123例老年人肺癌的外科治疗体会

本文报告自１９９０年５月￣１９９５年４月，手术治疗６０岁以上肺癌１２３例。鳞癌４７例，腺癌４３例，小细胞癌１６例，其他１２例。手术切除１１０例（８９．４％），术后并发症２４例（１９．５％），死亡１例（０．８％）。５年生存率３２．３％（１０／３１）。体会：加强围手术期的处理，选择适当的手术方式，是预防老年人肺癌手术后并发症的关键。     

支气管动脉灌注化疗加体外照射治疗晚期肺癌37例

１９９０年２月至１９９３年１２月，选择性支气管动脉灌注化疗（ＢＡＩ）加体外放射治疗（ＲＴ）３７例不能手术的晚期肺癌（Ⅲ期３３例，Ⅳ期４例），经治疗９０．１％的病例症状消失或减轻，近期有效率（ＣＲ＋ＰＲ）：单用ＢＡＩ疗法为７０．３％，ＢＡＩ＋ＲＴ为８９．２％。随访至１９９４年５月，生存１２例，生存期４～４８个月，死亡２５例，其中位生存期１２个月，平均１４．４个月。全组病例０．５、１、２、３年生存率分别为９４．４％、６１．３％、３７．５％及６．３％。对不能手术的晚期肺癌，ＢＡＩ合并放疗是一种选择的治疗方法。     

影响肺癌术后远期生存因素的探讨

影响肺癌术后远期生存因素的探讨邱新生袁普贵柳和武杨玉理沈阳市胸科医院胸外科（沈阳１１００４４）１９７２年～１９９０年４月期间我院胸外科手术治疗２３０例原发性支气管肺癌，其中１５例为开胸探查术，切除率为９３．５％。五年生存率２１．４％（４６／２１５）。...     

瑞士圣加仑州立医院外科大肠癌治疗状况（附183例临床病理分析）

１９９１年１月至１９９３年７月，共计１８２例大肠癌患者在瑞士圣加仑州立医院外科接受手术治疗。男女之比＝１．３６：１，平均年龄６９．９岁。６７．６％的患者有可证实的危险因素，其中以肠息肉为主（５４．９％）。平均症状期为４．５个月。主要症状为排便习惯改变（５０．５％）和便血（４０．１％）。１８０例患者（９８．９％）接受了根治性（７７．５％）或姑息性（２１．５％）肿瘤切除。７９．４％的直肠癌患者均可接受保肛手术。４５例（２４．７％）患者接受了包括一个或一个以上相邻脏器的扩大根治术。共计８７例（４７．８％）出现术后并发症，手术死亡率为６％。总的３年生存率为６５．１％。     

全肺切除治疗晚期肺癌108例临床观察

本文目的在于评价全肺切除术对晚期肺癌生存率的影响。自１９７０年２月￣１９９５年１０月，我科以全肺切除术治疗晚期肺癌１０８例，其中心包内处理血管４１例（３８％）。４５例行右全肺切除，６３例行左全肺切除。根治性全肺切除８９例（８２．４％），姑息性全肺切除１９例（１７．６％）。本组１０８例术后５年生存率为２８．６％，其中非小细胞癌５年生存率为３７．４％，未分化小细胞肺癌无一例生存满５年者。作者认为晚期肺     

支气管成形术和肺动脉成形术治疗支气管肺癌

我院胸外科从１９８８年４月－１９９４年４月手术治疗支气管肺癌２９例，作者采用肺叶切除支气管成形术，其中５例同时施行了肺动脉成形。病变主要在上叶运气了管口甚至邻近主支气管，其中病变累及右叶１７例，左叶１２例，病期Ｉ期７例，Ⅱ期１６例，Ⅲａ期６例。手术行袖式支气管肺叶切除右侧７例，左侧４例，另５例同时行支气管肺叶袖式切除与血管成形术。手术后并发症７．１％，主要是肺部感染，肺不张。死亡１例（占３．７％）     

肺癌支气管成形术77例分析

肺癌支气管成形术７７例分析玉寒冰，李士昌，刘顺寿，刘德贵，罗全，赵莹辽宁省肿瘤医院胸科（沈阳１１００４２）自１９７９年６月～１９９５年２月期间，我院对７７例中心型肺癌行支气管成形术，占同期肺癌手术的４．５％。男５９例，女１８例；平均年龄５４．２岁，高...     

晚期肺癌化放综合治疗的临床疗效观察

目的 探讨晚期肺癌化放综合治疗的疗效。方法 １９９２年１月至１９９４年１２月收治５２例晚期肺癌，化疗２￣４周期后行放疗，放疗以＾６０Ｃｏ－γ线照射，ＤＴ５５￣７０Ｇｙ／５．５￣７周，结果 完全缓解（ＣＲ）率１３．５％，部分缓解率５１．９％，总有效（ＣＲ＋ＰＲ）率６５．４％，中位生存期１５．３月。结论 晚期肺癌采用化放综合治疗疗效较满意。     

320例肺癌合并上腔静脉压迫综合征的治疗分析

１９５９年５月至１９９０年１２月，本院收治的３２０例伴上腔静脉压迫症的肺癌，经治疗２８６例（８９．４％）症状有缓解，２０５例（６４．１％）症状完全缓解。先行放射治疗者的完全缓解率（７１．６％）高于先行化疗者（２６．４％），Ｐ＜００１，放射治疗组中，接受冲击放疗者，１周内症状缓解率（５１．５％）高于常规放疗或低剂量分割放疗者（２７．２％），Ｐ＜０．０５，本结果提示，治疗并发上腔静脉压迫征肺癌，应先行放射治疗，冲击放疗可加速症状缓解。     

肺上沟癌5例治疗体会

肺上沟癌５例治疗体会严福来吕桂泉毛伟敏周星明陈奇勋浙江省肿瘤医院（抗州３１００２２）自１９８５年２月～１９９５年６月期间，外科收治５例肺上沟癌病例。占同期肺癌手术的０．７９％，５例均男性，年龄４９～６２岁。其中左上叶１例，右上叶４例。４例术前放疗２５...     

Gastrointestinal metastases from primary lung cancer

The aim of this study was to evaluate gastrointestinal metastases from primary lung cancer confirmed by autopsy. We identified and examined patients with a diagnosis of primary lung cancer over 33 years. We also reviewed patients with gastrointestinal metastases including the stomach, small bowel, and large bowel. This study comprised 470 patients with lung cancer. We detected 56 (11.9%) cases with gastrointestinal metastases. There were 12 (30%) cases with gastrointestinal metastases among 40 cases with large cell carcinoma. The histological type of large cell carcinoma led to a significantly higher rate of gastrointestinal metastases compared with that of non-large cell carcinoma (P = 0.004, odds ratio 3.524). Life threatening gastrointestinal metastases occurred in 12 cases and five occurred in large cell carcinoma. Gastrointestinal metastases from primary lung cancer may occur in the clinical course and result in life threatening gastrointestinal metastases, particularly if patients have the histological type of large cell carcinoma.     

不可手术的局部晚期非小细胞肺癌患者胸部放疗后脑转移特征及危险因素分析

目的 探讨不可手术的局部晚期非小细胞肺癌患者胸部放疗后脑转移特征及其危险因素.方法 选取经组织病理学检查或免疫组化检查证实的不可手术的局部晚期非小细胞肺癌患者72例.根据患者各项资料,分析不可手术的局部晚期非小细胞肺癌患者放疗后脑转移特征,使用多因素Logistic回归分析影响不可手术的局部晚期非小细胞肺癌患者放疗后脑转移的危险因素.结果 72例患者中,15例(20.83%)患者出现脑转移,其中腺癌14例,鳞癌1例;单纯脑转移2例,脑转移合并其他部位转移13例.患者出现脑转移的中位时间为8.5个月,1年、3年累积脑转移率分别为16.31%、29.94%.单因素分析结果显示:患者的年龄、吸烟史、CA125、NSE、CEA与局部晚期非小细胞肺癌患者胸部放疗后脑转移存在一定关系(P﹤0.05).多因素Logistic回归分析结果显示:年龄﹥60岁、有吸烟史、CA125升高、NSE升高、非鳞状细胞癌是影响局部晚期非小细胞肺癌患者胸部放疗后脑转移的危险因素.结论 年龄﹥60岁、有吸烟史、CA125升高、NSE升高、非鳞状细胞癌的局部晚期非小细胞肺癌患者胸部放疗后出现脑转移的危险性高.     

支气管动脉灌注化疗治疗肺癌的临床研究

目的　探讨支气管动脉灌注化疗 (BAI)对中晚期肺癌的疗效及影响因素。方法　对 45例中晚期肺癌进行BAI治疗 ,与同期接受全身化疗的 40例中晚期肺癌进行比较。结果　除开 1例大细胞肺癌 ,BAI组完全缓解 (CR) 15例 ( 3 4.1% ) ,部分缓解 (PR) 18例 ( 4 0 .9% ) ,缓解 (CR +PR) 3 3例 ,缓解率 75 .0 % ,与全身化疗之间的疗效 ( 5 0 .0 % )有显著性差异 ,前者优于后者 (P <0 .0 5 ) ,前者毒副反应亦少于后者 (P <0 .0 5 ) ,但BAI组有 1例灌注后截瘫。在BAI组中 ,小细胞未分化癌、鳞癌、腺癌的缓解率分别为 94.5 %、66.6%、40 .0 %。BAI组鳞癌和腺癌的缓解率显著高于全身化疗组 (P <0 .0 5 )。结论　BAI的疗效优于全身静脉化疗 ,且毒副反应低。鳞癌首选BAI治疗 ,小细胞未分化癌以全身化疗为基础 ,辅助应用BAI治疗 ,腺癌可先行BAI治疗 ,配合全身化疗或放疗     

209例晚期肺癌外科治疗分析

 本文就外科治疗晚期肺癌(Ⅲ、Ⅳ期)进行了分析。见女性随年龄增高而相对减少。鳞癌随年龄增高而相对增加;小细胞癌则相对减少。本组腺癌最多96例(45.9%);鳞癌次之87例(41.6%);小细胞癌14例(6.7%);其它型癌12例(5.8%)。术后生存率老年人最高,青年人最低。但同时期外科治疗早期、较早期(Ⅰ、Ⅱ期)肺癌术后生存率无统计学差异。提示青年人肺癌外科治疗更要强调“两早”,而老年人肺癌只要严格选好适应症,尽管晚期外科疗效也很满意。     

青少年原发性肺癌外科治疗及预后

目的 :探讨青少年肺癌的特点 ,分析原因 ,总结早期诊断方法。方法 :对 4 8例青少年肺癌进行回顾性统计。结果 :青少年肺癌发病率占本院同期原发性支气管肺癌的 0 97% (48/ 4 90 5例 ) ,误诊率约为 81 2 % (39/ 4 8) ,其中 3例病员误诊时间最长超过 9个月。病理分型以腺癌和鳞癌为主。两者相似比分别为 6 0 4 %和 2 7 0 % ;TNM分期 :中晚期肺癌达 93 7% ;术后死亡率为 2 0 % ,术后一年生存率为 6 2 5 % ;三年生存率为 4 5 8% ;五年生存率为 32 6 % ;七年生存率为 2 7 0 %。结论 :(1)青少年肺癌以误诊率高 ,恶性程度高 ,进展快 ,转移率高 ,手术切除率低 ,预后差等为特点。 (2 )普遍误诊原因有 :对青少年肺癌警惕性不高 ,鉴别诊断困难。 (3)应提高对青少年肺癌的认识 ,提倡早期诊断 ,早期治疗     

Occult lung cancer with positive cytology and normal chest film--an analysis of 54 cases

From 1973 to 1980 and 1982 to 1984, mass annual screening was carried out in Yunnan Tin Corporation. Chest X-ray and sputum cytology were used to detect lung cancer among subjects with an underground work history over 10 years and over 40 years of age. 54 cases of occult lung cancer with positive cytology and negative X-ray plain film were found, 48 out of 100,725 subjects and 6 out ot 8,808 out-patients. 42 lesions were located by bronchoscopy and 12 by various roentgenologic examinations. Among these 54 cases, 52 (96.3%) were central type lung cancers. Squamous cell carcinoma was found in 53 and small cell anaplastic carcinoma in only 1. Diagnosis was established by pathology in 35 and by cytology in 19. In 18 cases treated by surgery, there were 15 Ia stage and 3 Ib (UICC staging system). 3 Ib died of recurrence 33, 62 and 101 months after operation. 1 Ia died of residual cancer recurrence 21 months after sleeve-resection. The overall 5 year survival rate was 91.6% (11/12). The authors believe that X-ray plain films sometimes fail to detect the early stage central type lung cancers. Bronchoscopy, in particular fiberoptic bronchoscopy is one of the most effective means in diagnosis and location. By bronchoscopy, in general, the tumor could be detected and the extent of involvement in the bronchus assessed. Finally, the authors emphasize that mass screening is a useful method to detect early lung cancer among the high risk population.     

肺未分化癌p53基因蛋白的表达和预后相关性的研究

采用ＡＢＣ免疫组织化学法对６０例肺未分化癌进行ｐ５３蛋白阳性表达的研究。结果显示ｐ５３蛋白在肺大、小细胞癌的表达率皆为６３．３％，两者间无差异。在大细胞癌病例中，ｐ５３核浆型阳性者１年生存期较胞浆为主型阳性者为长，两者间无统计学意义。肺未分化癌ｐ５３过度表达者，其１年及半年生存率有增加倾向，但无统计学意义。大细胞癌ｐ５３阳性者其淋巴结转移率为８７．５％，两者呈正相关（Ｐ＜０．０５）。大小细胞癌中ｐ５３蛋白阳性者均易有远处转移，提示ｐ５３蛋白与肿瘤的晚期发展有关。同时，还证明癌旁的原位癌及不典型增生的肺泡上皮亦可呈ｐ５３蛋白阳性，而在正常组织则未见ｐ５３蛋白表达。作者认为ｐ５３蛋白有可能作为早期诊断的一个参考指标。     

Clinico-Pathological Profile and Haematological Abnormalities Associated with Lung Cancer in Bangalore,India

Background: Lung cancer is one of the most common types of cancer causing high morbidity and mortality worldwide. An increasing incidence of lung cancer has been observed in India. Objectives:To evaluate the clinicpathological profile and haematological abnormalities associated with lung cancer in Bangalore, India. Materials and Methods: This prospective study was carried out over a period of 2 years. A total of 96 newly diagnosed and histopathologically confirmed cases of lung cancer were included in the study. Results: Our lung cancer cases had a male to female ratio of 3:1. Distribution of age varied from 40 to 90 years, with a major contribution in the age group between 61 and 80 years (55.2%). Smoking was the commonest risk factor found in 69.7% of patients. The most frequent symptom was cough (86.4%) followed by loss of weight and appetite (65.6%) and dyspnea (64.5%). The most common radiological presentation was a mass lesion (55%). The most common histopathological type was squamous cell carcinoma (47.9%), followed by adenocarcinoma (28.1%) and small cell carcinoma (12.5%). Distant metastasis at presentation was seen in 53.1% patients. Among the haematological abnormalities, anaemia was seen in 61.4% of patients, leucocytosis in 36.4%, thrombocytosis in 14.5% and eosinophilia in 19.7% of patients. Haematological abnormalities were more commonly seen in non small cell lung cancer. Conclusions: Squamous cell carcinoma was found to be the most common histopathological type and smoking still remains the major risk factor for lung cancer. Haematological abnormalities are frequently observed in lung cancer patients, anaemia being the commonest of all.     

Combination chemotherapy with cis-platinum, adriamycin and mitomycin C (PAM) in the treatment of non-small cell carcinoma of the lung

Twenty-three patients with inoperable non-small cell lung cancer were treated with a combination chemotherapy of CDDP 100 mg/m2, ADM 30 mg/m2 and MMC 8 mg/m2 (PAM). Ten cases were adenocarcinoma, 9 cases were squamous cell carcinoma and 4 cases were large cell carcinoma. In 21 evaluable cases, partial response was obtained in 47.6%. (The response rates were 40.0% in patients with adenocarcinoma, 50.0% in those with squamous cell carcinoma and 66.7% in those with large cell carcinoma.) Leukocytopenia of less than 4,000/mm3 occurred in 100% of cases, thrombocytopenia of less than 100,000/mm3 occurred in 81.0%, and anemia(fall in hemoglobin over 2.0 g/dl) occurred in 66.7%. A transient elevation of Cr (over 1.5 mg/dl) and/or BUN (over 30 mg/dl) was observed in 23.8%. Nausea and vomiting occurred in almost all patients. No death occurred due to toxicity of PAM. These results demonstrate that PAM is an effective combination chemotherapy in patients with non-small cell carcinoma of the lung.     

MMP-2和MMP-9在肺癌组织中的表达

目的 :研究肺癌和正常肺组织中基质金属蛋白酶 2 (MMP 2 )和MMP 9的表达。方法 :采用免疫组织化学EnVision方法 ,对 71例肺癌标本和 31例正常肺组织检测MMP 2和MMP 9的表达。结果 :71例肺癌标本中 ,小细胞肺癌 (SCLC) 4例 ,MMP 2表达阳性 3例 (75 0 % ) ,MMP 9表达阳性 2例(5 0 0 % ) ;非小细胞肺癌 (NSCLC)有 6 7例 ,年龄 4 0岁以上 6 4例 ,MMP 2表达阳性 39例 ,阳性率 6 0 9%(39 6 4) ;MMP 9表达阳性 4 6例 ,阳性率 71 9% (4 6 6 4)。正常肺标本 31例 ,年龄 4 0岁以下MMP 2和MMP 9表达均为阴性 ,年龄在 4 0岁以上 2 6例 ,MMP 2阳性表达 9例 ,阳性率 34 6 % (9 2 6 ) ,MMP 9阳性表达 10例 ,阳性率 38 5 % (10 2 6 ) ;4 0岁以上NSCLC标本的MMP 2和MMP 9阳性表达与正常肺标本比较 ,差异均有显著意义。结论 :在NSCLC中高表达的MMP 2和MMP 9均是好的肿瘤标记物 ,但是 ,MMP 9阳性率比MMP 2更高 ,因此MMP 9的检测具有更大的临床意义。