胃平滑肌肉瘤八例

胃平滑肌肉瘤少见。我院于1981-1991年间手术治疗经病理确诊胃平滑肌肉瘤8例。男性3例;女性5例,年龄36-73岁。最常见症状为腹部肿块及消化道出血。术前仅确诊2例。8例中作胃根治术3例,胃大部切除4例,楔形切除1例,切除率为100%。5年生存率50%(4/8)。现结合文献就该病的诊断和治疗进行讨论。     

SMA、Desmin、CD10和Vimentin在特殊类型子宫肿瘤诊断中的应用

[目的]探讨SMA、Desmin、CD10和Vimentin在特殊类型子宫肿瘤诊断中的应用价值。[方法]收集特殊类型子宫肿瘤76例（子宫内膜间质肉瘤20例,癌肉瘤17例,平滑肌肉瘤10例,非典型平滑肌瘤16例,上皮样平滑肌瘤13例）,免疫组化SP法检测各组织中平滑肌肌动蛋白（SMA）、结蛋白（Desmin）、CD10和波形蛋白（Vimentin）的表达。[结果]CD10与Vimentin在子宫内膜间质肉瘤和癌肉瘤中高表达,SMA和Desmin在非典型平滑肌瘤和上皮样平滑肌瘤中高表达,Vimentin在平滑肌肉瘤中高表达。[结论]SMA、Desmin、CD10和Vi-mentin在特殊类型子宫肿瘤的诊断中有重要意义。     

胃平滑肌肉瘤（附23例报告）

１９８０年至１９９２年对２３例胃平滑肌肉瘤施行手术治疗，其中男１３例，女１０例，年龄１２岁～７２岁。患者最常见的症状是上腹不适或腹痛，腹部肿块及上消化道出血。术前确诊３例，疑诊２例，误诊１８例；分别误诊为胃癌，胰体、尾囊肿，平滑肌瘤等。行根治性切除２０例，姑息性切除和楔形切除各１例，单纯探查加切检１例。切除率９６％（２２／２３）。５年生存率５７％（１３／２３），１０年生存率１３％（３／２３）。此外对本病的诊断、病理和治疗进行了讨论分析。     

胃动脉介入化疗栓塞联合根治术治疗进展期胃癌

 目的 探讨进展期胃癌介入化疗栓塞联合根治术的切除率和生存率。方法 对63例进展期胃癌患者术前行胃动脉介入化疗栓塞后手术，并与术前常规静脉化疗后手术56例进展期胃癌对照组的切除率和随访结果比较。结果 胃动脉介入化疗栓塞后对进展期胃癌及合并呕血、便血的效果显著，根治性切除率达100％，对照治疗组根治性切除率达55．36％，姑息性切除术28．57％，转流术16．07％。研究组1／2、1、2、3、4、5、6年生存率分别为100％（63／63），93．65％（59／63），93．22%（55／59），90．90％（50／55），58．00%（29／50），41．37%（12／29），25．00％（3／12）。对照组1／2、1、2、3、4、5、6生存率（无6年生存者）分别为83．93％（47／56），87．23%（41／47），70．73％（29／41），72．41％（21／29），42．86%（9／21），11．11％（1／9），0．00％。经统计学处理，两组1～3年生存率有差异（P〈0．05）。结论 对进展期胃癌胃动脉多次介入化疗末次栓塞，可使肿瘤病灶缩小，有利于防止转移和复发，提高手术切除率和延长生存率。     

横结肠平滑肌肉瘤一例

横结肠平滑肌肉瘤一例李宁重庆第三军医大学新桥医院肿瘤治疗中心（６３００３７）消化道平滑肌肉瘤主要位于胃及小肠，而位于大肠者只约占１／５左右，肉瘤约占整个胃肠道恶性肿瘤的３％，而结肠肉瘤仅占结肠恶性肿瘤的１％，较之胃及小肠的肉瘤更为罕见［１］。ＡＫｗａ...     

34例胃平滑肌肉瘤临床分析

目的 对平滑肌肉瘤治疗方法及预后进行探讨。方法 分析了我院34例胃平滑肌肉瘤的诊断、治疗和预后。结果胃平滑肌肉瘤仅占同期胃肿瘤病例的0.8％,三年生存率为61.8％。五年生存率为47.1％。结论 胃平滑肌肉瘤的治疗主要依靠手术治疗,彻底手术至为关键。     

手术治疗胃平滑肌肉瘤24例分析

目的 分析胃平滑肌肉瘤的诊断与治疗效果。方法 回顾性分析我院近10年收治的胃平滑肌肉瘤24例，结果 24例胃平滑肌肉瘤术前确诊11例，患者均行手术探查，19例行手术切除，术后1-10年随访每发4例，其中死亡2例，单纯探查病人均于1年内死亡。结论 胃平滑肌肉瘤是一种低恶性肿瘤，临床表现无特异性，术前确诊困难。根治性手术治疗可以防止复发及转移。     

34例胃平滑肉瘤临床分析

目的 对平滑肌肉瘤治疗方法及预后进行探讨。方法 分析了我院３４例胃平滑肌的肉瘤的诊断。治疗和预后。结果 胃平滑肌肉瘤仅占同期胃肿瘤病例的０．８％,三年生存率为６１．８％,五年生存率为４７．１％,结论 胃平滑肌肉瘤的治疗主要依靠手术治疗,彻底手术至为关键。     

彩色多谱勒血流显像对胃癌术前分期的价值

[目的]评价彩色多谱勒血流显像（以下简称CDFI）对胃癌术前分期的应用价值。[方法]应用彩色多谱勒对97例胃癌病人超声检查并行手术治疗，将术前分期与术后病理结果进行分析。[结果]经CDFI术前分期的病例手术切除率为91.8%，胃癌浸润胃壁的深度（T）符合率T1,T2,T3,T4分别为75.0%(9/12),61.3%(19/31),85.3%(29/34),85.0%(17/20)。区域淋巴结（N）检出率为78.4%，对盆腔和肝转移的检出率分别为25.0%和90.9%。[结论]彩超对胃癌术前分期有较高的准确性，对治疗决策的制定有指导价值。     

同时性食管贲门重复癌34例报告

１９７６年１月至１９９４年１２月，我们收治同时性食管贲门重复癌３４例，占同期食管、贲门癌病人的０．７％（３４／５０４０）。全组食管病变全部为鳞癌，贲门病变中腺癌３２例、恶性纤维组织细胞瘤和平滑肌肉瘤各１例。术前诊断率７０．６％（２４／３４），手术切除率７９．４％（２７／３４），术后１、３、５年生存率分别为８７．５％（２１／２４）、４５．０％（９／２０）和１８．８％（３／１６）。作者认为：注意各项检查的相互配合及仔细的上消化道全面检查能提高诊断率，早期手术并扩大手术范围可提高手术疗效。     

Multivariate analysis of gastric cancer patients with liver metastases

In 93 cases of stomach cancer with liver metastasis, the influence of surgery and chemotherapy on the patients' prognosis was examined. Chemotherapy comprised systemic administration of mitomycin C (MMC) (39 cases), intra-hepatoarterial administration of MMC (19 cases) and intra-hepatoarterial infusion of cisplatin (CDDP) + MMC (PM intra-arterial chemotherapy) (24 cases) in the first 1-2 postoperative weeks. MMC and CDDP were given by 1-4 courses every 1-3 weeks. Examination of the prognosis factors by generalized Wilcoxon test revealed significant differences in the extent of lymph node metastasis (N0-2 vs N3,4), possible resection of primary lesion, and chemotherapeutic regimen (PM intra-arterial chemotherapy and other chemotherapeutic regimens). The response rate was 4.3% (1/23), 29.4% (5/17) and 73.8% (17/23) for MMC systemic administration, MMC intra-arterial chemotherapy and PM intra-arterial chemotherapy, respectively, with a significantly high response rate for the latter. Also for the 50% survival period, the latter showed 11.8 months compared with 2.7 months for other chemotherapeutic treatments, indicating its good prognosis regardless of possible resection of the primary lesion. Cox proportional hazard model revealed the latter alone to be a significant independent factor. The above results suggest that the PM intra-arterial chemotherapy is an effective approach to stomach cancer with liver metastasis.     

残胃贲门癌42例外科治疗报告

目的探讨残胃贲门癌的外科治疗效果。方法回顾性分析42例残胃贲门癌外科治疗的临床资料。手术切除40例,探查2例,根治性切除32例,姑息性切除8例,残胃切除空肠代胃术36例,贲门肿瘤切除余胃食管吻合术4例。结果手术切除率95.2%（40/42）,无手术死亡,手术并发症11例（26.2%）。根治性切除32例中术后生存1年以上30例,3年以上18例,5年以上12例。1,3,5年生存率分别为93.8%、56.3%和37.5%。结论以外科手术为主的综合治疗是治疗残胃贲门癌的有效方法。     

保留喉功能的非开胸食管拔脱颈段食管癌切除术

目的 探讨保留喉功能的非开胸食管拔脱切除颈段食管癌及胃上提、结肠上徙代食管的治疗方法。方法 非开胸食管拔脱切除颈段食管癌24例,17例保留喉功能。重建食管用胃上提(19例)或结肠上徙(5例)。术前或术后给予放疗。结果 T2期生存3年者3例,生存5年者1例;T3和T4期生存3年者8例,生存5年者3例。17例保留喉功能,喉功能保留率77．3％(17／22),术后拔管率75．0％(12／16)。并发症发生率为29．2％。结论 颈段食管癌可以行非开胸食管拔脱一期切除肿瘤及周围受侵组织,并尽可能保留喉功能。利用胃上提、结肠上徙重建食管,联合放射治疗,可以提高患者的术后生存率和生存质量。     

Surgical management of advanced gastric carcinoma in Zaria, Nigeria

In Zaria, Nigeria, 47 men and 37 women aged 25 to 70 years were operated upon for advanced carcinoma of the stomach between 1971 and 1982. In 1971-1976, gastric resection was performed in 33% of the 42 patients and by-pass in 31% compared to 67% and 17% respectively in the other 42 patients treated in 1977-1982. Increased resection of tumours of the corpus, cardia and fundus and of involved adjacent organs accounted for this increase. The in-hospital death rate (29%) was the same for gastric resection and by-pass operations. In this part of the world where reliable chemotherapy and radiation technology are not yet available, the role of the surgeon in securing palliation from gastric cancer remains very prominent.     

A clinicopathological study of recurrent gastric cancer cases treated by a resection of the remnant stomach

Seventeen cases of a recurrent gastric cancer that were treated by a resection of the remnant stomach have been studied retrospectively. For first management 12 cases were given a Billroth 2 procedure, 4 cases a Billroth 1 procedure and 1 case a fundectomy. For the recurrent cancer, 13 cases were given a total resection of the gastric remnant and 4 cases a partial resection. The overall mortality rate was 12% and the survival rate was 58% at 1 year, and 8% at 5 years. We thus have concluded that a resection of the remnant stomach should be carried cut in cases of a recurrent gastric cancer whenever possible.     

残胃癌的临床病理特征及预后分析

目的探讨残胃癌的临床病理特征及预后相关因素。方法回顾性分析45例残胃癌患者的临床病理资料,并进行随访。结果45例残胃癌患者的男女比例为44：1。初次手术距残胃癌的诊断时间为5～42年,平均23年。残胃病变位于吻合口28例,位于贲门9例,其余部位8例。未分化癌1例,低分化腺癌36例,中分化腺癌7例,高分化腺癌1例。根治性切除患者的1、3、5年生存率分别为100．0％、78．8％和47．2％,非根治性切除患者的1、3、5年生存率分别为62．5％、25．0％和0,两组患者生存率差异有统计学意义（P〈0．05）。10例病变未切除患者均于2年内死亡,平均生存时间为12个月。各病理分期患者间生存率差异有统计学意义（P〈0．05）。结论残胃癌多于Billroth Ⅱ式胃大部切除术后10年以上发生,男性多于女性,病变主要位于吻合口附近。进展期残胃癌病理类型以低分化腺癌常见。残胃癌的预后与病理分期、能否行根治性切除密切相关。     

Efficacy of Endoscopic Submucosal Dissection for Cancer of the Operated Stomach

Purpose

Cancer can develop in the operated stomach after partial gastrectomy and in the reconstructed gastric tube after surgery for esophageal cancer. It is considered that endoscopic therapy is more safe and suitable for the early gastric cancer developed in such stomach than operation. We investigated the efficacy of endoscopic submucosal dissection (ESD) for cancer of the operated stomach.

Methods

Subjects were 669 gastric cancer patients who underwent ESD: 22 patients (23 lesions) had surgically altered gastric anatomy, whereas 647 patients (727 lesions) had normal gastric anatomy. In the altered gastric anatomy group, 13 patients, 6 patients, and 3 patients had previously undergone distal gastrectomy, gastric tube reconstruction, and proximal gastrectomy, respectively. Rates of complete en bloc resection and curative resection were compared between the two groups. Influence of an anastomotic site and/or a suture line on ESD outcomes was examined in the altered gastric anatomy group.

Results

The rate of complete en bloc resection by ESD was 82.6 % (19/23 lesions) in the altered gastric anatomy group and 92.3 % (671/727 lesions) in the normal gastric anatomy group. The rate of curative resection and incident rates of complications were not significantly different between the groups. In the altered gastric anatomy group, the rate of complete en bloc resection was significantly lower when a lesion had spread across an anastomotic site and/or a suture line (P?=?0.0372). Furthermore, duration of ESD was significantly longer (P?=?0.0276), and resection efficiency was significantly lower (13 mm²/min, P?=?0.0283), when treating lesions with an anastomotic site and/or a suture line than when treating isolated lesions.

Conclusions

Outcome of ESD for cancer of the operated stomach compares with that in normal stomach anatomy. Anastomotic site/suture line within a lesion influenced the ESD procedure.     

Surgery for elderly patients with cancer of the cardia.

During the past 22 years, the operability rate has been 62.2% for patients 60 years or older, with cancer of the cardia (319/475). The resectability rate has been 66.2% (211/319). Proximal resection of the stomach with resection of the lower third of the esophagus was performed on 156 patients, and gastrectomy on 65. During the last 5 years the operative mortality has decreased from 24.2 to 12.5%. The major causes of death were leakage of anastomosis, pneumonia, acute cardiovascular failures, and myocardial infarction. The 5-year survival rate was 25.2%. The rate of relapse following radical surgery was 14.4% (23 operated patients). The mean duration of life for patients undergoing radical surgery was 26.3 months and those who had had explorative or palliative interventions was 4.5 to 9.3 months.     

Simple pathological examination technique for detection of cancer located at the surgical margin of the stomach

Background

The technique for examining surgical resection margins described in the Japanese Classification of Gastric Carcinoma is based on the examination of continuous infiltration by the primary tumor, and discontinuous lesions such as multiple cancers are not examined. However, examining lesions—particularly cancers—at the resection margins is important for the prevention of cancers in the remaining stomach that result from cancer remnants (remnant gastric cancer).

Methods

The clinical usefulness of a simple pathological examination technique for detecting cancer located at the surgical margin of the stomach was studied. A specimen 5–8 mm wide was resected from the surgical cut margin along the entire circumference of the stomach. When the pathological margin was positive for cancer, the surgical margin was also examined, and cases that were positive for cancer were regarded as marginally positive.

Results

Of the 1,498 patients with early gastric cancer who were examined using this method, 17 (1.1 %) were marginally positive for multiple cancers, and 8 of these 17 patients (57 %) had microcancers <5 mm in diameter.

Conclusion

This method is simple and useful for detecting cancer involving the surgical margin, which occurs at a rate of 1.1 %, making it possible to prevent remnant gastric cancer by reoperation.     

2005例食管和贲门癌切除一层吻合术的临·论著·床运用

目的食管和贲门癌切除术后吻合瘘口是常见的并发症之一,为了降低吻合口瘘的发生率,我院心胸外科对食管与胃或肠的吻合方法进行了改进。方法食管与胃空肠结肠吻合采用一层吻合法,共手术２００５例,其中食管与全胃吻合１０４１例,与残胃吻合８６９例,与空肠吻合８５例,与结肠吻合１０例。结果全组术后发生吻合口瘘４１例（２．０％）,死亡１５例（３６．６％）。结论经临床运用证明一层吻合术具有对合整齐血供好,肿瘤切除率高,吻合口瘘发生率低等优点。改进吻合技术,保护吻合口血供,减少术中污染,降低吻合口张力是预防吻合口瘘的重要措施。