粘附分子CD44变构体6在乳腺癌组织表达的研究

CD4 4分子是一种跨膜蛋白 ,是细胞粘附分子之一。因其介导肿瘤细胞与宿主细胞分子和细胞外基质的相互作用 ,而成为研究肿瘤转移及预后的热点。我们应用免疫组织化学 S- P法检测了 CD4 4变构本 6 (CD4 4 V6 )在乳腺癌中的表达 ,探讨其生物学意义。1　资料与方法1.1　资料 :选自我院 1997— 1999年手术切除乳腺癌标本87例。其中浸润性导管癌 5 3例 ,单纯癌 15例 ,髓样癌 8例 ,导管内癌 3例 ,黏液癌 5例 ,腺癌 3例。年龄 :2 8～ 72岁(中位年龄 5 1.3岁 ) ,有淋巴结转移 5 9例 ,2 8例无转移。 2 3例乳腺良性肿瘤组织 ,其中 :乳腺纤维瘤 18例…     

青年女性乳腺癌患者生活质量及影响因素研究

目的:了解青年乳腺癌患者生活质量及其影响因素,为提高患者生活质量奠定基础.方法:选取经诊断为乳腺癌的78例青年女性作为研究对象,在实施治疗半年后进行生活质量调查,并将数据导入SPSS17.0进行统计分析.结果.78例青年乳腺癌患者,生活质量平均得分为(56.2±11.3)分,年龄(β=-1.982,P=0.039)、家庭月收入(β=-6.839,P=0.003)、照顾者类型(β=2.896,P=0.029)、病程(β=-3.873,P=0.022)、淋巴结转移情况(β=4.060,P=0.017)、手术方式(β=1.221,P=0.048)这6个因素对生活质量得分具有影响.结论:根据青年女性乳腺癌患者生活质量及其影响因素,须加强年轻患者的心理干预,鼓励丈夫照顾,提倡建立癌症基金和病友会,逐渐提高患者社会适应能力和生活质量.     

腹腔镜下脾切除联合选择性贲门周围血管离断术

目的探讨腹腔镜下脾切除联合选择性贲门周围血管离断术(laparoscopic splenectomy combined with selectivepericardial devascularization,LSPD)治疗门脉高压症(portal hypertension,PHT)的安全性、可行性及操作技巧。方法回顾性分析2011年3月～2012年3月连续15例因PHT行腹腔镜下脾切除联合LSPD的围手术期资料。观察手术时间、术中出血量、术后排气时间、术后并发症发生率及术后住院时间并随访。结果 15例均顺利完成手术,无中转开腹。术中发现副脾2例。手术时间150～340 min,中位数230 min。术中出血量80～1600 ml,中位数450 ml。腹腔引流管留置时间3～8 d,中位数5 d。术后住院时间7～15 d,中位数10 d。无出血、胰漏等手术并发症。15例随访3～12个月,均存活,2例发生便血。结论LSPD治疗PHT安全、可行。     

乳管造影在56例乳头溢液乳腺癌诊治中的应用

目的 分析乳管造影及成像技术对有乳头溢液的早期乳腺癌的诊断及定位。方法 回顾性分析2000年1月～2004年12月56例乳管造影的结果。结果 经乳管造影明确诊断50例，占89％，造影可发现大导管及分支导管管壁狭窄、截断征象，并可通过向溢液孔注入染料（美蓝）予以定位。结论 乳管造影对乳头溢液的早期乳腺癌的诊断及定位有重要价值。     

腹腔镜探查术在急性肠系膜血管缺血性疾病诊治中的应用

目的:探讨腹腔镜探查术在急性肠系膜血管缺血性疾病(AMI)诊治中的应用价值.方法:收集6例行腹腔镜探查的AMI临床资料,对其基础疾病、发病特点、诊断及治疗方式进行回顾性分析.结果:6例病例中急性肠系膜上动脉栓塞(SMAE)2例,急性肠系膜上动脉血栓形成(SMAT)3例,急性肠系膜上静脉血栓形成(SMVT)1例,无非闭塞性肠系膜缺血(NOMI)诊断病例.6例行腹腔镜探查病例中,镜下肠切除吻合4例,因肠管广泛坏死或需行肠造瘘术而中转开腹2例.经治疗,4例治愈出院,1例因术后出现短肠综合征经住院治疗92 d后好转出院,1例术后发生肠瘘或因脓毒血症继发多脏器功能衰竭(MOF)而死亡.结论:在疑似AMI病例中尽早运用腹腔镜探查,可提高AMI的整体诊治效果.     

贲门周围血管离断优先策略在腹腔镜断流术治疗门静脉高压症的应用评价

目的探讨先离断贲门周围血管后切除脾脏的腹腔镜断流术治疗门静脉高压症(portal hypertension,PHT)的效果。方法选择2013年1月~2018年12月151例腹腔镜脾切除贲门周围血管离断术(laparoscopic splenectomy and pericardial devascularization,LSPD),以2015年8月调整腹腔镜断流术手术策略为界,分为2组:A组70例,腹腔镜下先切脾后断流手术;B组81例,腹腔镜下先断流后切脾手术。比较2组资料近期临床疗效和住院费用。结果151例均顺利完成手术,无中转开腹手术。所有患者术后均发热,对症处理后均消失。无胃肠漏、胰漏、大出血并发症发生。2组住院期间各1例死亡:A组1例术后第6天猝死,考虑为肺栓塞所致;B组1例术中胃内大出血,术后第3天多器官衰竭死亡。与A组相比,B组手术时间明显缩短[(261.4±46.1)min vs.(180.8±61.4)min,t=2.558,P=0.019],术中出血量明显减少[中位数:480(120~2000)ml vs.200(80~400)ml,Z=-5.376,P=0.000]。2组患者总住院时间、术后住院时间、引流时间、住院总费用差异无显著性(P>0.05)。随访术后1年,2组各有1例发生便血,门静脉系统血栓发生率差异无显著性[A组28.9%(20/69),B组23.8%(19/80),χ^2=0.526,P=0.468]。结论贲门周围血管离断优先的腹腔镜断流术治疗PHT疗效满意。     

不同肝癌分期方法对肝癌肝切除患者预后价值的比较研究

目的 比较CLIP评分、JIS评分、2001年中国肝癌分期对肝细胞癌肝切除术后患者预后的判断能力,探讨其在我国肝癌患者人群中的临床应用价值.方法 回顾性分析2000年1月至2005年7月经手术切除的肝细胞癌病例的临床病理及随访资料.利用病例构成比、Kaplan-Meier生存曲线分别比较各种分期方法的病例分层能力、组间生存差异识别能力和对早期患者的鉴别能力.采用似然比卡方检验(LR x2)和线性趋势卡方检验(line trend x2)评估各分期系统的同质性、判别力和梯度单一性.利用COX比例风险模型计算不同分期对模型预后预测价值的贡献大小.结果 病例构成比:中国分期Ⅰ a、Ⅰ b、Ⅱ a、Ⅱ b、Ⅲa组病例分别占全部病例的14.3%、17.4%、21.9%、31.7%、14.7%,各期分布均匀、分层能力突出.CLIP评分中0-2分占全部病例数的81.6%,早期患者比例较大,分层能力不足.JIS评分中0分组仅有3.1%,提示病例分层能力不足.生存曲线比较:CLIP评分2分与3分间的生存率差异无统计学意义.JIS评分和中国分期各分组间生存率两两比较,差异均有统计学意义.JIS评分和中国分期对早期患者的鉴别能力较强.而CLIP评分对预后较差患者的识别能力较强.分期的同质性、单调性、梯度单一性比较:中国分期>CLIP评分>JIS评分.对模型预后预测价值的独立贡献大小比较:中国分期>CLIP评分>JIS评分.结论 在我国肝癌肝切除患者人群中,2001年肝癌中国分期的预后价值优于CLIP评分和JIS评分.CLIP评分对中晚期肝癌患者的识别能力优于JIS评分和中国分期.

Abstract：

Objective To compare the CLIP score, the JIS score, and the China staging system (CS) in the prediction of survival of patients with resectable hepatocellular carcinoma (HCC). Methods The Clinicopathologic and follow-up data of 224 patients who underwent hepatic resection for HCC from January 2000 to July 2005 were retrospectively studied. The patient distribution and the survival curve of each staging system were used to compare the ability to stratify and to discriminate prognosis. The likelihood ratio, chi-square test and the linear trend chi-square test were used to compare the homogeneity and the monotonicity of the relationship between stage and mortality rate of each staging system. The increase in the -2 log likelihood statistic on removal of any one staging system was in turn used as a means of ranking the individual staging systems according to their importance within the regression model. The statistical package used was SPSS version 16. 0 and Stata SE version 8.0. Results Based on the China staging system, the percentages of patients categorized as Ⅰa, Ⅰ b, Ⅱa,Ⅱb and Ⅲ a were 14. 3%, 17.4%, 21.9%, 31.7% and 14. 7% respectively, showing excellent stratification ability. However, nearly 81. 6% of the patients were classified as a CLIP score of 0-2, which showed poor stratification ability, and only 3. 1 % of the patients were classified as score 0 category of the JIS scoring system. In the follow-up period, the log-rank test and the corresponding Kaplan-Meier survival curves confirmed each staging system to be able to differentiate patient survival in the different stages. Individual pairwise comparisons revealed inconsistencies across the different staging systems. In particular, using the log-rank test, the JIS scoring system and the China staging system showed significant differences in patient survival on all pairwise comparisons. By contrast, the CLIP scoring system failed to differentiate significantly between score 2 and score 3 patients. The JIS scoring system could identify the best prognostic group who would benefit from curative and aggressive treatments, whereas the discriminatory value of the CLIP score was noted in the intermediate- and advanced-phase HCC patients. The China staging system was shown to have the best homogeneity, overall discriminatory capacity and monotonicity of gradient. The change in the -2 log likelihood statistic on removal of any staging system revealed that for this cohort of patients, the appropriate importance in the ranking of the independent contribution of each factor to the regression model was: CS> CLIP>JIS. Conclusion Among three clinical staging systems, the China staging system had the highest prognostic value, with better stratification and higher discriminatory capacity than the CLIP scoring system and the JIS scoring system for this cohort of patients who received partial hepatectomy for HCC. The CLIP scoring system performed better in identifying the worst prognostic patients.