以Krukenberg瘤为首发表现胃癌55例临床分析

目的比较Krukenberg瘤为首发表现的胃癌患者与原发卵巢上皮性癌患者的临床病理资料,探讨前者的临床病理特征。方法回顾性分析2005年9月至2013年9月郑州大学第一附属医院妇产科以Krukenberg瘤为首发表现的胃癌患者55例（Krukenberg瘤组）的临床资料,同期原发卵巢上皮癌患者55例（原发卵巢癌组）作为对照。结果 Krukenberg瘤组患者的平均年龄为（35.1±4.6）岁（20~56）岁,显著低于原发卵巢癌组的（57.2±6.8）岁（40~72）岁（P〈0.05）。Krukenberg瘤组合并腹水比例（34.5%,9/55）明显低于原发卵巢癌组（90.9%,50/55;P〈0.05）。Krukenberg瘤组血清CA125升高30例,平均CA125水平为（98.7±14.1）kU/L;原发卵巢癌组CA125升高55例,平均CA125水平为（473.9±123.9）kU/L;两组CA125水平比较,差异有统计学意义（P〈0.05）。Krukenberg瘤组术前术后诊断符合率（9.1%,5/55）明显低于原发卵巢癌组（100.0%,55/55;P〈0.05）。Krukenberg瘤组病理类型多为胃印戒细胞癌（49.1%,27/55）,原发卵巢癌组多为浆液性囊腺癌（74.5%,41/55）。Krukenberg瘤组患者6个月生存率为54.5%（30/55）,1年生存率为36.4%（20/55）,3年生存率为3.6%（2/55）;原发卵巢癌组分别是72.7%（40/55）、60.0%（33/55）和23.6%（13/55）。结论以Krukenberg瘤为首发表现的胃癌患者病理类型以胃印戒细胞癌为主,术前诊断率低,预后差,患者多为中青年妇女,合并腹水比例较低,血清CA125的测定及PET-CT检查对鉴别诊断有重要价值。     

ⅠB期妊娠合并宫颈癌与年轻非妊娠宫颈癌的临床分析

目的探讨妊娠期宫颈癌与非妊娠期宫颈癌在临床表现及手术方面存在的差异,分析其存在的差异,为临床实践提供可靠的医学依据。方法回顾性分析自2012年1月2016年6月郑州大学第一附属医院妇科收治的年龄≤40岁宫颈癌患者160例,就ⅠB期妊娠期宫颈癌患者与非妊娠宫颈癌患者的一般情况、临床表现、辅助检查、分期、诊断、病理、治疗、术中及术后情况进行统计学对比分析。结果妊娠期宫颈癌患者与非妊娠期宫颈患者一般情况比较无明显差异;妊娠期宫颈癌与非妊娠患者平均孕产次数、平均流产次数、分期、诊断方法、病理类型、病理分级、浸润深度、脉管浸润、淋巴结转移、治疗方式比较,差异均无统计学意义(P0.05);妊娠期宫颈癌患者平均手术时间(284.80±66.86)min,术中出血量(217.33±207.73)ml,非妊娠期患者的为(249.59±57.04)min、(131.85±95.96)ml,差异有统计学意义(P=0.011、P=0.035)。结论妊娠合并宫颈癌与非妊娠宫颈癌之间亦存在很多相同点,不同的是妊娠合并宫颈癌患者平均手术时间、术中出血量均较非妊娠宫颈癌患者严重。     

Beclin 1与PD-L1蛋白在子宫颈肿瘤中的表达及临床意义

目的检测酵母自噬相关基因Beclin 1及程序性死亡受体配体-1(PD-L1)蛋白在宫颈肿瘤组织中的表达,探究两者的相关性及临床意义。方法选取134例宫颈石蜡标本为研究对象,采用免疫组化法检测正常宫颈组织、高级别鳞状上皮内病变及宫颈癌中Beclin 1及PD-L1蛋白的表达。结果在正常宫颈、HSIL及宫颈癌组中Beclin1蛋白的阳性表达率分别为88.2%、70.2%和27.0%,PD-L1蛋白的阳性表达率为3.0%、32.4%及54.0%。Beclin1蛋白表达与患者HPV感染(P 0.001)、肿瘤分化程度(P 0.001)及淋巴结转移(P 0.05)等有关,PD-L1蛋白表达与HPV感染(P 0.001)、肿瘤分化程度(P 0.05)及临床分期(P 0.05)有关,Beclin 1与PD-L1蛋白表达呈负相关(r=-0.553, P 0.001)。结论 Beclin1蛋白表达随宫颈病变严重程度的增加而降低,PD-L1蛋白表达随病变严重程度的增加而升高,二者呈负相关。     

胎盘部位滋养细胞肿瘤二例报告

<正>一、病例摘要例1:患者女,24岁,以"阴道分娩后1年,阴道淋漓出血半年"于2014年6月10日入院。1年前足月阴道顺娩一女婴,产后21 d恶露干净,产后1个月恢复正常月经。半年前无明显诱因出现经间期阴道出血,量少,色暗红,伴轻度腹痛,至当地医院查彩超:宫腔积血,未治疗。2个月前阴道出血较前增加,性状同前。彩超示:宫腔内     

165例卵巢恶性肿瘤不全分期术后行再分期手术必要性的临床初探#br#

Objective?To investigate the necessity of the re-staging operation after incomplete staging of epithelial cancer, ovarian malignant germ cell tumor and sex cord stromal tumor. Methods?A retrospective analysis was made on 165 ovarian cancer patients with surgical stageⅠA~ⅠC after incomplete staging operation who underwent re-staging operation in the First Affiliated Hospital of Zhengzhou University from January 2013 to January 2021. There were 85 cases in the epithelial carcinoma group, 31 cases in the malignant germ cell tumor group and 49 cases in the malignant sex cord stromal tumor group. Results?The rate of benefit from re-staging operation (surgical-pathological staging upgraded after re-staging operation) was 36.47% (31/85) in the epithelial cancer group, which was significantly higher than that in the germ cell tumor group (9.68%, 3/31) and sex cord stromal tumor group (4.08%, 2/49), the difference was statistically significant (P<0.05). The rates of benefit from re-staging operation among epithelial cancer, germ cell tumor and sex cord stromal tumor patients who had no residual impression tumor in incomplete staging operation are 33.33%(27/81), 3.44%(1/29) and 0%(0/47), which are significantly lower than that in the patients who had residual impression tumor in incomplete staging operation (P<0.05); The rates of benefit from re-staging operation among epithelial cancer, germ cell tumor and sex cord stromal tumor patients who had no positive imaging findings before re-staging are 34.15%(28/82), 3.44%(1/29) and 2.08%(1/48), which are significantly lower than that in the patients who had positive imaging findings before re-staging (P<0.05). Conclusion?The epithelial ovarian carcinoma with early surgical stage in incomplete staging operation should be treated with re-staging surgery after incomplete staging surgery; When there are residual tumor in incomplete staging operation or positive imaging findings before re-staging in the early surgical stage germ cell tumors and in the early surgical stage sex cord stromal tumors, it is necessary to perform re-staging surgery for them.     

脉管平滑肌瘤8例临床分析

目的 探讨脉管平滑肌瘤的临床特点、诊断、治疗和预防.方法 回顾分析2012年6月至2016年6月郑州大学第一附属医院收治的8例脉管平滑肌瘤病患者的资料,总结其临床特点,结合国内外相关文献,分析发病特点及治疗方法.结果 术前仅有1例彩超提示可疑,确诊主要依据术中所见及术后病理,随访结局良好.结论 脉管平滑肌瘤发病率低,临床表现无特异性,术前无特异的辅助检查明确诊断,主要依靠术中所见及病理;治疗首选手术.术后需严密随访.