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手术切除是惟一有希望治愈结直肠癌肝转移的手段。随着微创技术的不断进步,腹腔镜和机器人技术越来越多地应用于结直肠癌肝转移的手术治疗中,并取得了较好的疗效。腹腔镜和机器人技术的应用,只有在结直肠癌肝转移外科治疗的总体原则框架下,严格把握手术指征,合理选择手术时机,才能充分发挥微创技术的优势,以更小的创伤、更小的打击和更小的风险使结直肠癌肝转移病人得到合理的治疗。临床上,在充分考虑每个病人的整体情况后,经过多学科综合治疗协作组讨论,合理应用腹腔镜及机器人等手术方式,将扩大微创手术治疗的优势,给更多的结直肠癌肝转移病人带来更佳的近期和远期疗效。     

转移性结直肠癌药物治疗研究进展

目的 了解化学治疗、靶向治疗和免疫治疗药物对转移性结直肠癌治疗疗效的最新研究进展。方法 检索近年国内外有关研究转移性结直肠癌不同治疗药物疗效的文献并综述。结果 转移性结直肠癌治疗的临床研究较多,新药层出不穷,靶向药物尤为突出,治疗药物的选择及药物联合治疗方案的试验也越来越多。根据患者RAS/RAF基因突变状态及错配修复蛋白表达情况选择不同治疗方式,生存获益有巨大差异。结论 精准医学愈加重要,筛选患者选择适宜的治疗方式可进一步提高生存获益。     

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目的 评价盆腔脏器联合切除术（PE）对局部进展期直肠癌的疗效。方法 对12年中79例局部进展期直肠癌PE术后结果进行回顾性总结。结果 全盆腔脏器切除术（TPE）46例，其中保肛TPE5例，TPE联合骶骨切除1例，TPE联合半骨盆切除1例，后盆腔脏器切除术（PPE）33例。根治性切除65例（82．8％），合并症发生率48．6％，手术死亡2例（2．5％），根治术后再复发36例（58．1％），术后1、3、5年生存率75．8％、39．3％、35．8％。根治性切除与大体根治切除术后3年、5年生存率分别为44．2％、40．8％与11．1％、0。结论 PE是目前治疗局部进展期直肠癌有效的方法，积极的根治性切除病灶，可以有效提高其治愈率，改善生活质量。     

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目的回顾性研究结直肠癌的术前肠镜活检标本中能否发现黏膜下层浸润证据与肿瘤临床病理学以及肠镜取材特点间的关系。方法对第二军医大学附属长海医院2007年1月至2008年12月收治的结直肠癌病例相应的肠镜活检标本石蜡切片进行回顾性阅片,观察是否具有黏膜下层浸润证据,利用卡方检验、t检验以及logistic回归分析对肿瘤临床病理学特点与能否在活检标本中发现黏膜下层浸润证据的关系进行统计学分析。结果 321例结直肠癌病例中,共216例(67.3%)可以发现黏膜下层浸润,单因素分析显示活检组织块直径较小的病例(P=0.042)、黏液腺癌(P=0.003)、高级别肿瘤(P=0.001)、淋巴结阳性的病例(P=0.011)以及深层次浸润病变(P=0.092)中发现黏膜下层浸润证据的比例显著下降,多因素回归分析显示高级别肿瘤(OR2.155,95%CI1.081～4.296,P=0.029),以及活检组织直径较小的病例(OR1.944,95%CI1.149～3.290,P=0.013)与活检组织中无法确定黏膜下层浸润相关。结论对于临床上高度怀疑恶性的结直肠肿瘤,虽然肠镜活检标本中未发现黏膜下层浸润,不能简单的诊断为高级别上皮内瘤变,应怀疑为晚期或者恶性程度较高的病变。     

靶向Neddylation修饰通路抗结直肠癌作用及其机制研究进展

蛋白类泛素化修饰Neddylation是一种重要的蛋白质翻译后修饰。Neddylation修饰在结直肠癌中过度活化,并且与结直肠癌患者的预后不良密切相关。小分子抑制剂MLN4924通过阻断Neddylation修饰通路诱导结直肠癌细胞凋亡、自噬、DNA损伤及细胞衰老发挥抗肿瘤效应。此外,MLN4924还可作为化学增敏剂...     

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由于胰腺癌具有早期浸润转移和多发性浸润生长等生物学特性 ,使得大多数胰腺癌在出现明显的临床症状时病程已属中晚期。进一步提高胰腺癌的临床治疗效果 ,除了努力提高胰腺癌的早期诊断率外 ,对于大多数进展期胰腺癌需要进行正确的术前影像学评估、手术风险预测和切除可能性判断 ,以保证对胰腺癌治疗抉择科学合理和治疗安全有效是及其重要的。现代影像学如ＣＴ、ＭＲ/ＭＲＡ(磁共振血管显影 ) /ＭＲＣＰ(磁共振胰胆管成像 )及超声内镜 (ＥＵＳ)的发展 ,使得胰腺癌的术前定位、定性、胰外转移及血管浸润等术前诊断正确率明显提高。1　胰腺癌…     

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目的　探讨乳腺癌前哨淋巴结 (SLN )的分布及其在活检中的意义。方法　用 1%美蓝染色的方法 ,对2 72例可手术乳腺癌病人术中行前哨淋巴结活检 (SLNB) ,分析SLN的分布与病人的年龄、肥胖指数、乳房大小以及肿瘤的大小、部位和腋窝淋巴结有无转移的关系。结果　 (1)SLN检出率 90 1%,假阴性率 9 8%,准确率90 2 %。 (2 )SLN位于腋下群为 91 2 %,腋中群为 8 0 %,腋上群为 0 8%。 (3)肿瘤位于外侧象限者 ,SLN位于腋下群为 97%,位于腋中群为 3%;肿瘤位于内侧象限者 ,SLN位于腋下群为 74%,位于腋中上群为 2 6 %,(P <0 0 5 )。 (4)肿瘤位于乳房外侧象限的SLN检出率为 96 3%,肿瘤位于内侧者检出率 76 5 %(P <0 0 1)。 (5 )肿瘤位于乳房内侧象限的SLN假阴性率为 3%,肿瘤位于外侧象限者为 12 2 %(P <0 0 5 )。结论　 90 %以上的乳腺癌SLN位于腋下群 ,尤其是肿瘤位于乳房外侧象限者。乳房内侧乳腺癌 ,有 1/3的SLN位于腋中、上群。SLN假阴性多见于肿瘤位于乳房外侧象限者。     

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重症急性胰腺炎是一种高发病率和高病死率的外科急腹症。介入影像医学在重症急性胰腺炎病人诊断、治疗和随访的过程中发挥着重要作用。微创治疗如超声或CT引导下穿刺抽吸、置管引流等能有效降低腹腔内压力和减少炎性介质,甚至能避免开腹清除脓肿。     

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结直肠癌是消化系统中常见的恶性肿瘤之一,在西方国家恶性肿瘤致死病因中占第二位,在我国其发病率也逐年上升,并呈年轻化趋势,就目前的医疗水平而言,最有效的治疗手段仍是行彻底的手术切除。自1991年Jacobs等     

靶向分子时代转移性肾癌治疗进展与治疗方案的合理化选择

肾癌是泌尿系统常见的恶性实体肿瘤,占所有实体肿瘤发病总数的3％～4％。近年来其发病率以2％～3％／年的速度逐年递增。随着影像技术的发展及个体健康意识的提高,多数肾癌在诊断时都属于局限性肾癌,约20％～30％的肾癌患者在确诊时已出现远处转移。虽然局限性或局部晚期肾癌能够通过外科手术切除达到治愈,但由于肾癌细胞存在异质性,     

Chemotherapeutic and targeted biological agents for metastatic bladder cancer: A comprehensive review

The American Cancer Society estimates that 73 510 new cases of bladder cancer will be diagnosed and 15 000 deaths will result this year. The paper summarizes the clinical evidence for the use of platinum‐based, non‐platinum‐based and new targeted biological agents, while reporting the future directions in the treatment of metastatic bladder cancer. For cisplatin‐base regimens, the combination of methotrexate, vinblastine, doxorubicin and cisplatin (M‐VAC) has been the mainstream treatment for both advanced and metastatic bladder cancers. It showed significant improvement in the complete response rate and overall survival time in comparison with single‐agent cisplatin. For cisplatin‐ineligible patients, namely patients with renal impairment, symptomatic cardiac disease and poor performance status, alternative therapies consisting of paclitaxel, gemcitabine and carboplatin were shown to be of benefit. Pemetrexed and vinflunine have also shown effectiveness, with small but demonstrable overall survival benefits. Gemcitabine‐based doublet therapies (combined with paclitaxel, docetaxel, irinotecan, oxaliplatin or epirubicin) have all been shown to be effective and well‐tolerated. Several new targeted therapies, such as gefetinib, sorafenib and lapatinib, have received attention in recent years; however, their effectiveness as single agents in a relapse setting have not been optimal and more studies are warranted.     

分子靶向药物在胃肠道肿瘤综合治疗中的应用

分子靶向药物在晚期胃肠道肿瘤治疗中,被证实可提高患者的客观缓解率并延长总生存期.因此,其在局部进展期胃肠道肿瘤综合治疗中的价值被逐渐重视.曲妥珠单抗用于HER-2基因阳性的局部进展期胃癌新辅助化疗中的临床研究正在进行中,结果值得期待.大量研究证明,西妥昔单抗联合化疗对于KRAS基因野生型潜在可切除的结直肠癌肝转移患者,能提高手术切除率并延长总生存期;而贝伐珠单抗在KRAS基因突变型结直肠癌肝转移术前转化治疗中的作用正在评估中.对于可切除的结直肠癌肝转移,虽现有的证据显示,分子靶向药物在新辅助治疗中未能带来长期生存益处,但最终结论仍存议甚多.对于局部进展期直肠癌患者,新辅助化疗中的西妥昔单抗在二期临床研究中未能显示治疗获益,贝伐珠单抗的作用同样需要在三期临床研究后进一步证实.与晚期肿瘤单一治疗模式不同,在肿瘤综合治疗中,需要系统评估分子靶向药物与细胞毒药物、手术以及放疗之间可能的相互影响及协同作用,制定出科学并适用于临床实践的综合治疗模式.     

Our directions for the treatment of colorectal cancer

Authors make a review of personal experience in colorectal surgery from 1998 to 1997 (18 year) and indicate the own opinion about oncological principle of colorectal surgery. Colo-rectal cancer is the most frequent tumor in West Countries (United States 156,000 new case/year, Europe 58,300 deaths/year). A Medline analysis using terms "colon and rectal cancer" prove a progressive increasing of interest about many problems regard prevention, diagnosis, prognosis and therapy of colorectal cancer. Prognosis of colorectal cancer depend on correct and complete stadiation. The most used classifications are Dukes classification, modified from Astler-Coller, and TNM classification of UICC. In the past years oncologic al principle of colorectal surgery was modified from a new debated concept of oncological radicality. The authors analyze own experience in comparison to Literature about the "no touch isolation technique", the principle of vascular ligation at the origin of vessels, lymphectomy extension, total mesorectal excision, surgical decision about advanced loco-regional cancer, surgical decision of complicated colorectal cancer (perforation and occlusion), the role of bilateral prophylactic ovariectomy, surgical treatment of liver metastasis, correct indication of T.E.M. and finally the role of laparoscopic surgery for the treatment of colorectal cancer.     

不断提高结直肠癌复发与转移的外科治疗水平

结直肠癌是最常见的恶性肿瘤之一,预计每年全球结直肠癌的新发病例数为100万人,死亡人数高达50万人,这些患者基本上都是死于肿瘤的复发与转移。肿瘤局部复发和肝、肺转移是结直肠癌复发与转移的主要形式,对于这些肿瘤患者,若不采取外科干预治疗,5年生存率〈5％,及时切除复发与转移的肿瘤病灶仍然能使部分患者达到根治性切除的手术效果。因此,外科手术治疗复发转移性结直肠癌是患者获得长期生存的唯一手段。本文针对该领域存在的问题和发展方向,阐述提高复发转移性结直肠癌治疗水平的一些想法。     

分子靶向时代胰腺癌综合诊治的现状与展望

胰腺癌发病率呈上升趋势,以早期诊断困难、手术切除率低及预后差为特点,临床诊治极具挑战性。由于其遗传异质性显著,不同患者之间在疾病进展、临床疗效、放化疗敏感性及预后等方面差异巨大,深入探讨胰腺癌分子生物学特征及其与临床表现、放化疗敏感性的相关性,研发相应的靶向药物,是胰腺癌从传统形态学分型转变到分子分型的重要基础,也是实现从"异病同治"到"同病异治"精准治疗模式转变的前提。在分子靶向时代,胰腺癌的治疗模式转变为综合诊治,有望成为胰腺癌治疗的突破口。     

Meta-analysis of new treatment strategies for metastatic colorectal cancer

Metastatic disease is present at diagnosis in 30% of the patients with colorectal cancer (CRC), and approximately half of early-stage patients with CRC will eventually present with metastatic disease. Until recently, few chemotherapy options were available to treat metastatic colorectal carcinoma (MCRC). Fluorouracil (5-FU) with leucovorin (LV) modulation has a marginal but positive effect on survival in those patients. The recent incorporation of irinotecan (CPT-11) and oxaliplatin for the management of advanced CRC has generated further improvement in survival. The development of oral fluoropyrimidines, mimicking continuous infusion 5-FU, is convenient to use. Recently completed or ongoing clinical trials to study novel targeting agents have initiated a new era of drug development. Anti-angiogenesis drugs, tyrosine kinase inhibitors, and epidermal growth factor blockers are among the new generation of agents.     

Novel targeted pro-apoptotic agents for the treatment of prostate cancer

PURPOSE: We reviewed and highlighted novel targeted apoptotic mediated therapies that can be used to treat prostate cancer. MATERIALS AND METHODS: A comprehensive review of the peer reviewed literature in the area of apoptosis was performed with special emphasis on apoptotic mediated pathways with promising novel targeted therapies that can be used for patients with prostate cancer. RESULTS: The apoptotic pathway can be classified into 2 separate broad categories, including the extrinsic and the intrinsic pathways. Targeting the extrinsic or intrinsic mediated pathway holds promise for developing novel agents for treating prostate cancer. We discuss apoptosis related molecules and therapies, as categorized by 1) targeting apoptosis pathway for antitumor treatment, 2) targeting apoptosis regulators for antitumor treatment and 3) drugs that potentiate pro-apoptotic agents. CONCLUSIONS: Defining the molecules responsible for apoptosis and their intricate molecular interactions will help guide us in developing drugs with less toxicity for appropriately selected patients with prostate cancer and other malignancies. Because neoadjuvant and adjuvant clinical trials are under way using novel pro-apoptotic agents for prostate cancer, it is imperative for urologists to be active members of the clinical research team and become familiar with the molecular pathways, and potential benefits and toxicities associated with these novel agents.     

结肠直肠癌腹膜转移的腹腔药物治疗研究

在世界范围内,结肠直肠癌(colorectal cancer , CRC)发病率和死亡率在所有肿瘤中均居第3位[1].5％～10％的CRC 病人发生同时性腹膜转移(peri-toneal metastasis,PM).有报道高达 20％～30％的CRC病人可发生异时性PM.