18F-氟脱氧葡萄糖PET和PET-CT在结直肠癌术后复发或转移中的应用价值

临床常规检查方法对结直肠癌术后复发转移的诊断及再分期有一定局限性，^18F-氟脱氧葡萄糖（^18F-FDG）PET作为一种功能代谢显像检查，能早期探测到肿瘤有无复发，准确鉴别术后瘢痕与复发，且能提供全面、准确的再分期信息，有助于制定合理的临床治疗方案，但仍存在假阳性及假阴性诊断。PET-CT融合显像有助于PET图像的正确解释，定位、定性准确度高，应用前景广阔。     

内乳淋巴结在乳腺癌治疗中的重要性

目的探讨乳腺癌术后内乳淋巴结复发的原因,强调内乳淋巴结在乳腺癌治疗中的重要性。方法回顾性分析40例以内乳淋巴结转移为首先复发的女性乳腺癌患者的临床资料、初发病时的临床特征、手术方式、术后病理分期以及治疗经过。结果40例患者内乳淋巴结复发与患者年龄、经期状况、手术方式无关(P>0.05)。而与原发肿瘤直径、部位、腋窝淋巴结阳性数、临床病理分期相关(P<0.05)。结论位于乳腺内侧区、中央区的大块肿瘤(>3cm),腋窝淋巴结阳性数多(>3),且临床病理分期晚(IIb IIIab)的乳腺癌患者,内乳淋巴结转移机率较高,须加强术后综合治疗。     

Treatment failure in intracranial primary germinomas

Object A radiation dose of 40–50 Gy is able to produce a cure rate of more than 90% in intracranial pure germinoma. However, many attempts have been made to reduce the dose and volume of radiation without compromising the disease control rate because of the toxicity of irradiation. This retrospective study is intended to provide the physician with an appropriate therapeutic strategy. Materials and methods We reviewed a series of 10 recurrent germinomas among 117 germinomas diagnosed histologically or clinically between 1979 and 2002. These patients involved underwent three different treatment modalities; radiation alone (N = 71), chemotherapy alone (N = 9), and combined therapy (N = 37). The 10-year overall and relapse-free survival rates were 97 and 93% in the radiation alone group, 89 and 67% in the chemotherapy alone group, and 92 and 92% in the combined therapy group, respectively. As expected, both radiation therapy and combined therapy were effective in controlling the disease. Tumor recurrence was closely related to the volume of radiation but not to the dose of radiation. If the tumor bed and craniospinal axis were fully covered, the radiation dose might be reduced. Chemotherapy alone showed earlier recurrence and a higher tumor recurrence rate. In the case of combined therapy, chemotherapy was useful in reducing the radiation dose but revealed some toxicity (death of two patients). Conclusions The investigation of a possible further dose reduction seems worthwhile. Radiation therapy alone with a dose of less than 40 Gy should be compared with ongoing chemotherapeutic protocols combined with low-dose irradiation.     

原发性腹膜后脂肪肉瘤20例报告

自１９６５年５月至１９９１年７月共收治原发性腹膜后脂肪肉瘤２０例，均经手术及病理证实。２０例中完全切除者１５例，部分切除者４例，活检１例。肿瘤切除合并肾，肠襻等邻近器官切除者达１２例。全组的５年，１０年生存率分别是５７．１％和２０．０％，完全切除组的５年１０年生存率分别是６３．６％和２８．６％。２０例病人共进行了４８次切除手术。首次手术死亡２例。着重讨论了本病的诊断、治疗和突出的临床特点。     

A review of incisional hernia repairs: preoperative weight loss and selective use of the mesh repair

At the Shouldice Clinic pre-operative weight loss is used prior to incisional hernia repairs. Mesh repair is selectively used, based on specific hernia characteristics. A series of 236 patients were reviewed and followed up for 36 months. Data were available on 188 patients (80%). There were 15 recurrences (8%). The number of obese patients was reduced from 67 (35.6%) to 25 (13.3%) through the weight loss program. The hernia diameter, gastrointestinal complications, and surgical site infection were significantly related to recurrence but not the type of repair, obesity, location, or previous recurrences. The risk factors of incisional hernias include size, intestinal complications and infections. A selective use has a comparable result to the exclusive use of mesh repair. Weight reduction has yet to be shown to affect the rate of recurrence, and further prospective studies are required.     

结直肠癌复发再手术60例报告

目的为探讨结直肠癌术后复发的原因、诊断和术后复发的治疗效果。方法笔者回顾性分析10年间收治的60例结直肠癌术后复发患者的临床资料。结果手术后2年内复发40例(66.7%)。60例中吻合口处复发15例,腹腔、盆腔内复发20例,会阴部复发10例,肝脏转移8例,腹壁切口复发7例。全组患者均再次行手术治疗,其中根治性切除38例,姑息性切除22例。再手术后的1,3,5年生存率根治性切除分别为93.6%,48.8%,36.3%;姑息性切除为54.5%,0,0。结论重视术中无瘤技术、切除足够的肠管、彻底清除淋巴结及其所在的肠系膜、消灭微小转移灶是预防结直肠癌术后复发的主要措施。对复发患者应根据复发部位、病期早晚选择以手术为主的综合治疗方案。     

复发脑膜瘤血管内皮生长因子及增殖细胞核抗原的表达

目的探讨脑膜瘤细胞增殖能力、肿瘤复发与血管内皮生长因子（VEGF）蛋白表达之间的关系。方法应用免疫组织化学方法检测36例复发脑膜瘤及30例原发脑膜瘤标本的VEGF和增殖细胞核抗原（PCNA）表达。结果复发脑膜瘤VEGF蛋白阳性表达率89％（32／36）明显高于原发脑膜瘤43％（13／30）（X2=25．59，P〈0．01）。复发脑膜瘤PCNA指数（65．72±9．22）高于原发脑膜瘤（20．81±7．43，P〈0．05）。VEGF蛋白表达强阳性、弱阳性及阴性者的PCNA指数分别为78．64±10．02、49．45±8．31、6．23±1．45，差异有统计学意义（P〈0．01）。结论VEGF蛋白的表达水平与脑膜瘤的复发和增殖能力有关，VEGF蛋白表达水平可能是脑膜瘤复发的预测指标之一。     

放射性125I粒子组织间植入或联合放化疗治疗复发直肠癌

目的探讨超声或CT引导下放射性125I粒子组织间植入治疗复发直肠癌的技术可行性、近期疗效和副反应.方法 15例直肠癌术后盆腔复发患者,女4例,男11例.硬膜外麻醉,2例经阴道超声引导,13例CT引导,行放射性125I粒子植入术.肿瘤匹配周边剂量为90～110 Gy,每颗粒子活度为0.50～0.70 mCi,植入33～70颗.术后24～48 h拍胸、盆腔X线片了解粒子是否发生移位.术后6例加三维适形放疗,4～6野/次,200～300 cGy/次,5次/周,总剂量为4 500～5 000 cGy,间隔4周.2例粒子治疗后加草酸铂、5-氟尿嘧啶和四氢叶酸化疗1个周期,随访3～15个月,根据CT扫描结果判断肿瘤大小. 结果术后平均7天疼痛缓解,其中12例完全缓解,2例部分缓解,1例无变化,有效率93%(14/15).9例肿瘤完全缓解,2例部分缓解,4例局部进展,局部控制率73%(11/15).2例术后6个月和12个月时死于肺转移.1例1颗粒子移位至盆壁,随访12个月无症状.无治疗相关并发症和副作用发生. 结论经超声或CT引导放射性125I粒子植入治疗复发直肠癌具有安全、微创、并发症发生率低和疗效肯定等优势,粒子治疗后应配合外放疗和全身化疗,有望进一步提高疗效.     

18 F-FDG PET-CT在肺癌疗效监测中的临床应用价值

目的:探讨18F-FDG PET-CT对可疑复发和转移的肺癌患者的诊断和临床应用价值。方法:对17例经临床、生化指标和影像学检查可疑复发的肺癌患者行18F-FDG PET-CT检查,并将结果与同期CT检查结果相比较。最终复发的诊断经外科手术、穿刺活检或经进一步的临床和影像学随访证实,评价PET-CT对制订患者治疗计划的价值。结果:8例经证实为复发或转移的患者PET-CT全部显示为阳性。8例证实为无复发的患者PET-CT阴性,1例PET-CT诊为复发的患者,经1年后随访证实为假阳性。9例无复发的患者CT仅肯定正确诊断4例,另5例CT假阳性患者皆由于CT无法鉴别复发与放疗后反应或术后疤痕所致,PET-CT改变了6例患者的最初治疗计划。结论:对治疗后可疑复发和转移的肺癌患者,PET-CT是有效的检查手段,与CT相比具有明显的优越性,对临床治疗计划的制定有较高的指导价值。     

无张力疝修补术治疗复发性腹股沟疝(附16例临床分析)

目的探讨无张力疝修补术在复发性腹股沟疝中的临床应用价值。方法自2002年1月至2005年1月,我院应用无张力疝修补术治疗复发性腹股沟疝16例进行回顾性分析。结果平均手术时间55min,术后1例出现阴囊积液,2例切口脂肪液化,无切口感染病例,平均住院5天,随访12～36个月均无复发。结论无张力疝修补术是治疗复发性腹股沟疝的较理想术式,具有安全、创伤小、术后恢复快、疗效满意,尤其是复发率低等优点。