成人附睾梭形细胞横纹肌肉瘤1例

梭形细胞横纹肌肉瘤 (rhabdomyosarcoma,RMS)是由长梭形细胞束组成的高分化的横纹肌肉瘤 ,好发于儿童 ,术后生存率高 ,局部复发率及转移率均较低。成人梭形细胞 RMS极罕见 ,国外文献中仅报道 2例 ,均在术后 1 3个月内死于肿瘤复发和转移 ,提示成人病例预后与儿童不同。现报告 1     

成人前列腺肉瘤7例临床分析

目的 :探讨前列腺肉瘤的诊断、治疗及预后因素。　方法 :回顾性分析我院诊治的 7例成人前列腺肉瘤临床表现、实验室检查、治疗方案、病理类型及预后。　结果 :平滑肌肉瘤 3例 ,横纹肌肉瘤 3例 ,恶性神经鞘瘤 1例。前列腺肉瘤有膀胱颈梗阻为主的复合表现 ,确诊依靠病理诊断 ,病理分型与疾病的进展相关联。 2例行根治性膀胱前列腺切除术者于术后 13个月和 2 1个月死亡 ;2例行全盆腔脏器切除术辅以放疗和 (或 )化疗者 ,随访 15个月仍存活 ;3例仅行放疗和 (或 )化疗 ,平均于初诊后 7个月死亡。　结论 :前列腺肉瘤预后较差 ,早期诊断和完整的外科切除有重要意义 ,密切随访可以早期发现复发。     

成人睾丸旁横纹肌肉瘤诊治五例报告

目的提高成人睾丸旁横纹肌肉瘤(RMS)的诊治水平。方法回顾性分析2004年至2005年收治5例成人睾丸旁RMS患者的临床资料,结合文献复习进行讨论。结果5例患者均行经腹股沟睾丸根治性切除术,病灶直径4～15 cm。病理检查证实为睾丸旁RMS,其中胚胎型3例,腺泡状和胚胎型伴腺泡状各1例。4例Ⅰ、Ⅱ期患者接受了腹膜后淋巴结清扫手术,其中3例存在淋巴结转移,术后采用以异环磷酰胺和阿霉素为主的辅助化疗4个周期。1例存在肺转移的Ⅳ期患者化疗后达到完全缓解。5例中位随访时间16个月,1例患者因疾病复发而死亡,2例带瘤生存,2例无瘤生存。结论睾丸旁RMS是少见的男性生殖系统恶性肿瘤,常见病理类型为胚胎型和腺泡状。Ⅰ、Ⅱ期患者首要进行完整的原发灶和腹膜后淋巴结切除,并辅助化疗,Ⅳ期患者化疗短期内有效。     

睾旁胚胎型横纹肌肉瘤5例报告并文献复习

目的:提高睾旁胚胎型横纹肌肉瘤的诊治水平。方法:回顾性分析5例睾旁胚胎型横纹肌肉瘤患者的临床资料,结合文献复习进行讨论。结果:5例患者中精索胚胎型横纹肌肉瘤2例、附睾胚胎型横纹肌肉瘤2例、鞘膜横纹肌肉瘤1例,临床病理分期Ⅰ期2例,Ⅱ期1例,Ⅳ期2例。5例患者最终均行根治性睾丸切除术及肿块完整切除术。1例Ⅰb期和1例Ⅱ期患者术后采用异环磷酰胺、长春新碱、足叶乙甙、丝裂霉素、顺铂化疗并配合局部放疗,余3例未行进一步治疗。2例Ⅰ期、1例Ⅱ期患者随访28、18、12个月未见复发和转移,1例Ⅳ期患者随访6个月后死于多发转移,1例Ⅳ期随访6个月未见复发和转移,后失访。结论:早期诊断,根治性手术并辅助化疗、放疗是治疗睾旁胚胎型横纹肌肉瘤的有效手段。     

腹膜后横纹肌肉瘤一例

横纹肌肉瘤(rhabdomyosarcoma,RMS)是儿童软组织肉瘤中最常见的一种,成人少见。RMS主要发生在头颈部,发生于腹膜后者较罕见。其恶性程度高,发生于成人的RMS预后更差。尤其是腹膜后RMS早期无特异性症状,不易被发现,一旦出现症状已属中、晚期,治疗难度相当大。本文报道1例腹     

睾旁横纹肌肉瘤（附三例报告）

目的 提高对睾旁横纹肌肉瘤的认识。方法 对3例睾旁横纹肌肉瘤患者的发病、诊断及治疗情况进行总结。结果 3例均行根治性睾丸切除＋同侧阴囊切除＋腹膜后淋巴清扫术。Ⅰ期2例,Ⅱ期1例。1例Ⅰ期患者术后采用足叶乙甙、丝裂霉素、顺铂联系化疗,余2例未行进一步治疗。3例分别随访28、18及6个月,均未见肿瘤复发和转移。结论 手术辅以化疗、放疗是治疗睾旁横纹肌肉瘤的有效手段。     

前列腺肉瘤(附3例报告)

目的报告3例前列腺肉瘤的病例,结合文献回顾分析其临床特点,探讨前列腺肉瘤的诊断和治疗。方法复习病案,分别为青年、中年和老年男性,病理分别为前列腺横纹肌肉瘤、平滑肌肉瘤和纤维肉瘤。PSA介于0．4ng/ml到1．5ng/ml之间。术前CT均诊断为前列腺恶性肿瘤,确诊则采用经直肠超声引导下的前列腺穿刺活检。本文3例前列腺肉瘤中,1例采用规律VAC化疗；1例术前给予VAC新辅助化疗后行前列腺根治切除术；术后继续辅助VAC化疗。结果1例前列腺恶性纤维组织肉瘤的患者放弃治疗,半年后死亡。1例前列腺横纹肌肉瘤后前列腺体积明显缩小,于确诊10个月后发现肝转移、肺转移而死亡。1例前列腺平滑肌肉瘤行“前列腺根治性切除术”,术前、术后均给予VAC方案化疗,术后5个月发现肿瘤复发,术后1年死亡。结论前列腺肉瘤患者生存率的提高有赖于早期诊断和根治性切除,而新型放疗和化疗的应用,有助于改善患者的预后。     

成人前列腺肉瘤6例临床分析

目的:探讨前列腺肉瘤的诊断、治疗及预后因素。方法:本组6例患者,年龄18~44岁,中位年龄31岁。病程3~12个月,中位病程7个月。Ⅱ期2例,Ⅲ期3例,Ⅳ期1例。6例中,5例行手术治疗+放疗和(或)化疗,1例行单纯膀胱造瘘术。结果:病理诊断:平滑肌肉瘤3例,横纹肌肉瘤2例,恶性神经鞘瘤1例。免疫组化结果显示6例vim entin均为阳性,PSA和PAP均为阴性。平滑肌肉瘤和横纹肌肉瘤肌动蛋白(HHF35)为阳性,恶性神经鞘瘤S-100和溶解酶为阳性。1例失访,5例于术后2~11个月死亡。结论:前列腺肉瘤首发症状为进行性排尿困难,直肠指检可以提示前列腺肉瘤,依靠前列腺穿刺病理学检查获得确诊,早期诊断和完整的外科切除有重要意义,预后较差。     

成人膀胱横纹肌肉瘤2例报告及文献复习

目的 探讨成人膀胱横纹肌肉瘤的临床特征及诊疗特点.方法 回顾性分析2例成人膀胱横纹肌肉瘤患者的临床资料并进行文献复习.结果 1例行膀胱部分切除术,术后给予VAC方案化疗4周期及放疗,随诊24个月,未见复发;1例行膀胱全切,术后拒绝放、化疗,8个月后死于远处转移.术后病理诊断为膀胱横纹肌肉瘤.结论 成人膀胱横纹肌肉瘤罕见,需病理确诊,治疗需手术结合放化疗.     

成人膀胱横纹肌肉瘤2例报告及文献复习

目的 探讨成人膀胱横纹肌肉瘤的临床特征及诊疗特点.方法 回顾性分析2例成人膀胱横纹肌肉瘤患者的临床资料并进行文献复习.结果 1例行膀胱部分切除术,术后给予VAC方案化疗4周期及放疗,随诊24个月,未见复发;1例行膀胱全切,术后拒绝放、化疗,8个月后死于远处转移.术后病理诊断为膀胱横纹肌肉瘤.结论 成人膀胱横纹肌肉瘤罕见,需病理确诊,治疗需手术结合放化疗.     

腹腔镜手术治疗阴道子宫内膜异位症43例疗效分析

目的：探讨腹腔镜手术治疗阴道子宫内膜异位症（内异症）的有效性和安全性。方法2002年1月～2013年6月我院腹腔镜手术治疗43例经病理证实的阴道内异症,按照内异症治疗原则,常规腹腔镜检查后注射水垫,游离直肠,下推膀胱,分离输尿管,切除病灶,验证直肠完整性,缝合切口并放置引流。结果32例行腹腔镜病灶切除及粘连松解术,11例行腹腔镜病灶切除和全子宫切除术,其中5例同时行单/双侧附件切除术。36例随访6～126个月,中位随访时间43．7月。26例保守性术式,术后痛经、肛门坠胀、慢性盆腔痛、性交痛、阴道出血的缓解率分别为77．8％（14/18）、50％（4/8）、60％（3/5）、100％（5/5）、100％（8/8）,复发3例,复发时间分别为术后1、5、8个月。5例半根治术式和5例根治性术式,8例痛经、5例肛门坠胀和1例阴道出血者均显著缓解,2例慢性盆腔痛者,1例症状显著缓解,1例部分缓解,术后3个月复发1例。8例合并不孕者,4例术后1年内自然妊娠并活产。结论腹腔镜手术治疗阴道内异症安全有效。     

含洛铂方案的新辅助化疗在骨肉瘤及尤因肉瘤中的疗效观察

背景：化疗是骨肉瘤及尤因肉瘤最主要的治疗手段之一,目前化疗疗效已进入平台期,选择低毒高效的化疗药物及方案是关键。目的：观察含洛铂（LBP）方案的新辅助化疗对骨肉瘤及尤因肉瘤的疗效及不良反应。方法：2011年10月至2012年10月收治经病理学检查确诊为原发恶性骨肿瘤患者22例,其中骨肉瘤13例,尤因肉瘤9例;男17例,女5例,年龄9～23岁,平均18.3岁;Enneking分期：ⅡA期3例,ⅡB期19例。给予LBP-多柔比星（AMD）方案交替异环磷酰胺（IFO）方案（LBP 30mg/m2,AMD 60mg/m2;IFO12g/m2;全身静脉给药）的新辅助化疗,后行保肢手术治疗。采用RECIST评价标准评价其疗效,并观察不良反应。结果：22例中完全缓解（CR）1例,部分缓解（PR）18例,疾病稳定（SD）3例,总有效率（RR）为86.4%。随访3～14个月,平均9.2个月,1例脊柱骨肉瘤患者术后5个月复发,其余患者未发现复发或转移征象。主要不良反应为限制性骨髓抑制,化疗间歇期患者恢复快,无明显肾功能异常及过敏反应。结论：骨肉瘤及尤因肉瘤接受含LBP方案的新辅助化疗的近期疗效满意,不良反应可耐受,值得进一步临床研究。     

Robotic radical hysterectomy and pelvic lymphadenectomy for uterine rhabdomyosarcoma

Mullerian rhabdomyosarcoma (RMS) is a rare malignancy most commonly diagnosed in childhood and adolescence. RMS of the female genital tract is often difficult to diagnose. Treatment includes chemotherapy with adjuvant surgery and/or radiation therapy reserved for persistent disease. We report a case of an 18-year-old African-American female who presented with severe menometrorrhagia, and was diagnosed with embryonal rhabdomyosarcoma of the uterus. After vincristine, dactinomycin, and cyclophosphamide failed to eradicate the central tumor, she underwent a robotic radical hysterectomy and pelvic lymphadenectomy. Mullerian rhabdomyosarcoma was once managed with multimodality therapy that often included ultraradical surgery including total pelvic exenteration. Surgical procedures that were exclusively performed via large abdominal incisions can now be completed with minimally invasive techniques. Robotic surgery can be safely and successfully applied to radical hysterectomy and lymphadenectomy for uterine rhabdomyosarcoma Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Surgery in rhabdomyosarcoma of the bladder,prostate and vagina

Summary The treatment of bladder and prostate rhabdomyosarcoma (RMS) is highly controversial. Aside from chemotherapy, treatment modalities include conservative surgery, radical surgery, and pre-, intra-, or postoperative irradiation. Between 1968 and 1993, 78 children with RMS were treated at our institution. In all, 22 tumors were located in the urogenital tract (bladder/prostate, 13; paratesticular, 5; vaginal, 2; others, 2). Altogether, 6 patients had stage II disease; 7, stage III disease; and 2, stage IV disease. All 15 patients with RMS of the bladder, prostate, or vagina received chemotherapy, and 4 had additional radiotherapy. Surgery was also done in 10 patients; parents refused an operation in 3 cases. In all, 3 patients in an advanced tumor stage died of their disease. All other children currently show no evidence of disease (mean follow-up, 6 years; range, from 2 months to 18 years). After chemotherapy, radical operative intervention with multiple biopsies (encircling the tumor) — in contrast to local tumor excision or partial resection — permits complete tumor resection followed by excellent long-term results. Following radiotherapy, often a consequence of organ-sparing therapy, many complications ensued (60%); therefore, irradiation should be restricted to highly selected cases.     

女性生殖道畸形合并子宫内膜异位症185例临床分析

目的探讨女性生殖道畸形与子宫内膜异位症（内异症）的关系,分析不同类型女性生殖道畸形合并内异症的严重程度。方法对2001年1月～2011年3月在我院手术的230例生殖道畸形的临床资料进行回顾性分析。结果230例生殖道畸形中,合并内异症185例,发生率80．4％（185／230）。梗阻性生殖道畸形合并内异症的发生率为85．0％（17／20）,非梗阻性生殖道畸形为80．0％（168／210）。梗阻性生殖道畸形合并内异症I期和Ⅱ期占17．6％（3／17）,Ⅲ期和Ⅳ期占82．4％（14／17）;非梗阻性生殖道畸形合并内异症I期和Ⅱ期占69．1％（116／168）,Ⅲ期和Ⅳ期占30．9％（52／168）。结论梗阻性生殖道畸形合并内异症严重程度高于非梗阻性生殖道畸形。在进行下腹部腹腔镜手术或开腹手术时,若患者曾有生殖道畸形病史或术中发现女性生殖道畸形,应常规手术探查盆腔是否存在内异症。     

Extent of surgery in rhabdomyosarcoma of urogenital structures

After high inguinal semicastration in group-1 paratesticular rhabdomyosarcoma (RMS), the patient having undergone chemotherapy can be followed closely by CT scanning without retroperitoneal lymphadenectomy. In contrast, retroperitoneal RMS should be operated on as radically as possible after downstaging the tumor mass. In RMS of the female genitalia locally limited organ-preserving surgery is the method of choice. The prognosis is excellent with adjuvant chemotherapy. Only 20% of all bladder RMS arise from the bladder dome or the movable part of the bladder, where primary partial resection including a safety margin of 3 cm of healthy tissue is possible. The majority, however, arising from the submucous tissue of the bladder base, trigonal area and bladder neck, infiltrates the prostatic urethra and the surrounding pelvic fascia. Therefore differentiation between primary bladder or prostate RMS is often doubtful. The current strategy of downstaging by chemotherapy or chemo-radiotherapy followed either by limited organ-preserving surgery or by a wait-and-see policy includes the high risk of residual tumor or local tumor recurrence, which has proved to have the worst prognosis of all. As organ-preserving therapy was recommended as the method of choice, mainly to avoid anterior pelvic exenteration and urinary diversion, the question of advantages in comparison to the risk of tumor recurrence is still open. The routine use of chemoradiotherapy and increasing follow-up has called attention to a variety of chronic sequelae, such as contracted bladders with reduced capacity and upper urinary tract deterioration, which subsequently require secondary urinary diversion. Progress in continent urinary diversion may be an alternative procedure for better life quality.(ABSTRACT TRUNCATED AT 250 WORDS)     

原发女性生殖道恶性黑色素瘤21例临床分析

目的探讨原发性女性生殖道恶性黑色素瘤的临床特点、治疗及预后。方法回顾分析本院1986年1月至2006年3月收治的原发性女性生殖道恶性黑色素瘤患者21例。其中外阴8例、阴道10例、阴道及宫颈1例、外阴及阴道1例、盆腔1例。结果患者中位年龄50(21~71)岁。临床表现主要为阴道流血、流液及发现外阴或阴道肿物。本资料阴道恶性黑色素瘤发病率高于外阴恶性黑色素瘤。按照国际妇产科联盟(FIGO)分期,期别和预后呈负相关。治疗以手术为主,手术方式由根治性切除逐渐衍变为扩大局部切除。随访:21例患者中随访率为67%(14/21),随访时间6~96个月,死亡7例,随访期间的死亡率为50%。结论女性生殖道恶性黑色素瘤发病率低,预后差。肿瘤厚度和淋巴结转移是其主要的危险因素。应采用手术基础上的综合治疗,治疗方案个体化。     

Vaginal neoplasms in infancy: the combined role of chemotherapy and conservative surgical resection

This retrospective review of nine infants treated for vaginal tumors between 1964 and 1986 identifies the spectrum of lesions and examines the trend toward more conservative surgical therapy. Our patients' ages ranged from 1 to 30 months. Symptoms of vaginal bleeding or protruding tissue prompted examination under general anesthesia in all cases. Two children had benign protruding polypoid masses treated by simple excision. Seven had malignant tumors, two with endodermal sinus lesions and five with embryonal rhabdomyosarcoma. Early in this series, surgical therapy for embryonal rhabdomyosarcoma consisted of either anterior or complete pelvic exenteration, with adjuvant chemotherapy given in two of the three patients. One patient was operated on prior to the development of effective chemotherapy, and died of recurrent tumor 14 months after surgery. A second patient died from cardiac failure secondary to adriamycin toxicity 6 years after initial therapy. A third patient underwent total pelvic exenteration followed by successful reanastomosis of the colon to the anal verge. This patient, a female, is the oldest survivor and is free of disease 14 years after therapy. The most recent therapeutic approach used in two patients with embryonal rhabdomyosarcoma consisted of local tumor excision followed by postoperative chemotherapy. Both patients are alive and disease-free 9 and 11 years after therapy. Two patients with endodermal sinus tumor were treated with chemotherapy after simple excisional biopsy. They were then followed with serial vaginal biopsies at 3-month intervals. One required a partial vaginectomy for local recurrence 21 months after initial presentation. Both patients are alive and disease-free 18 months and 4 years after surgery.     

新辅助化疗对乳腺癌组织中ER、Survivin及C-erB-2表达的影响

目的：探讨乳腺癌新辅助化疗的临床效果及其对ER、Survivin和C-erB-2表达的影响。方法：62例可手术乳腺癌采用TE方案新辅助化疗观察客观有效率及新辅助化疗前后ER、Survivin和C-erB-2的表达。结果：新辅助化疗后临床完全缓解（CR）9例,部分缓解（PR）38例,病情稳定（SD）14例,疾病进展（PD）1例。新辅助化疗后Survivin表达明显下降（P〈0.05）,ER及C-erB-2阳性表达率均低于新辅助化疗前但差异无统计学意义（P〉0.05）。Survivin化疗后表达降低者化疗有效率高,Survivin表达升高者化疗有效率低,二者之间有相关性,ER、C-erB-2表达变化与化疗有效率之间无相关性。结论：乳腺癌新辅助化疗可以有效的缩小肿瘤;Survivin在新辅助化疗后表达显著降低,而ER、及C-erB-2的阳性表达降低,但无显著影响。     

经皮肾微造瘘吸引碎石清石鞘在微创经皮肾镜取石术中的应用

目的：探讨应用专利设计的经皮肾微造瘘吸引碎石清石鞘（简称专利鞘）治疗上尿路结石的临床疗效和安全性.方法：回顾性分析2008年8月～2009年10月应用专利鞘行微创经皮肾镜取石术（MPCNI.）治疗上尿路结石患者198例的临床资料,其中肾结石138例,输尿管上段结石46例,单侧肾结石并同侧或对侧输尿管结石12例,双肾结石并双侧输尿管上段结石2例.均应用专利鞘进行MPCNL,并对手术时间、肾盂内压、清石率、手术并发症等进行分析.结果：198例均一期建立通道.采用单通道取石192例,双通道取石5例,三通道取石1例.平均手术时间（46±10.8）min,术中监测肾盂内压力平均（0.28±0.068）kPa（1 mmHg=0.133 kPa）;术后血红蛋白含量较术前平均下降（4.2±1.5）%,术中输血5例,术后2例出血严重者经高选择性肾动脉栓塞治愈.一期清石率为95.95%.术后3天出现体温≥38.5℃者3例.结论：应用专利鞘行MPCNL治疗上尿路结石安全、高效,临床效果显著.