78例胃窦癌的治疗分析

自１９８８年２月至１９９２年８月期间手术治疗的７８例胃窦癌患者进行了回顾性分析，手术后肿瘤复发的情况，与十二指肠断端有无癌细胞残存密切相关，并发现于幽门环下切断十二指肠少于３ｃｍ者有癌细胞残存达３４％，切除十二指肠达３ｃｍ者，无论肿瘤分化程度如何，恶性程度高低，切除断端均无癌细胞残存，手术后辅以化疗，对于病人的预后有一定提高。本组随访到的５９例病人中，接受化疗的３３例，在２年３个月至６年１个月内死亡７例（２１．２％），未接受化疗的２６例，在５个月至３年８个月内死亡的２６例，在５个月至３年８个月内死亡９例（３５％）。     

大剂量免疫化疗预防肾癌复发和转移的临床研究

目的 观察免疫化疗对肾癌远期复发及转移的预防作用。方法 肾癌根治术后患者18例。男13例，女5例。年龄37～78岁，平均56岁。分2组：①免疫化疗组13例。T1 1例，T2 8例，T3 4例。根治术后第10天起联合应用大剂量白细胞介素-2(远策欣，重组人白细胞介素-2，IL-2)和干扰素(远策素，重组人干扰素α2b，IFN-α)皮下注射以及5-氟脲嘧啶(5-Fu)静滴治疗。②对照组5例。T1 1例，T2 3例，T3 1例。均因为经济原因未行免疫化疗，仅行肾癌根治术。免疫治疗方法：IL-2800万U／次，皮下注射，每周3次，第1、4周；400万U／次，皮下注射，每周3次，第2、3周；IFN-α 600万U／次，皮下注射，每周3次，第2、3、6、7周；900万U／次，皮下注射，每周3次，第5、8周；用药后1h直肠应用消炎痛栓50mg。5-Fu1000～1250mg加入5％葡萄糖液500ml缓慢静滴(4～6h)，每周1次，第5～8周。2个月为1个治疗周期，间隔3个月可重复进行。治疗后每月检查血常规、肝肾功能、腹部B超、胸部及骨X线。结果 治疗组13例完成1～4个治疗周期，平均1．9个周期。未见严重毒副反应发生。随访60—87个月，12例无癌生存，1例术后43个月出现股骨转移，现行放疗，病灶稳定。对照组5例术后3—14个月发现远处转移，首发转移病灶：肺3例，肝1例，皮下1例。5例术后生存6～21个月，平均12．8个月。结论 以大剂量IL-2为主的免疫化疗方法安全，可有效地预防肾癌的远期复发和转移。     

原发性肝癌肝移植治疗现状与展望

肝移植已成为原发性肝癌治疗的一种重要选择。选择合适的肝癌病例作为移植对象是决定疗效及预后的关键,另外手术禁忌证及术后复发等问题也要慎重考虑。本文就肝癌肝移植治疗方面相关问题近年来的研究情况进行综述。     

Parapubic hernia: case report and review of the literature

Parapubic hernia is considered rare, with 18 hernias described in five articles published since 1971. The hernia results from iatrogenically or traumatically detached rectus abdominis muscles at the pubic bone and presents a therapeutic challenge because there is no strong aponeurotic anchoring structure in the defect's caudal aspect. We describe a patient with a large parapubic hernia repaired by a combined preperitoneal and onlay prosthetic method. This report adds another dimension to the prosthetic repair options in parapubic hernias and illustrates the effectiveness of the tension-free repair principle in their definitive management. Electronic Publication     

Needle tract recurrences after closed biopsy for sarcoma: Three cases and review of the literature

Background: Percutaneous closed needle biopsy of musculoskeletal neoplasms has gained in popularity. However, it remains controversial whether or not to resect the needle tract for fear of a local recurrence. A single published case report exists, noting the lone tract recurrence of an extremity skeletal osteosarcoma. Methods: We report on three additional individuals who demonstrated that tract local recurrences may occur after a closed needle biopsy for nonosteosarcoma, nonextremity sarcomas. For perspective, the world literature is reviewed to identify tract recurrences for other malignancies and the results of needle biopsy in musculoskeletal neoplasms. Results: Eighty-nine percent of needle tract local recurrences occur when carcinomas are subjected to biopsy, as reported in the literature. Forty-seven cases since 1950 are described representing essentially all tumor types. The nature of musculoskeletal neoplasms makes closed biopsy more difficult than for softer, more homogeneous, and easier to access neoplasms. Conclusions: Local recurrences of sarcoma may occur in closed needle biopsy tracts. Strong consideration should be given to open biopsy and tract resection.     

PET/CT显像在探测卵巢癌术后复发、转移中的应用

目的探讨PET／CT在探测和诊断卵巢癌术后复发、转移中的应用价值。方法回顾性分析54例卵巢癌术后患者全身或局部PET／CT显像结果。临床随访时间3～20个月。确诊依据为手术病理检查、多种影像学检查和临床随诊。结果54例中41例有肿瘤复发、转移，13例无肿瘤复发。PET／CT诊断肿瘤复发、转移的灵敏度为90．2％，特异性为84．6％。与PET／CT显像前的CT、B超检查结果比较，9例腹腔及盆腔常规CT和（或）B超检查阴性者，PET／CT显像于腹腔及盆腔发现1处或多处隐匿性恶性肿瘤病灶，31．7％的患者PET／CT显像发现多处病灶且提示肿瘤广泛转移，从而改变临床分期和治疗方案。转移灶的分布以腹腔和盆腔为主，远处转移较少。19例患者糖类抗原（CA）125升高，PET／CT显像阳性率为89．4％。结论PET／CT显像能灵敏、准确地检出卵巢癌术后复发和转移病灶，使分期更准确、更全面。     

膀胱癌膀胱全切术后尿道复发的风险评估及对策

目的 探讨膀胱癌膀胱全切术后尿道复发的危险因素及处理方法。方法 回顾分析278例膀胱癌膀胱全切患者的临床资料，其中24例发生了尿道复发。运用cox’s多因素回归模型对影响复发的危险因素进行评价。结果 6例选择性尿道切除者无1例死于肿瘤；24例尿道复发者10例死于肿瘤转移。多因素分析表明前列腺受累、膀胱颈受累、三角区肿瘤、多发肿瘤和原位癌是影响尿道复发的危险因素，相对危险度分别为1．573，1．532，1．360，1.337和1．213。结论 前列腺受累、膀胱颈受累、三角区肿瘤、多发肿瘤或原位癌是预防性尿道切除术的指征。保留尿道的患者宜尽量行正位排尿的尿流改道术。     

经皮胆囊碎石术后结石复发439例随访分析

目的探讨经皮胆囊碎石术(PCCL)后长期临床预后和结石复发情况,了解与结石复发的相关因素。方法对439例PCCL患者随访10年,评估结石复发率和临床预后。结果439例患者中182例结石复发,总复发率41.46%,术后1~10年结石累计复发率分别为9·57%、18·91%、27·33%、34·14%、37·59%、39·86%、41·90%、42·73%、42·85%和43·21%。182例结石复发患者中,94例无症状,80例表现有非特异性上消化道不适症状,8例有上腹痛或胆绞痛,其中38例行胆囊切除术治疗。与结石复发相关的因素包括胆囊结石家族史、喜好油腻食品、伴发肝病、PCCL术前复发胆囊结石和胆囊功能不全。结论PCCL术后结石复发不可避免,术后前6年结石复发率逐年增加明显,随后增长缓慢,术后10年约50%的患者无结石复发。一些危险因素与结石复发有关。PCCL可作为高龄和高危胆囊结石患者有价值的治疗选择,治疗其他胆囊结石患者尚需慎重选择。     

原发性细胞癌伴微血管侵犯的危险因素分析

目的探讨原发性肝细胞癌（hepatocellular carcinoma，HCC）伴微血管侵犯的危险因素。方法回顾性复习134例HCC切除术病人的临床资料，分析微血管侵犯与HCC病人临床理资料的相关性。结果134例HCC中46例（34．3％）有微血管侵犯。单因素分析显示肿瘤体积〉3cm、包膜缺失、组织分化恶性程度高、血清AFP阳性（〉20ng／ml）与微血管侵犯显著相关（P〈0．05），而病人年龄、性别、肝炎病毒感染、是否合并肝硬化、组织学类型与微血管侵犯之间无明显相关性。微血管侵犯与HCC大体卫星结节的形成成显著相关（P=0．001）。结论微血管侵犯是HCC的常见恶性事件，肿瘤体积〉3cm、包膜缺失、组织分化恶性程度高、血清AFP阳性是微血管侵犯的危险因素。     

Long-term follow-up after umbilical hernia repair: are there risk factors for recurrence after simple and mesh repair

Adult umbilical hernia is a common surgical condition mainly encountered in the fifth and sixth decade of life. Despite the high frequency of the umbilical hernia repair procedure, disappointingly high recurrence rates, up to 54% for simple suture repair, are reported. Since both mesh and suture techniques are used in our clinic we set out to investigate the respective recurrence rates and associated complications, retrospectively. Patients who were treated between January 1998 and December 2002 were identified from our hospital database and invited to attend the outpatient department for an extra follow-up, history taking and physical examination. The use of prosthetic material, occurrence of surgical site infection, body mass and height as well as recurrence were recorded at the time of this survey. In total, 131 consecutive patients underwent operative repair of an umbilical hernia. Twenty-eight percent of the patients were female (n=37). In 12 patients (11%) umbilical hernia repair was achieved with mesh implantation. Fourteen umbilical hernia recurrences were noted (13%); none had been repaired using mesh. No relationship was found between wound infection or obesity and umbilical hernia recurrence. In the light of these results it is necessary to re-evaluate our clinical “guidelines” on mesh placement in umbilical hernia repair: apparently not every umbilical fascial defect needs mesh repair. Research should focus on establishing risk factors for hernia recurrence.