study II; The aortic adventitia and the outer half of the media of the same size was resected on day 3, 7,14, 21, and on day 28, after the stent graft placement. The resected portion was covered by the free fascia patch in half experimental dogs, and was uncovered in the others. Study III; The aortic adventitia and the outer half of the media of 1 cm in length and 1/2 of the circumference was resected and was uncovered on day 7 after stent graft placement. Histological examinations were performed on day 28 and at one year after aortic resection. Results: The aortic wall could be resected in all cases with no complication, except in resection of 1/2 the circumference where the aorta had become narrow. There was no difference in healing of the resected portion of the aorta between with and without fascia covering. Conclusion: An aortic endovascular stent graft could be applied to surgery for an esophageal cancer involving the aorta.     

胆囊鳞癌6例报告

目的：探讨胆囊鳞癌的发病情况、特点、诊断、治疗、预后及预防。方法：结合有关文献复习分析6例胆囊鳞癌的病例。结果：5例行手术治疗，术后两月内死亡3例，另两例至今存活，分别为术后8个月，3个月。1例行B超引导穿刺活检，入院后两周死亡。结论：胆囊鳞癌早期无特异症状，诊断时多已属晚期，手术效果较差。早期诊断、根治性手术有助于胆囊鳞癌的预后。