子宫内膜癌手术范围的前瞻性临床研究

目的探讨子宫内膜癌的适宜手术范围、方法对105例子宫内膜癌患者施行广泛性或次广泛性子宫切除术,加盆腔及(或)腹主动脉旁淋巴结清扫术;另外36例子宫内膜癌患者仅作次广泛子宫切除术。对141例的手术切除标本,包括子宫旁结缔组织及淋巴结、盆腔及腹主动脉旁淋巴结等进行病理学检查。结果 105例子宫内膜癌患者中,盆腔淋巴结发生转移26例,占24．76％。除Ⅰa期外,其余各期均有淋巴结转移发生。Ⅰb、Ⅰc期淋巴结转移率分别为12．50％、21．05％。141例行广泛性或次广泛性子宫切除术者中,宫旁组织转移2例(Ⅱa、Ⅲb期),宫旁淋巴结转移2 例(Ⅰc、Ⅲb期);宫旁血管瘤栓2例(Ⅰb、Ⅰc期)。结论除Ⅰa期以外的其他各期,均宜施行广泛性或次广泛性子宫切除术,以及盆腔和／或腹主动脉旁淋巴结清扫术。     

miR-30b 在肾癌中的表达和临床意义

目的：通过检测 miR-30b 在肾癌组织及其配对癌旁正常组织中的表达水平,探讨其与临床病理特征之间的相关性,为进一步研究在肾癌发生、发展过程中 miR-30b 的作用奠定基础.方法从33例经手术切除的肾癌组织及其配对癌旁正常组织中分别提取各自的RNA,经逆转录得到 cDNA,使用 RT-qPCR检测两者 miR-30b 的表达水平,通过统计学软件进一步分析其表达量与患者临床病理特征的相关性.同时,通过检测 miR-30b 在不同肾癌细胞系的表达量,分析 miR-30b在正常细胞系和肾癌细胞系的表达差异.结果 miR-30b 在肾癌组织中的表达量明显高于配对的癌旁正常组织(P＜0.001),其中22例肾癌标本 miR-30b呈现高表达.肾癌组织中 miR-30b的表达水平与患者的年龄、性别、肾癌组织类型、TNM分期及 UICC/AJCC 临床分期均无显著相关性(P＞0.05).miR-30b在不同肾癌细胞系表达水平不同,但均高于正常组织细胞系(P＜0.05).结论肾癌组织中 miR-30b的表达明显上调,提示其可能与肾癌的发生、发展相关.     

59例30岁以下原发性肺癌的临床及病理

目的 探讨30岁以下青少年原发性肺癌的特殊临床和病理特点.方法 外科治疗年龄8～29岁,平均23岁的原发肺癌病人59例.术前有症状者49例,其中18例术前被误诊.根治性手术46例,姑息性手术3例,剖胸探查术7例,胸腔镜下活检术3例.术后病理腺癌18例,类癌13例,黏液表皮样癌9例,鳞癌5例,小细胞癌4例,腺鳞癌3例,其他4例.TNM分期:Ⅰ a期8例,Ⅰ b期3例,Ⅱ a期9例,Ⅱ b期12例,Ⅲa期15例,Ⅲ b期8例,Ⅳ期4例.结果 术后并发肺不张3例,发生率5.08%,剖胸探查组术后并发呼吸衰竭死亡1例.全组5年生存率为27.0%,其中根治组为35.0%.单因素分析显示不同p-TNM分期和手术方式与其生存率高度相关(P<0.05),性别、病理类型和术后化疗均不是预后的影响因素(P>0.05),Ⅰ期、Ⅱ期、Ⅲa期、Ⅲb期+Ⅳ期5年生存率分别为75.0%、33.3%、14.3%和0.0%.叶切、全切和探查术5年生存率分别为43.0%、18.2%和0.0%.多因素分析显示仅TNM(P=0.000)是影响青少年原发性肺癌术后的独立影响因素.结论 青少年肺癌应引起重视,提高确诊率,避免当作肺部良性疾病而耽误手术时机.青少年肺癌根治性手术治疗5年生存率为35%,与普通肺癌人群相当,应积极采取以手术为主的综合治疗.

Abstract：

Objective To investigate and analyze the clinical and pathological features of surgical treatment for primary bronchogenic carcinoma in adolescent patients.Methods A retrospective review is presented of patients less than 30 years with surgical treatment of bronchogenic carcinoma between 1969 and 2008.There were59 patients (36 male and 23 female).Mean age was 23 years ( range 8-29 ) .The ratio of men to women patients was 1.7∶1.Forty-nine cases ( 83.0% ) were symptomatic at presentation and 18 cases(30.5% )were misdiagnosed as other diseases.Surgical procedures included radical resection in 46 cases,palliative resection in 3 cases,thoracotomy only for unresectable disease in 7 cases and VATS biopsy in 3 cases.The histological types were 18 adenocarcinomas,13 carcinoids,9 mucoepidermoid carcinoma,5 squamous cell carcimomas,4 small cell lung cancer,3 adenosquamous carcinoma and 4 others.On TNM staging,8 cases in stage Ⅰa,3 cases in stage Ⅰb,9 cases in stage Ⅱ a,12 cases in stage Ⅱb,15 cases in stage Ⅲa,8 cases in stage Ⅲb,4 cases in stageⅣ.Results There were no operative death in radical group.Post-operative atelectasis in 3 cases.One case died from postoperative respiratory failure in explosive group,the postoperative five year survival rate was 27.0%.radical resection group 5-year survival was 35%.Univariate analysis identified TNM stage and surgical procedures as predictors of survival( P <0.05).factors that had no significant effect on overall survival included gender,histologic sbutype and postoperative chemotherapy (P > 0.05).The 5 year survival in stage Ⅰ,Ⅱ,Ⅲa,Ⅲb + Ⅳ were 75.0%,33.3%,14.3% and 0,respectively.The 5 year survival in lobectomy,pneumonectomy and exporsive were 43.0%,18.2% and O,respectively.On multivariate analysis,TNM stage of disease was the only independent predictor of survival ( P =0.000) .Conclusion We should pay attention to adolescent lung cancer and improve the diagnosis rate avoiding of delaying surgical treatment.The five year survival rate of radical resection for adolescent lung cancer was good.They should be treated with aggressive multimodality therapy and surgical resection is the first-line treatment for them.     

卵巢癌分型及其分子遗传学研究进展

卵巢癌是最常见的妇科恶性肿瘤之一,如何正确认识这类肿瘤一直备受关注。多年的病理形态学观察和临床病理资料积累,提示其各组织学亚型的生物学行为和发生、发展规律是有差异的。近年分子遗传学技术的应用为更客观的认识、诊断这类肿瘤和进一步指导患者的临床治疗、估价预后提供了新的研究方法和途径。本文对卵巢癌及其不同组织学亚型分子遗传学改变的研究进展进行综述。     

Shortcomings of the current TNM classification for penile carcinoma: time for a change?

Introduction  Accurate tumor staging is essential in the management of malignancies. It provides a guide in selecting accurate treatment and gives an indication of prognosis based on the extent of disease. The current TNM classification for penile carcinoma has remained unchanged since 1987. In this article, we focus on several deficiencies of the current classification. Materials and methods  An analysis of the current literature regarding the current classification was done, focusing on known prognostic factors for survival. Furthermore, we discuss in detail the results from a recent analysis of more than 500 patients treated at our institute to evaluate the practical and prognostic value of the TNM-classification. Results  We found that, using the current classification system, accurate clinical staging is often difficult, because the T and N categories are defined by structures that are not easily identified using physical examination or imaging. Furthermore, the prognostic stratification of the present staging system is not optimal and there is a substantial overlap in disease-specific survival between several categories. We give an overview of modifications that could improve clinical staging and prognostic ability. Conclusion  The current TNM classification for penile carcinoma has several shortcomings in terms of usability in clinical staging and prognostic value. With modifications clinical staging is facilitated, while the prognostic stratification of the classification is improved.     

胃肠道来源卵巢转移瘤的手术治疗及预后

目的 探讨胃肠道卵巢转移瘤的治疗方法及预后因素.方法 回顾性分析110例胃肠道卵巢转移瘤患者的治疗、生存情况及预后因素.结果 全组患者中位年龄45岁.原发病灶位于胃82例,结直肠28例.全组中位总体生存期16.3个月,中位无进展生存期8.2个月,1、3、5年的生存率分别为68.4%、15.4%和2.5%.单因素分析结果显示,原发灶部位(P＜0.01)、转移灶范围(P＜0.01)、肿瘤细胞减灭术(P＜0.01)、腹腔化疗(P＜0.05)和卵巢转移瘤组织学类型(P＜0.05)是影响患者预后的主要因素,而年龄、月经史、腹水、不同疗程化疗与患者的预后无明显相关性(P＞0.05);多因素分析结果显示,原发灶部位(P＜0.01)、转移灶范围(P＜0.05)、肿瘤细胞减灭术(P＜0.01)是影响卵巢转移瘤患者预后的独立因素.结论 卵巢转移瘤的预后较差.在切除原发肿瘤的同时,积极行满意的肿瘤细胞减灭术有助于延长患者的生存时间.     

Long-term survival in patients with ovarian metastases from colorectal carcinoma

Background: Ovarian metastases (OM) are a relatively uncommon consequence of primary colorectal carcinoma (CRC). The authors present a retrospective review of the impact of elective and therapeutic oophorectomy on the natural history of CRC. Methods: Patients with primary CRC from January 1964 through March 1996 were reviewed. Survival from the time of OM diagnosis was estimated by the Kaplan-Meier method; differences between groups were based on the log-rank test. Results: A total of 155 patients were studied. Synchronous OM occurred in 90 patients (58.1%); metachronous OM occurred in 65 patients (41.9%). Estimated 5-year survival for patients with synchronous OM was 9%, versus 20% for metachronous OM (P<.0001). Resection of metastatic disease was associated with an improved 5-year survival for synchronous OM (15% vs. 0%,P=.0001) and metachronous OM (24% vs. 0%,P<.0001) if patients were disease-free postoperatively. Other clinical characteristics, including age, menopausal status, stage, and location of primary tumor, had no significant impact on survival. Conclusions: Ovarian metastases from colorectal carcinoma are associated with a poor outcome. Although there is no survival advantage associated with resection of occult microscopic disease, long-term survival is possible if patients are rendered surgically disease-free.Presented at the 51st Annual Cancer Symposium of The Society of Surgical Oncology, San Diego, California, March 26–29, 1998.     

Solitary splenic metastasis of ovarian carcinoma: Report of two cases

Capsular splenic metastasis from ovarian cancer, which is associated with peritoneal spread, is not uncommon. Conversely, solitary involvement of the splenic parenchymal is unusual, and secondary debulking may improve the prognosis if there is no sign of residual disease. Thus, splenectomy is indicated for this type of isolated splenic metastasis. We report two cases of successful splenectomy for solitary splenic metastasis of ovarian carcinoma and review the relevant literature.     

卵巢透明细胞癌CT表现

目的分析卵巢透明细胞癌(OCCC)的CT表现。方法回顾性分析22例OCCC(26个病灶)的CT表现,包括肿瘤位置、形态、大小、边界、CT平扫和强化特征及有无肺动脉栓塞等。结果 4例病灶位于于双侧卵巢,18例病灶位于单侧卵巢。肿瘤呈类圆形或类椭圆形,边界清,有包膜,平均最长径(12.54±4.48)cm。26个病灶中,26.92%(7/26)为实性,3.85%(1/26)为囊性,69.23%(18/26)为囊实性。18个囊实性病灶中,12个为单房囊实性,实性成分呈结节状、球状、团片状、云絮状或分叶状向囊内突出,病灶平扫呈等或稍低密度(CT值28~47 HU)。增强扫描2个实性病灶和1个囊实性病灶实性成分动、静脉期均呈明显强化,23个(23/26,88.46%)病灶实性成分呈进行性中度到明显强化。囊实性病灶囊性成分和囊性病灶平扫及增强各期CT值为13~34HU。6例患者伴不同程度肺动脉栓塞。4例患者伴恶性腹腔积液。结论 OCCC好发于单侧,多表现为边界清晰的单房囊实性肿块,实性成分呈多种形态向囊内突出,增强扫描多呈进行性中度到明显强化,同时易伴发肺栓塞。     

Early gastric carcinoma in Japanese patients under 30 years of age

The clinicopathological characteristics of early gastric carcinoma (EGC) in 23 Japanese under 30 years of age were reviewed and the findings compared with data on 53 patients over age 70. In the young patients, there was a female preponderance, a macroscopic solitary lesion and the cancer was of the poorly differentiated type without intestinal metaplasia in the surrounding mucosa. In the old patients, there was a male preponderance; about half the number of patients had macroscopically elevated lesions and 10 of the 53 had a multifocal gastric carcinoma. Here, most lesions were well to moderately differentiated types with intestinal metaplasia in the surrounding area. Growth patterns of EGC in the young patients were analysed. Curative operations with dissection of regional lymph nodes were done in all the young patients. Metastases to the regional lymph nodes were present in only 2 of 23. Twenty of twenty-three followed for 5 years or longer are well.     

SIAH2和骨桥蛋白在肿瘤组织的表达及临床意义

目的:探讨在卵巢上皮性癌组织中SIAH2和骨桥蛋白(OPN)的表达水平以及临床意义。方法:收集2015年6月至2020年7月惠州市中心人民医院(广东医科大学惠州临床医学院)以及广东医科大学附属医院卵巢良性肿瘤组织标本40例以及卵巢上皮性癌组织标本65例,应用免疫组织化学方法检测各组织中的SIAH2和OPN的表达,结合临...     

Solitary cerebral metastases from ovarian epithelial carcinoma: 11 cases

Ovarian cancer is quite common in women, but brain metastases from ovarian cancer are considered rare. Eleven patients with solitary cerebral metastasis from ovarian epithelial carcinoma were treated at the Neurosurgical Department of University of Rome La Sapienza, between 1980 and 2000. We treated all of the 11 patients by surgical en bloc removal and by postoperative radiotherapy and chemotherapy. Mean survival was 28 months, and the cause of death was recurrence of the systemic disease in all cases. Multimodal treatment by surgery, radiation and chemotherapy is the best choice of treatment and leads to a median survival of about 20 months.     

内镜超声对结直肠癌术前分期的评价

目的：探讨内镜超声(endoscopic ultrasonography，EUS)在结直肠癌术前TNM分期中的应用价值。方法：对81例手术切除的结直肠癌患者术前行内镜超声检查，所有病例术后均得到病理证实。结果：EUS检查发现正常结直肠壁表现为5层结构，第1，3，5层表现为高回声，第2，4层表现为低回声。第1，2层为黏膜层，第3层为黏膜下层，第4层为固有肌层，第5层为浆膜下和浆膜层。EUS下结直肠癌表现为低回声肿块，其回声强度介于第3层高回声和第4层低回声之间。根据EUS下结直肠壁5层结构和邻近器官的改变判断肿瘤侵犯的深度，进行T分期诊断。肿瘤旁直径≥5mm圆形的低回声病灶诊断为转移性淋巴结。EUS对结直肠癌T分期诊断总的准确率为82．7％，周围淋巴结转移诊断的敏感性和特异性为55．4％和68．7％。结论：EUS对结直肠癌侵犯深度的判断有较高的准确率，对术前TNM分期诊断有一定价值。术前EUS检查可以为结直肠癌选择合适的治疗方案提供指导。     

N1期食管鳞癌淋巴结转移规律及预后分析

目的：探讨N1期食管鳞癌淋巴结转移规律及其与预后的关系。方法回顾性分析2005年1月至2008年12月间天津医科大学肿瘤医院行食管癌根治术且术后病理诊断为N1期（1～2枚淋巴结转移）的126例患者的临床及随访资料,分析各组淋巴结转移情况及其对预后的影响。结果126例患者中仅1枚淋巴结转移者70例,2枚淋巴结转移者56例。上纵隔淋巴结、中下食管旁淋巴结、贲门周围淋巴结和胃左动脉旁淋巴结的早期转移率较高,分别为53．8％（14/26）、38．3％（41/107）、34．5％（30/87）和36．8％（39/106）。隆突下淋巴结转移（P＝0．031）和中下食管旁淋巴结转移（P＝0．042）是影响食管鳞癌早期淋巴结转移患者的独立预后因素。隆突下淋巴结转移者5年生存率明显低于其他部位淋巴结转移者（8％比26％,P＝0．004）;而仅中下食管旁淋巴结转移者5年生存率则明显高于其他部位淋巴结转移者（33％比12％,P＝0．029）。结论 N1期食管鳞癌淋巴结易转移至上纵隔、中下食管旁、贲门周围和胃左动脉旁淋巴结等部位,而隆突下及中下食管旁淋巴结转移是N1期患者的独立预后因素。     

卵巢癌术后孤立性脾转移循证治疗一例

目的 借助循证医学的方法为一例临床罕见卵巢癌术后脾转移患者确定治疗目标和方案.方法 充分评估患者情况,提出临床问题,从Cochrane Library、CNKI、万方数据库、PubMed、Embase和ScienceDirect数据库检索相关证据,检索时间截至2009年10月.对所获证据进行评价,并结合医生经验及患者愿望制定治疗方案.结果 共检索出英文文献15篇,中文文献11篇.Cochrane数据库内尚无卵巢癌术后脾转移治疗方面的RCT,PubMed、Embase和ScienceDirect数据库含5篇综述类文章,CNKI和万方数据库含回顾性队列研究1篇,其余均为个例报道.综合分析检索结果,为患者制订相对合理方案,经20个月随访,该方案适合.结论 本例属罕见病例,虽然循证证据强度偏低,不能充分体现循证治疗的价值,但最终治疗结果 满意.本研究可为此类缺乏大型RCT的罕见病例运用循证思维诊治提供参考.

Abstract：

Objective Evidence-based medicine was used to make an individualized treatment plan for rare solitary splenic metastasis of an ovarian carcinoma in a female patient. Methods After clinical problems were discovered, evidence was collected from the Cochrane Library, PubMed, EMBASE, ScienceDirect, CNKI and Wanfang databases according to our predefined search strategy. The search was done until October, 2009. The validity of the evidence was assessed. The evidence, combined with the doctor experience and the patient value, was applied to the patient. Results A total of 15 English literature and 11 Chinese literature were identified. A rational treatment plan was made upon a critical evaluation of the data. There were 5 review articles in PubMed, EMBASE and ScienceDirect databases and no RCT in the Cochrane Library. And there was one retrospective cohort study inCNKI and Wanfang databases. The others were all case reports. After 20 month follow-up, the treatment protocol was proven correct. Conclusion The patient has rare disease, and the evidence intension for the evidence-based medicine was low. It can not present the efficacy of the evidence-based medicine treatment sufficiently, though it could provide some suggestion for rare disease which was lack of large RCT for evidence-based Methods .     

卵巢癌肠道转移64例临床分析

目的回顾性分析卵巢癌肠道转移瘤的临床特点,评价手术切除的可行性及其与预后的关系。方法64例肠道转移卵巢癌术前全面评估肠道受累程度。采用肿瘤细胞减灭术并行盆腔淋巴结清扫和腹主动脉旁淋巴结切除或/及活检术。肠道手术包括肿瘤剥除术或/及肠修补术、肠切除吻合术和结肠造口术。术后予以规律化疗,分析术后并发症及预后。结果54例直肠/乙状结肠转移(84.4%),其他部位结肠转移26例,小肠转移18例;肠浆膜层及浅肌层浸润47例,深肌层及粘膜层浸润17例;上皮性癌侵及肠粘膜者4例(7.7%),生殖细胞肿瘤无一例侵及肠粘膜;行肿瘤剥除44例,肠切除20例;直肠乙状结肠切除 吻合14例,6例行结肠造口。达到理想细胞减灭术56例(87.5%),其化疗后缓解率为58.9%,部分切除者8例化疗缓解率为12.5%;49例规则化疗者缓解率为65.3%,未完成充分化疗者为15.4%。术后并发症发生率26.6%,2例死于腹膜炎。结论肠道是卵巢癌的常见转移部位,肠道的肿瘤剥除和肠切除术是达到理想肿瘤细胞减灭术的先决条件,术后规则化疗能改善卵巢癌患者预后。     

甲状腺滤泡癌105例预后分析

目的 分析甲状腺滤泡癌的临床生物学特征及影响预后的因素.方法 回顾性分析1970-1990年间天津市肿瘤医院收治的105例甲状腺滤泡癌患者的临床资料.结果 本组病例5、10和15年生存率分别为85.3％、76.7％和72.9％.≥45岁及＜45岁患者15年生存率分别为45.9％、89.8％.双侧腺叶及单侧腺叶发病患者15年生存率分别为50.0％、76.2％.有颈淋巴结转移及无颈淋巴结转移患者15年生存率分别为54.2％、79.2％.AJCC分期Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者15年生存率分别为89.3％、70.0％、45.5％、35.3％.随访中11例发生远处器官转移,发生转移时间为术后1 ～33年,9例在发生转移后5年内死亡.17例发生局部复发,复发时间为术后3个月至34年,10例因复发死亡,占55.8％.结论 甲状腺滤泡癌患者的年龄、临床分期、双侧甲状腺叶发病和颈部淋巴结转移与预后关系密切.早期诊治和密切随访是改善患者预后、延长术后生存的主要手段.     

妇女年龄和卵巢储备与反应的关系

卵巢储备是卵巢产生卵母细胞数量和质量的潜能,可间接反映卵巢功能。客观正确地评价妇女的卵巢储备功能,制定合理的IVF治疗方案对妊娠结局至关重要。临床研究报道最多的卵巢储备功能评估指标有基础性激素、抗苗勒管激素(AMH)以及窦卵泡数等,其中任何一个指标都不能独立地预测卵巢反应性。在影响卵巢储备的所有因素中,年龄是首要因素,也是卵巢反应性的独立预测因子之一。本文综述了最新的相关研究进展,以期指导临床,能准确地对年轻和高龄女性进行卵巢储备评估后,预测卵巢的反应性。