年轻妇女卵巢上皮癌的临床特点及预后分析

背景与目的:卵巢上皮癌多发生于老年妇女,年轻妇女较少见.有关35岁以下妇女卵巢上皮癌的临床特点、预后因素分析报道较少.本研究旨在探讨年轻妇女卵巢上皮癌的临床特点、治疗、生存率及预后因素分析.方法:回顾性分析1980年1月至2003年12月我院收治的71例≤35岁的卵巢上皮癌患者的临床资料.生存率用寿命表法计算.利用Cox模型分析比较影响预后的因素.结果:71例确诊为卵巢上皮癌患者中位年龄28岁.临床表现为自扪及腹部包块或体检发现腹部包块18例,腹痛、腹胀各11例.肿物最大径平均为13.7 cm,肿瘤位于单侧52例(73.2%),68例(95.7%)行满意细胞减灭术,手术病理分期I期44例(62.O%)、Ⅱ期5例、Ⅲ期18例、Ⅳ期4例.病理类型以浆液性囊腺癌(40例,56.3%)和粘液性囊腺癌(22例,30.9%)为最多.病理分级为高分化42例(59.2%)、中分化18例(25.4%)、低分化11例(15.5%).68例术前或术后进行了以铂类和紫杉醇类为基础的化疗.15例保守手术中(均为I a、G1期患者),12例无瘤生存(80.0%).按寿命表法计算的2年生存率为86.0%.5年生存率为82.0%.Cox模型多因素分析显示病理分级、残留病灶大小是影响年轻妇女卵巢上皮癌预后的因素(P<0.05).结论:35岁以下妇女卵巢上皮癌患者,以单侧多见,以浆液性囊腺癌多见,预后好.部分I a、G1期患者可保留生育功能.病理分级、残留病灶大小是影响35岁以下妇女卵巢上皮癌预后的因素.     

盆腔肿块40例手术治疗

目的:探讨盆腔肿块的种类、特征以及外科手术治疗的可行性和疗效.方法:对本院2008年1月到2010年1月间40例盆腔肿块并行手术治疗病例的临床资料进行回顾性分析.结果:40例中,卵巢肿瘤32例,占80%(良性肿瘤27例,占84.4%;恶性肿瘤4例,占12.5%;交界性瘤1例3.1%);慢性盆腔炎症性肿块5例,占总例数12.5%;其他3例,占总例数7.5%.结论:由本组案例见,盆腔肿块以卵巢肿瘤占大部分,且恶性肿瘤发生率高,提示盆腔肿块应积极行手术治疗,可以及早诊断、治疗,改善预后和病人的生存质量.     

宫颈癌患者术后盆底功能障碍性疾病的相关因素分析

目的 探讨宫颈癌患者术后发生盆底功能障碍性疾病的相关因素,为预防和临床治疗提供一定的参考依据.方法 收集121例宫颈癌患者的临床资料,采用Logistic逐步回归分析法对宫颈癌患者术后发生盆底功能障碍性疾病的危险因素进行分析.结果121例宫颈癌患者中,74例(61.16%)患者术后发生了盆底功能障碍性疾病.单因素分析发现,年龄、肿瘤直径、绝经情况和留置尿管时间对盆底功能障碍性疾病的发生有影响.多因素分析发现,年龄≥45岁(OR=2.380,95% CI:1.194~4.744)、肿瘤直径≥4 cm(OR=1.866,95% CI:1.870~2.935)、绝经(OR=1.902,95% CI:1.217~2.974)和留置尿管时间≥7 d(OR=4.010,95% CI:1.259~12.773)是宫颈癌患者术后发生盆底功能障碍性疾病的独立危险因素.结论 宫颈癌根治术后盆底功能障碍性疾病的发生率较高,对于年龄较大、绝经、分娩次数较多的患者应尽早采取相应措施,减少盆底功能障碍性疾病的发生率.     

Clinical Prognostic Factors and Survival Outcome in Renal Cell Carcinoma Patients - A Malaysian Single Centre Perspective

Background: This study concerns clinical characteristics and survival of renal cell carcinoma (RCC) patientsin University Malaya Medical Centre (UMMC), as well as the prognostic significance of presenting symptoms.Materials and Methods: The clinical characteristics, presenting symptoms and survival of RCC patients(n=151) treated at UMMC from 2003-2012 were analysed. Symptoms evaluated were macrohaematuria, flankpain, palpable abdominal mass, fever, lethargy, loss of weight, anaemia, elevated ALP, hypoalbuminemia andthrombocytosis. Univariate and multivariate Cox regression analyses were performed to determine the prognosticsignificance of these presenting symptoms. Kaplan Meier and log rank tests were employed for survival analysis.Results: The 2002 TNM staging was a prognostic factor (p<0.001) but Fuhrman grading was not significantlycorrelated with survival (p=0.088). At presentation, 76.8% of the patients were symptomatic. Generally,symptomatic tumours had a worse survival prognosis compared to asymptomatic cases (p=0.009; HR 4.74).All symptoms significantly affect disease specific survival except frank haematuria and loin pain on univariateCox regression analysis. On multivariate analysis adjusted for stage, only clinically palpable abdominal massremained statistically significant (p=0.027). The mean tumour size of palpable abdominal masses, 9.5±4.3cm,was larger than non palpable masses, 5.3±2.7cm (p<0.001). Conclusions: This is the first report which includessurvival information of RCC patients from Malaysia. Here the TNM stage and a palpable abdominal mass wereindependent predictors for survival. Further investigations using a multicentre cohort to analyse mortality andsurvival rates may aid in improving management of these patients.     

盆腔肿块40例手术治疗

目的：探讨盆腔肿块的种类、特征以及外科手术治疗的可行性和疗效。方法：对本院2008年1月到2010年1月间40例盆腔肿块并行手术治疗病例的临床资料进行回顾性分析。结果：40例中,卵巢肿瘤32例,占80%（良性肿瘤27例,占84.4%;恶性肿瘤4例,占12.5%;交界性瘤1例3.1%）;慢性盆腔炎症性肿块5例,占总例数12.5%;其他3例,占总例数7.5%。结论：由本组案例见,盆腔肿块以卵巢肿瘤占大部分,且恶性肿瘤发生率高,提示盆腔肿块应积极行手术治疗,可以及早诊断、治疗,改善预后和病人的生存质量。     

Correlation between side of palpable tumor and side of pelvic lymph node metastasis in clinically localized prostate cancer.

Of 411 patients with palpable but clinically localized (Stages B or C) adenocarcinoma of the prostate, 100 (24.3%) were found at complete bilateral pelvic lymphadenectomy to have one or more lymph nodes positive for metastasis. These patients were divided into five subgroups on the basis of the location of the palpable tumor at digital rectal examination: left side only, left predominantly, both sides, right side predominantly, or right side only. Among 35 patients with positive nodes and a palpable tumor limited to one side of the prostate (clinically unilobar), metastases were found in the ipsilateral pelvic lymph nodes in 29 (83%). Only 6 (17%) of the patients had contralateral metastasis alone. A unilateral pelvic lymphadenectomy (ipsilateral to the side of the largest palpable tumor, or on either side if the tumor were bilateral) would have detected 80% of the patients with positive lymph nodes, with a positive predictive value of 100% and a negative predictive value of 94%. Lymph node metastases in patients with clinically localized palpable prostate cancer are most likely to be found on the same side as the palpable tumor and are considerably less likely to be found on the contralateral side alone. If frozen section examination of lymph nodes or laparoscopic lymph node dissection is planned before definitive therapy for prostate cancer, the pelvic lymph nodes ipsilateral to the side of the palpable tumor should be removed first.     

Synchronous primary cancers of the endometrium and ovary： review of 43 cases

Objective:To investigate the clinicsl and pathological characteristics.treatment methods,and prognosis of synchronous primary cancer of the endometrium and ovary.Methods:The clinical data of 43 patients with synchronous primary cancer of endometrium and ovary were retrospectively reviewed.The survival was calculated by Kaplan-Meier method and compared using the log-rank test.Results:The median age of the patients at diagnosis was 49 years(range.28-73 years).The most common symptoms were abnormal vaginal bleeding(69.8%)and abdominal or pelvic pain(44.2%).Pelvic masses were found in 39.5%of the patients and enlarged corpus in 27.9%at physic examination.while pelvic masses were found in 67.4%of the 43 patients(29 cases)and thickening or abnormal endometrium in 23.3%(10 cases)during ultrasound exami-nation.Of 25 patients examined by CT/MRI.pelvic masses were found in 13 cases and enlarged uterus in 11 cases.All 15 patients who underwent endometriaI biopsies were proven to have endometrioid carcinomas.Serum CA125 level was found to be elevated in 22 of the 34 examined cases(64.7%)with median value 500 U/mL(range,39-3439 U/mL).FIGO stages of endometrial carcinomas:ⅠA 18 cases,ⅠB 20 cases.ⅠC 2 cases,and ⅡA 3 cases;Stages of ovarian cardnomas:ⅠA 19 case,ⅠB 4 cases,ⅠC 7 cases.Ⅱ 4 cases,and ⅢC 9cases.Twenty-four patients(55.8%)were in stage Ⅰ both endometrial and ovar-ian carcinomas.Thirty-one patients underwent total hysterectomy plus bilateral salpingo-oophorectomy with omentectomy and appendectomy,meanwhile,12 patients had pelvic lymph nedes dissection.Thirty-eight of the 43 patients(88.4%)had a pathologically proven endometrial adenocarcinomas.The predominant ovarian histologies were endometrioid or mixed tumors with endometrioid components(30/43,69.8%).Postoperatively,26 patients(60.5%)received adjuvant chemotherapy alone.12 had chemotherapy plus radiotherapy,only one patients had radiation alone and the remaining 4 cases received no adiuvant treatment.The 3-year and 5-year survival rates of the group were 87.4%and 71.1%respectively.The 3-year and 5-year survival rates of patients with endometriold carcinoma at both endometrial and ovarian were higher than that of those with non-endometriold or mixed histologic subtypes(93.8%,82% vs 79.7%.69%).The 3-year and 5-year survival rates of patients with earty stages disease were better than those of other patients(93.3%,93.3% vs 69.7%,36.7%).Recurrence developed in 15 patients(34.9%).It was showed by univariate analysis that lower CA125 level,early FIGO stage,and adjuvant chemotherapy plus radiotherapy significantly and positively affected the 5-year survival rate.while only eady FIGO stage and chemotherapy plus radiotherapy were revealed by multivariate analysis as independent prognostic factors.Conclusion:Syn- chronous primary cancers of the endometrium and ovary were different from either the primary endometrial or ovarian cancer,while usually it can be detected in early stage with a good prognosis.The impact of the CA125 level on prognosis needs to be further studied.Surgery treatment alone may be enough for early stage patients.Chemotherapy plus radiotherapy may benecessary for advanced patients.     

子宫内膜和卵巢双原发癌43例临床与预后分析

目的 探讨子宫内膜和卵巢双原发癌的临床病理特点、治疗方法及其预后.方法 回顾性分析43例子宫内膜和卵巢双原发癌的临床病理资料、治疗方法、生存情况及其预后.结果 43例患者的年龄为28～73岁,中位年龄49岁.主要症状为不规则阴道出血和盆腹腔疼痛.查体发现盆腹腔肿物17例(39.5%),子宫增大12例(27.9%).所有患者均行超声检查,超声发现盆腔肿瘤29例(67.4%),子宫内膜增厚或异常回声10例(23.3%).行CT或MRI检查的25例患者中,子宫增大11例(44.0%),盆腔肿瘤13例(52.0%),1例未见异常.15例患者分段取内膜活检,病理均诊断为子宫内膜癌.行CA125检查的34例患者中,22例(64.7%)CA125值升高,中位值为500 U/ml,平均为812.9 U/ml.31例患者接受全子宫双附件、大网膜及阑尾切除术;12例患者同时接受了盆腔淋巴结清扫术.以内膜样腺癌为主的子宫内膜癌38例(88.4%),卵巢癌中内膜样腺癌或含内膜样腺癌成分的混合癌患者30例(69.8%).子宫内膜癌中,ⅠA期18例,ⅠB期20例,ⅠC期2例,ⅡA期3例;卵巢癌中,ⅠA期19例,ⅠB期4例,ⅠC期7例,Ⅱ期4例,ⅢC期9例.子宫内膜癌与卵巢癌均早期(均为Ⅰ期)患者24例,占55.8%.术后接受化疗26例(60.5%),接受化疗联合放疗12例(27.9%),单纯放射治疗1例.43例患者总的3年和5年生存率分别为87.4%和71.1%.子宫内膜与卵巢肿瘤均为内膜样腺癌患者的3年和5年生存率分别为93.8%和82.0%;子宫内膜与卵巢肿瘤不均是内膜样癌患者分别为79.7%和69.0%.子宫内膜癌与卵巢癌早期患者的3年和5年生存率分别为93.3%和93.3%,明显高于非早期患者(69.7%和36.7%,P=0.0002).患者治疗后复发15例,复发率为34.9%.单因素分析显示,CA125值升高、手术病理分期、化疗联合放疗对预后有显著影响.多因素分析显示,分期、化疗联合放疗对患者预后有显著影响.结论 子宫内膜和卵巢双原发癌患者多为早期,病理分化较好,多数患者预后较好,监测患者CA125水平的意义值得进一步研究.早期患者可行全子宫双附件和大网膜切除,但淋巴结清扫的意义尚不能肯定;晚期患者术后可行化疗联合放疗.     

恶性神经鞘瘤25例临床分析

目的:对恶性神经鞘瘤的临床特征进行分析,以期提高对该病的认识。方法:对我院1993年1月~2006年2月收治的25例患者的临床表现、治疗模式及转移复发情况进行回顾性分析。结果:全组男性14例(56%),女性11例(44%),平均发病年龄53.7岁。表现为体表肿物16例(64%),腹腔及盆腔肿物7例(28%),腰背痛、下肢乏力1例(4%),体检发现肺转移结节1例(4%)。病理类型均为梭形细胞恶性肿瘤,S-100阳性者24例(96%),S-100阴性1例(4%)。23例给予手术完整或部分切除,1例未行手术,1例行剖腹探查发现广泛转移而无法切除。6例予术后放疗,2例行术前导管化疗。25例随访时间为7个月~5年,随访期内,4例(16%)发生肺转移,2例(8%)淋巴结转移,7例(28%)局部复发,2例失访,余10例(40%)未见复发及转移。结论:恶性神经鞘瘤可发生于全身各部位,体表肿块为常见症状,确诊依赖病理组织学检查。肿瘤易复发及转移,手术切除是最有效的治疗方法。     

宫颈癌手术治疗后阴道残端复发灶的放射治疗

目的：研究３８例狗颈癌术后阴道残端复发放疗的疗效及预后的有关因素。方法：３８例患者中,２５例为单纯阴道残端复发,１３例为阴道残端合并盆腔复发。根据阴道残端肿瘤大小分为３组,Ａ组：肿瘤直径≥３ｃｍ,Ｂ组：肿瘤直径〈３ｃｍ,Ｃ组：肿瘤结节不明显。采用阴道高剂量率后装加盆腔外照射治疗。结果：１７例患者治疗后存活期超过５年,五年生存率为４４．７％;其中Ａ组五年生存率２３．１％（３／１３）,Ｂ组五年生存率３     

CLINICAL DIAGNOSIS AND TREATMENT OF SMALL OVARIAN TUMOR IN POSTMENOPAUSAL WOMEN

Objective： To investigate the clinical symptom, ultrasonographic scan finding, serum CA125 value, histopathological type and treatment of small ovarian tumor （〈5 cm） in postmenopausal women. Methods： Retrospective analysis was carried out for 52 clinical materials of ovarian tumor cases in women more than one year after menopausal between Jan 1997 and Dec 2004. The largest diameter of the ovarian mass is less than 5 cm. Results： There were 11 ovarian cancers and 1 borderline ovarian tumor among 52 small ovarian tumors （23.1%）. 10 ovarian cancers were epithelial neoplasms and 2 were sex cord-stromal tumors, and 8 cases were in late stage according to FIGO staging system （33.3%）. Compared with benign tumor, there is no significant difference in the onset age, interval after menopausal and duration of history. The main clinical feature is abdominal symptoms, such as abdominal pain and distension in the malignant cases. The patients with benign tumors often showed the ovarian mass during the annual screening or admitted into hospital for other causes. The ultrasonography finding and serum CA125 level showed much difference between benign and malignant cases. Unilocular smooth-walled ovarian cysts mostly were found in benign tumor and the CA125 values were always less than 35 U/ml; but the solid or complex sonographic structures （multilocular, or with a papillary projections on the wall） often indicated a high risk of cancer, especially there was ascites in the pelvic cavity. Serum CA125 level in many cancer cases was elevated （〉35 U/ml）, over 300 U/ml in more than half of the patients. Surgery is still the first choice to treat ovarian cancer, and chemotherapy would be an auxiliary method. Till now, 3 ovarian cancer patients died of complications of cancer and 2 cases had recurrence. Conclusion： Small ovarian tumor in postmenopausal women has a comparatively low malignant occurrence but more in later stage. Many are epithelial carcinoma. If there is complex or parenchymal sonographic structure accompanied with a high serum CA125 level, operation should be considered, while it can be followed up when the ultrasound shows a smooth cyst with normal CA125 value.     

卵巢恶性风险计算法预测盆腔包块患者卵巢癌风险

  目的   探讨血清人附睾蛋白4（Human epididymis protein 4 HE4）和癌抗原125（CA125）联合检测（卵巢恶性风险计算法ROMA）预测盆腔包块患者上皮性卵巢癌（EOC）风险。   方法   采用电化学发光法检测因盆腔包块或卵巢囊肿住院拟行手术的患者血清HE4和CA125水平,根据是否绝经,采用ROMA方法计算卵巢癌预测概率（PP）,绘制受试者工作曲线（ROC）,分别确定绝经前后临界值,并将患者划分至高危组和低危组,评估预测模型的应用价值。   结果   评估了1 683例患者,其中1 448例盆腔良性疾病,235例盆腔恶性肿瘤,包括106例EOC。在经病理确诊为良性盆腔包块患者中有1 356例被划分至低危组,特异性93.6%;盆腔恶性肿瘤中121例划分至高危组,敏感度80.7%;卵巢交界性上皮瘤20例划分至高危组,敏感度28.2%;EOC中93例划分至高危组,敏感度87.7%,未划分至高危组包括黏液性腺癌2例,透明细胞癌11例。卵巢非上皮性恶性肿瘤患者中5例划分至高危组,敏感度38.5%;非卵巢恶性肿瘤患者中35例划分至高危组,敏感度85.3%;转移性卵巢癌患者中1例划分至高危组,敏感度25.0%。   结论   ROMA较成功地将盆腔恶性肿瘤患者划分至高危组,其中EOC患者大部分被正确地划分至高危组,ROMA在诊断恶性肿瘤尤其是EOC方面具有较高的应用价值。      

Paget＇s Disease of the Breast： Clinical Analvsis of 45 Patients

Objective Paget’s disease is an uncommon breast malignancy and often misdiagnosed. If the patient is treated at an early stage, the prognosis is satisfactory. Our study analyzed the clinical characteristics of the disease and the factors influencing the prognosis. Methods Fourty-five patients with Paget’s disease who were admitted to our hospital were analyzed retrospectively. Results The most common symptoms of the disease were erosion and a bleeding-like eczematoid change at the nipple/areola. Of the 40 patients with an eczematoid change, 11 patients had verified Paget’s disease with a palpable mass on physical examination, and 29 patients had verified Paget’s disease with a nonpalpable mass. Only 5 patients manifested a mass with no eczematiod change. Thirteen patients had ipsilateral axillary lymphadenopathy. In this study, 25 cases were treated by radical mastectomy and 20 cases were treated by modified radical mastectomy. Five and 10-year survival rates for the patients with nonpalpable masses and for those with palpable masses were 95.5%, 78.6%, and 53.8%, 36.4% respectively. The former were significantly higher than the latter (P <0.01 and <0.05 respectively). Five and 10-year survival rates for the patients without underlying carcinoma (DCIS/IDC) and for the patients with underlying carcinoma were 100%, 88.9% and 69.6%, 43.8% respectively. The former were significantly higher than the latter ( P<0.05) Five and 10-year survival rates for the patients with negative lymph nodes and for the patients with positive lymph nodes were 92.0%, 76.5% and 50.0%, 25.0% respectively. The former were also significantly higher than the latter (P<0.05). Conclusion Treatment at an early stage is very important and influences the prognosis directly for Paget’s disease of the breast. The survival rates of patients with nonpalpable masses without underlying carcinoma and without lymphadenopathy, were significantly higher than patients with palpable masses with underlying carcinoma and with lymphadenopathy respectively. There was significant statistical difference between each of the 2 groups.     

真空辅助旋切微创术对超声检查良性乳腺实性肿块的诊治价值

目的探讨真空辅助旋切微创手术对超声检查为良性乳腺实性肿块的诊治价值。方法收集2008年1月至2009年6月在本院乳腺病中心超声检查为乳腺影像报告和数据系统分级(Breast Imaging Reporting and Data System,BI-RADS)2、3、4级的良性乳腺实性肿块患者831例,所有患者行真空辅助旋切微创手术。对患者的超声检查、手术及病理资料进行回顾性分析。结果根据超声检查BI-RADS分级,2级167例、3级588例、4级76例。831例患者共检出肿块1383处,所有乳腺肿块均被准确、完全切除,全部患者切口隐蔽,乳房无变形,有较好的外观美观效果。831例患者中,良性病变822例,占所有病例的98.92%,乳腺癌9例占所有病例的1.08%,其中临床分期I期8例,Ⅱa期1例.418例不可扪及肿物患者中检出1例乳腺癌,占不可扪及患者的0.24%,占所有病例的0.12%(1/831)。413例可扪及肿物患者中检出8例乳腺癌,占可扪及患者的1.94%,占所有病例的0.96%(8/831)。588例BI-RADS3级病例中检查出3例乳腺癌,76例BI-RADS4级病例中检查出6例乳腺癌。结论真空辅助旋切微创手术诊治超声检查良性乳腺实性肿块不仅美容效果好,而且定位准确能全切除良性病变,更重要的是能检出临床上考虑良性肿块中的早期乳腺癌。     

HE4 and Mesothelin: Novel Biomarkers of Ovarian Carcinoma in Patients with Pelvic Masses

Objectives: To evaluate the utility of novel serum tumor markers, HE4 and mesothelin either alone or incombination with CA125 in diagnosis and early detection of ovarian carcinoma in patients with pelvic masses.Subjects and methods: Sera were obtained preoperatively from 65 women underwent surgery for a pelvic massand 25 age- and menopausal status-matched healthy women. All samples were analyzed for levels of CA125,HE4, and mesothelin by serum based immunoassays and patients results were compared to final pathologyfindings. Results: Of 65 patients with pelvic masses; 41 had histologically diagnosed ovarian cancer, and 24 hadbenign ovarian diseases. The studied tumor markers were significantly increased in malignant compared tobenign cases and healthy subjects, and in benign cases compared to healthy subjects (p<0.001). Based uponReceiver operator characteristic (ROC) curves analysis, HE4 had the highest sensitivity as a single marker indetecting ovarian malignancy (82.9%) and early stage malignancy (76.9%), followed by CA125, then mesothelin.The combination of HE4 and CA125 gave the highest sensitivity in detecting ovarian carcinoma and early stagedisease (90.2%, 84.6% respectively). Addition of mesothelin to this combination did not show any improvementin the sensitivity. Conclusions: As a single marker, HE4 had the highest sensitivity for detecting ovarian carcinomaspecially early stage disease. Combined CA125 and HE4 was a more accurate predictor of ovarian malignancythan either alone.     

卵巢少见原发肿瘤的临床特点及 MRI 征象对比

目的：探讨几种卵巢原发少见肿瘤的临床及 MRI 特点,提高该类病变的诊断准确率。方法：回顾性研究45例经手术病理证实的卵巢少见原发肿瘤的临床及术前 MRI 资料。结果：45例卵巢肿瘤患者48处肿块,单侧病灶42例,双侧病灶共3例,包括卵巢子宫内膜样腺癌12例,透明细胞癌6例,颗粒细胞瘤8例,卵泡膜细胞瘤10例,纤维瘤9例;患者多数见于围绝经期及绝经后女性,临床表现多样,上皮样肿瘤可见 CA125升高及部分 CEA 升高,颗粒细胞瘤及卵泡膜细胞瘤可出现雌激素增高及相关依赖症状,纤维瘤症状轻微;MRI 平扫卵巢肿块多为囊实性,实性肿块次之,但病灶内成分及信号存在差异,增强扫描强化特点及 DWI 信号各异,有助于提高诊断率。结论：几种卵巢少见肿瘤的临床表现及 MRI 征象具有一定的差异性,综合应用对肿瘤的定性诊断有重要的临床价值。     

输卵管良性肿瘤5例临床病理分析

目的探讨输卵管良性肿瘤的临床病理特点。方法回顾性分析本院1992年～2003年收治的5例输卵管良性肿瘤的临床及病理资料。患者平均年龄40.7岁(26.8～50.1岁),月经均规律,无不育患者。结果5例中仅有1例有盆腔包块。妇科检查均发现附件肿物,直径6～10cm;B超检出4例附件包块,直径2～10cm。肿瘤标志物CA125均正常。术前4例诊断为盆腔肿瘤(其中3例为卵巢肿瘤),无1例诊断为输卵管肿瘤。手术探查发现3例输卵管肿瘤,冷冻切片病理检查证实为良性;另2例子宫肌瘤中1例双侧输卵管稍增粗,另1例双侧输卵管外观正常。5例均施行肿瘤切除术。术后病理诊断输卵管囊性腺纤维瘤3例,输卵管囊性腺瘤样瘤1例,双侧输卵管平滑肌瘤1例。术后随诊3年6个月至13年7个月无异常发现。结论本组输卵管良性肿瘤以输卵管囊性腺纤维瘤居多。输卵管良性肿瘤可有盆腔包块的临床表现,但手术前大多误诊为卵巢肿瘤,术中也易漏诊,术中冷冻和术后病理检查方可确诊。输卵管良性肿瘤单纯切除术疗效满意。     

腹膜后神经鞘瘤82例临床分析

目的通过临床病例分析,了解腹膜后神经鞘瘤的临床诊治状况,提高鉴别诊断能力.方法对本组病例行临床分析.结果本组82例均行手术治疗,肿瘤全切除60例(占73.2%),次全和大部分切除13例(占15.9%),无法切除9例(占11.0%);术中探查单发肿瘤78例(占95.1%),多发4例(占4.9%).肿瘤多位于脊柱旁,呈囊实性,有包膜,表面光滑,血管丰富,界清,包膜表面可与周围组织粘连.病理结果诊为神经鞘瘤81例(占98.8%),恶性神经鞘瘤1例(占1.2%);在多发肿瘤4例中,2例(占2.4%)诊为双原发,伴随病灶为升结肠腺癌及左上肺鳞癌,术后复发1例.结论腹膜后神经鞘瘤发病率低,术前诊断困难,绝大部分为良性,恶性少见,主要治疗方法为手术治疗,恶性神经鞘瘤对放化疗不敏感,预后差.