脐尿管癌12例的诊断与治疗

背景与目的：脐尿管癌是来源于脐尿管残存组织的少见的恶性上皮肿瘤，由于发生部位特殊，早期诊治比较困难。本研究探讨脐尿管癌的诊治方法和远期疗效。方法：同顾性分析12例脐尿管癌患者的临床资料、治疗方案和随访结果，其中粘液腺癌10例，腺癌2例．结果：3例（均为临床Ⅲ期）膀胱全切患者术后1—3年内死于肿瘤。2例（Ⅱ期1例，Ⅲ期1例）膀胱部分切除者术后分别在术后3个月、5个月局部复发．并于1年内死亡。6例行扩大性膀胱部分切除术，患者中1例（Ⅳ期）术后7个月因肺转移死亡，2例（Ⅲ期）术后1年3个月及1年9个月死亡，1例（Ⅱ期）术后5年无瘤生存，2例（Ⅲ期）分别为术后6个月和1年，仍在随访中。结论：脐尿管癌发病位置隐匿．术前诊断较为困难，治疗方法主要是行扩大性膀胱部分切除术；本病的预后很差，临床分期与预后密切相关。     

脐尿管癌11例诊治分析

目的探讨脐尿管癌的诊断、治疗及方法。方法回顾性分析11例脐尿管癌患者的临床症状、影像学特点、治疗和随访结果。结果 11例脐尿管癌中黏液腺癌9例,腺癌2例。Ⅱ期1例、Ⅲ期9例、Ⅳ期1例。1例经尿道行膀胱肿瘤电切术,于术后2个月肿瘤复发,复发后7个月死亡;2例膀胱部分切除者分别于术后3、4个月复发和(或)转移,并分别于肿瘤复发后2、11个月后死亡;2例膀胱全切患者术后1.2、2年死于肿瘤复发;6例行扩大性膀胱部分切除术,其中4例术后1.1～2.1年死亡,1例术后5年无瘤生存,1例术后1.4年,仍在随访中。结论脐尿管癌发病位置隐匿,早期诊断较为困难,易误诊。主要治疗方法是扩大性膀胱部分切除术。脐尿管癌预后很差。     

膀胱脐尿管癌合并膀胱尿路上皮癌1例及文献复习

目的:探讨脐尿管癌的诊断和治疗方法。方法:报道1例膀胱脐尿管癌合并膀胱尿路上皮癌,探讨脐尿管癌的诊治。结果:患者为72岁老年男性,2004年手术确诊为膀胱尿路上皮癌。2013年6月因右下腹肿块手术,术后病理提示肿块为膀胱脐尿管腺癌。故患者诊断为膀胱癌及膀胱脐尿管双原发癌。结论:脐尿管癌是来源于脐尿管残存组织的少见恶性上皮肿瘤,由于发生部位特殊,早期诊断困难。膀胱部分切除术是主要的治疗方法,病理分期是主要的预后因素。目前仍没有公认的化疗方法,预后较差。     

脐尿管癌的临床诊疗及预后分析

目的探讨脐尿管癌的临床诊断和治疗方法。方法选取2008年10月至2016年10月间北京大学首钢医院收治的9例脐尿管癌患者,均行手术治疗,其中行扩大膀胱部分切除术7例,行根治性膀胱切除术2例。术后均给予奥沙利铂+亚叶酸钙+氟尿嘧啶(FOLFOX4方案)化疗4~6个周期。7例患者术后采用三维适形放疗。结果患者术后腺癌8例,移行细胞癌1例。术后复发转移的中位时间为15个月,中位生存时间为22个月。结论脐尿管癌恶性程度高,早期诊断较困难,预后差,诊断应结合临床表现、影像学和病理检查,治疗以手术为主。     

脐尿管癌14例临床分析

背景与目的:脐尿管癌临床少见.本研究旨在探讨脐尿管癌的诊断与治疗方法,以提高其疗效.方法:回顾性分析中山大学肿瘤防治中心及中山大学附属第一医院1994年5月至2007年4月收治的14例脐尿管癌临床资料.结果:本组患者最常见的临床症状为血尿和膀胱刺激症状,膀胱镜检查主要表现为膀胱顶部宽基底肿物,影像学检查征象常见膀胱顶前壁与腹壁之间质软组织肿块影,常浸润膀胱壁.本组病例腺癌13例,恶性间质细胞瘤1例.7例行扩大性膀胱部分切除术患者中,1例术后24个月局部复发,6例随访14～120个月,中位随访42个月无复发:3例行全膀胱切除 尿流改道术,其中2例分别随访16个月和84个月无复发,1例术后3个月死于手术并发症;1例在外院行膀胱部分切除术,术后10个月局部复发;3例晚期未切除者行化疗,2例肿瘤无进展生存7个月和8个月,1例化疗后6个月死于肿瘤.本组病例1年、5年生存率分别为85.7%和61.2%.结论:扩大性膀胱部分切除术是值得推荐的手术方式.首次手术彻底切除肿瘤及对晚期及术后复发转移患者积极的综合治疗,是提高脐尿管癌疗效的关键.     

膀胱脐尿管癌7例临床病理分析

目的：探讨膀胱脐尿管癌临床病理特征及诊断标准。方法：回顾性总结7例膀胱脐尿管癌的临床病理资料，就其病理类型、临床特征等进行研究。结果：7例膀胱脐尿管癌均位于膀胱顶部。病理类型：黏液腺癌4例，高分化乳头状肠型腺癌、高分化鳞状细胞癌、神经内分泌癌各1例；其中4例可见囊形脐尿管残留。临床表现以血尿多见，术式为部分膀胱及脐尿管切开术。结论：膀胱脐尿管癌主要病理类型为黏液腺癌，常伴有脐尿管残留结构。肿瘤的发生和生长部位、组织形态学特征是诊断脐尿管原发癌的关键标准，脐尿管残留结构的存在应作为确诊的重要依据。     

腹腔镜手术治疗脐尿管癌4例及文献复习

目的:探讨腹腔镜手术治疗脐尿管癌的可行性和临床疗效。方法:2007年1月-2014年6月,对4例平均年龄54岁,肿瘤最大径平均3.6cm(2.4～5.2cm)的脐尿管肿瘤患者行腹腔镜手术治疗。手术切除范围包括膀胱顶部、肿瘤相连的腹膜与Retzius间隙内的结缔组织、脐、脐尿管、肿瘤周围2cm的膀胱壁及双侧盆腔淋巴结清扫。记录手术时间、出血量及术后住院时间,术后随访患者生存时间及有无肿瘤复发。检索PubMed及国内CMB等数据库中相关文献,讨论脐尿管肿瘤发病特点、影像学特征及临床诊治。结果:4例手术均成功,无中转开放手术,平均手术时间125min,术中估计平均出血量60ml,术后平均住院时间5天,留置引流管时间平均3天。术中、术后无严重并发症发生。术后病理诊断黏液腺癌3例,乳头状腺癌1例,所有病例切缘及淋巴结均为阴性。术后平均随访14个月,均存活,未发现肿瘤局部复发或远处转移。结论:脐尿管癌预后与肿瘤临床分期关系密切,CT、MRI及膀胱镜检查是主要诊断手段,扩大性膀胱部分切除术是治疗局限性脐尿管癌的主要治疗方法。相对于开放手术,腹腔镜手术治疗脐尿管肿瘤具有创伤小、手术视野清晰、术后恢复快等优点,是一种值得推广的微创方法。     

脐尿管癌的诊断与治疗(附12例报告)

目的探讨脐尿管癌的诊断与治疗的方法，提高对脐尿管癌的认识及诊治水平。方法总结12例脐尿管癌的诊治经验。结果1年生存率66．7％（8／12）、3年生存率41．7％（5／12）、5年生存率16．7％（2／12）。结论最常见的临床表现是耻骨上肿块、血尿、尿频和尿中有黏液。CT、膀胱镜检查是诊断脐尿管癌的最好方法。治疗应行扩大性膀胱部分切除术，强调不仅切除膀胱顶部，且将覆盖肿瘤的腹膜以及与Retzius间隙相连的组织一起切除。脐尿管癌的预后较差。联合放疗、化疗和免疫治疗可望提高远期生存率。     

脐尿管腺癌（附11例报告）

脐尿管癌临床少见，预后不良，发病机理一般认为是脐尿管的移行上皮化生所致。临床表现主要是无痛性肉眼血尿，伴尿频尿急，尿中含有粘液及耻骨上肿块。通过ＣＴ、Ｂ超和膀胱镜等多项检查再根据脐尿管癌的诊断标准，１１例中有７例患者术前作出正确诊断。２例有盆腔淋巴结转移，其中１例合并腹腔广泛转移。治疗以手术为主，采用扩大的膀胱切除术，即包括膀胱顶部、腹横筋膜和部分腹膜连同肿瘤整块切除，病理报告均为脐尿管粘液性腺癌。术后生存３例，２例术后１年，１例术后６年。５年存活率为９％。     

脐尿管癌的CT诊断

目的探讨脐尿管癌的CT表现特点。方法回顾性分析经病理证实的18例脐尿管癌及炎性病变患者的临床资料和CT表现。结果脐尿管癌15例，脐尿管炎性病变3例。所有患者的病变部位均在腹中线Retzius间隙脐尿管走行区，其中17例位于脐尿管膀胱交界区的膀胱顶壁或前壁，1例位于脐尿管上端。15例脐尿管癌cT扫描时呈囊实性（11例）或实性（4例）；6例可见病灶中心或周边点状、斑点状或弧形钙化。3例脐尿管炎性病变中，1例为囊肿伴感染，表现为厚壁囊性肿块；2例为慢性炎性肉芽肿，表现为软组织肿块；3例炎性病灶周同脂肪间隙均呈明显炎性反应，可见较多斑片、条索影。结论脐尿管癌的CT表现具有特征性，CT扫描能提供较为准确的定位和定性诊断信息。     

Cytologic classification of precancer and cancer of the endometrium and esophagus and of malignant lymphomas

The paper discusses cytological classifications of precancer and cancer of the endometrium, esophagus and malignant lymphomas presented by cytologists from five Soviet research institutes of oncology. The classifications were based on the data of 4400 cases in conformity with WHO histologic classifications.     

E-钙粘蛋白及PTEN基因编码蛋白与胃癌浸润转移

目的:观察抑癌基因PTEN蛋白和ECD在胃癌组织中的表达,探讨其与胃癌生物学行为及预后的关系。方法:以兔抗人PTEN多克隆抗体、鼠抗人ECD单克隆抗体,采用SABC免疫组化法,检测100例胃癌手术切除标本中拟测指标的表达。以χ2和Logrank检验对结果做统计学分析。结果:ECD、PTEN蛋白在非癌胃粘膜中均见表达;在胃癌组织中表达下调或缺失。ECD异常表达率为42.0%;弥漫型胃癌异常表达率(48.57%),明显高于肠型胃癌(26.67%),(P<0.05);ECD异常表达与浸润深度有关(P<0.05)。胃癌组织中PTEN蛋白缺失率为59%;弥漫型胃癌缺失率(65.71%)明显高于肠型胃癌(43.33%),(P<0.05);伴淋巴结转移的胃癌缺失率(64.47%)明显高于无淋巴结转移者(41.67%),(P<0.05);PTEN蛋白缺失的患者比阳性表达者预后差(P=0.0066)。65.85%PTEN阳性表达者同时伴ECD正常表达。结论:两种标志物与胃癌浸润转移有关,PTEN表达与胃癌患者预后密切相关。将两种指标联合检测,可作为正确判断胃癌患者预后,指导临床治疗的分子生物学指标。     

Schwannomas of Head and Neck and Review of Literature

Benign nerve cell tumours have been given various names like schwannoma, neurilemmoma, neurinoma, neurofibroma, spindle cell tumours etc. Extra cranial head and neck schwannomas usually present as solitary and well-demarcated lesions. The lesion can cause secondary symptoms, such as nasal obstruction, dysphasia, and hoarseness, depending upon the location of the lesion. Fine needle aspiration cytology, CT scans, and MRI may be of limited help in the diagnosis of schwannomas. The treatment is complete surgical excision of the benign tumour and postoperative histopathological examination establishes the final diagnosis.     

世界卫生组织骨质疏松症防治工作报告和防治建议

引 言 作为对第51号综合处理非传染性疾病预防与控制的世界卫生组织决议的反应,1998年7月WHO成立了致力于不断完善对骨质疏松预防和治疗策略的工作小组。小组成员来自世界各国致力于骨质疏松研究的知名专家。Harry K.Genant为本届主席。这一项世界范围内的骨质疏松教育计划旨在通过世界范围的研究,不断改善对骨质疏松的诊断水平和发展并完善对骨质疏松病人的合理治疗。其重点将以发展中国家为主。并为各国政府及其卫生部门和病人群体提供世界性有关骨质疏松症的总体的、完整的指导性资料。该项研究、教育计划的实施将由世界各国的骨质疏松症研究和治疗机构共同完成,并经权威学术机构、政府和非政府组织进行有针对性的回顾研究,最终由WHO审议通过。     

A comparative study of knowledge and awareness of colorectal and breast cancerA comparative study of knowledge and awareness of colorectal and breast cancer

Aims: To assess and compare knowledge and awareness of colorectal cancer and breast cancer in a sample of the general population. Methods: Eleven hundred visitors to six different outpatient clinics, in a University Hospital, were given a study-specific questionnaire, based on educational material from the British Association of Cancer United Patients (CancerBACUP). The questionnaire consisted of 12 statements on the incidence, presentation, detection, treatment and prognosis of colorectal and breast cancer. Results: One thousand and sixty-eight individuals returned the questionnaire. One thousand and four completed questionnaires were analysed. The mean age (SD) of respondents was 50.1 (17.2) years, and the male to female ratio was 2:3. Respondents had read more about breast than about colorectal cancer (60.3%vs 32.4%,P <0.0001, McNemar's test). The proportion of correct answers for each statement on breast cancer was higher than for answers to corresponding items on colorectal cancer. Mean overall scores (95% CI) for breast and colorectal cancer were 88.1 (86.9, 89.2) and 64.4 (62.5, 66.3) respectively, the mean difference (95% CI) being 23.7 (22.0, 25.5). Scores were higher for breast cancer irrespective of age or gender. Conclusion: There is a low level of understanding of colorectal cancer in the general population when compared to breast cancer. This highlights the importance of public education in this common cancer.     

Quality of life and care in leukemia,myeloma and non-malignant disease. Opinions of patients and relatives,and effects of geography and time

In a questionnaire study 140 subjects answered 4200 questions in 1980 and 1986. They consisted of patients with myeloma, acute leukemia, lung carcinoma, and non-malignant disease and their relatives. In 22 additional cases the questionnaire was not answered. The results show that myeloma patients are less content with the general care than leukemia patients (P < 0.05). Similarly, relatives of deceased myeloma patients are less satisfied with the information given to them than relatives of deceased leukemia patients (P < 0.001). The information has improved with time, however, since the patients were more satisfied in 1986 than in 1980 (P < 0.001) and relatives of myeloma patients still alive were more satisfied than relatives of patients who had died earlier (P < 0.001).     

Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers

BACKGROUND: Frequent consumption of fruit and vegetables has been associated with a reduced risk of colorectal cancer in many observational studies. METHODS: We prospectively investigated the association between fruit and vegetable consumption and the incidence of colon and rectal cancers in two large cohorts: the Nurses' Health Study (88 764 women) and the Health Professionals' Follow-up Study (47 325 men). Diet was assessed and cumulatively updated in 1980, 1984, 1986, and 1990 among women and in 1986 and 1990 among men. The incidence of cancer of the colon and rectum was ascertained up to June or January of 1996, respectively. Relative risk (RR) estimates were calculated with the use of pooled logistic regression models accounting for various potential confounders. All statistical tests were two-sided. RESULTS: With a follow-up including 1 743 645 person-years and 937 cases of colon cancer, we found little association of colon cancer incidence with fruit and vegetable consumption. For women and men combined, a difference in fruit and vegetable consumption of one additional serving per day was associated with a covariate-adjusted RR of 1.02 (95% confidence interval [CI] = 0.98-1.05). A difference in vegetable consumption of one additional serving per day was associated with an RR of 1.03 (95% CI = 0.97-1.09). Similar results were obtained for women and men considered separately. A difference in fruit consumption of one additional serving per day was associated with a covariate-adjusted RR for colon cancer of 0.96 (95% CI = 0.89-1.03) among women and 1. 08 (95% CI = 1.00-1.16) among men. For rectal cancer (total, 244 cases), a difference in fruit and vegetable consumption of one additional serving per day was associated with an RR of 1.02 (95% CI = 0.95-1.09) in men and women combined. None of these associations was modified by vitamin supplement use or smoking habits. CONCLUSIONS: Although fruits and vegetables may confer protection against some chronic diseases, their frequent consumption does not appear to confer protection from colon or rectal cancer.