头面部皮肤恶性肿瘤及癌前病变手术切除和创面修复的方法探讨

目的:探讨头面部皮肤恶性肿瘤及癌前病变手术切除和创面修复的方法。方法:58例头面部恶性肿瘤及癌前病变患者,根据恶性肿瘤手术原则,彻底切除病灶,应用原位缝合9例,游离皮片18例,局部皮瓣31例的方法进行修复。结果:本组58例,除1例皮片移植表皮部分坏死,经换药治疗伤口二期愈合外,其余植皮及皮瓣均一期修复,供区均一期愈合,颜面部外观满意。完成随访的42例中,1例面部鳞癌经局部皮瓣修复术后1年复发,再次扩大切除行皮片移植术后随访3年未见复发,其余41例均未见复发。结论:对于头面部恶性肿瘤及癌前病变应早期诊断,依据恶性肿瘤的治疗原则彻底切除病灶,术中快速冰冻切片可降低复发率,修复缺损应最大程度兼顾缺损区域功能和外形。     

头面部皮肤恶性肿瘤手术切除及组织缺损修复探讨

目的:探讨头面部皮肤恶性肿瘤手术切除和组织缺损修复的临床经验。方法:1991年1月～2006年1月共收治56例头面部皮肤恶性肿瘤患者,术后组织缺损根据患者情况分别采用原位缝合12例、皮片移植8例、局部皮瓣25例、邻位皮瓣9例和远位皮瓣2例修复。结果:本组56例,除1例皮瓣远端表皮坏死,经换药治疗伤口II期愈合外,其余皮瓣及植皮均成活,供区均I期愈合。38例患者获随访1～6年,1例复发;复发病例为植皮治疗的鳞状细胞癌患者于术后1年复发,经再次手术扩大切除后采用皮瓣移位修复,随访3年未再复发;随访患者均存活良好,外形及功能满意。结论:头面部皮肤恶性肿瘤早期诊断、彻底切除、及时修复、杜绝复发及取得良好的外观和功能效果是治疗的关键所在。修复方法根据患者具体情况和头面部美学单位或亚单位原理遵循由简至繁的原则,尽可能兼顾缺损区域外形和功能的恢复。     

整形技术在修复头面部皮肤软组织缺损中的运用

目的总结运用整形技术修复头面部软组织缺损创面的临床经验。方法对86例头面部软组织缺损的患者,采用直接拉拢缝合12例,分次切除后直接拉拢缝合5例,皮肤软组织扩张法术11例,植皮术14例,邻近皮瓣转移加植皮联合修复术6例,邻近皮瓣转移修复术37例,吻合血管的游离大网膜＋游离皮片移植修复1例。结果扩张器外露1例;4例皮瓣远端小部分坏死,创面延期愈合;1例游离移植的大网膜坏死后重新植皮修复;移植的皮片小部分表皮坏死或水疱形成2例,换药后延期愈合,余均一期愈合。植皮成活率为85%-100%。24例随访3个月-10年：2例皮瓣蒂部“猫耳”再次手术矫正;3例植皮周边疤痕增生,经再次手术后平整;3例死亡（肺部转移2例,脑溢血1例）;16例功能、外形均满意,头发生长良好。结论头面部皮肤软组织缺损的修复方法应根据患者的具体情况灵活运用,尽量选用质地相配的组织。     

再切除在肝癌复发治疗中的作用和地位

目的 探讨再切除在肝癌术后复发治疗中的价值。方法 回顾性分析1988～1999年30例肝癌复发再手术切除的随访资料。结果 对30例肝癌术后复发病人共行33例次手术，首次手术后1，2，3，5年总生存率分别为93．3，73．3，56．7，36．7％。第一次再手术后1，3，5年生存率分别为63．3，23．3，13．3％。肺转移切除后1，3，5年生存率分别为71．4，42．9，28．6％。结论 肝癌术后复发行再切除能显著提高病人远期生存率，是目前肝癌术后复发的首选治疗方案。     

老年指甲旁囊肿的诊断和治疗

目的：介绍改良老年指甲旁囊肿手术方法后其疗效明显提高。方法：对17例手指指甲旁囊肿患者，将远侧指间关节处的甲旁滑囊连同皮肤彻底切除，采用中厚皮片一期游离植皮将创面完全覆盖，以免术后复发。结果：17例患者伤口全部I期愈合。术后随访1年以上，无复发病例。结论：老年指甲旁滑液囊肿因手术切除不彻底或创面破溃等常导致复发。该术式将囊肿连同皮肤完全切除，行游离植皮术后创面无破溃或复发。     

胃癌根治术后再发癌的外科治疗

作者１９７０～１９９２年２２年间收治胃癌根治术后再发癌患者２６例。其中再次手术切除１２例，探查８例，术后均辅以化疗；另６例单纯放疗。随访截止于１９９３年底。结果显示切除并化疗组之生存率显著高于其他两组（Ｐ＜０．０５），手术探查加化疗组与单纯放疗组差异无显著性（Ｐ＞０．０５）。因此，对胃癌根治术后再发癌的治疗应以手术切除为主，术后辅以化疗。对未能切除者应采用化疗。     

小儿肝肿瘤的外科治疗

目的 探讨儿童肝肿瘤的临床诊断与治疗。方法 本组肝肿瘤患儿共23例，21例行手术切除。结果 术后病理：良性肿瘤10例，恶性肿瘤11例。随访0．5～3年，死亡2例。1例肝母细胞瘤死于肿瘤复发，腹腔淋巴结广泛转移、肺转移；另1例肝血管内皮肉瘤行肝移植术，术后1年肿瘤复发，再次行肿瘤切除术，术后1．5年复发，死亡。其余均存活。良性肿瘤术后3年生存率100％（10／10），生长发育良好；恶性肿瘤1年生存率100％，3年82％（9／11）。结论 儿童肝肿瘤多为先天性。恶性肿瘤体积大、生长快，需手术与化疗结合治疗，可以改善预后；良性肿瘤可完整切除，术后效果满意。     

游离皮瓣修复老年头面部皮肤肿瘤术后缺损

目的探讨游离皮瓣在修复老年头面部皮肤肿瘤术后缺损的临床效果。方法回顾性研究自2012年1月至2019年1月收治的31例老年(年龄61～75岁)头面部肿瘤患者,皮肤肿瘤根治性切除并进行一期修复。缺损面积5 cm×4 cm～20 cm×15 cm。根据缺损部分和范围,分别采用前臂游离皮瓣(n=19)和股前外侧游离皮瓣(n=12)修复。结果 31例游离皮瓣全部成活,患者头面部容貌有了较大改善。术后随访5～28个月,平均10个月;1例3个月后行二期去脂修整,其余均未发现严重并发症,供区采用中厚皮片移植均全部成活,无明显疼痛,患者均较满意。结论采用游离皮瓣一期修复是治疗老年头面部皮肤肿瘤切除后缺损可靠而安全的方法。     

头面部皮肤恶性肿瘤手术切除及创面修复与重建的方法探讨

目的：探讨头面部皮肤恶性肿瘤手术切除及创面修复和重建的临床经验。方法：对2006年9月～2011年3月共收治的38例头面部皮肤恶性肿瘤患者进行回顾性分析,术后创面根据患者情况分别采用人工脱细胞异体真皮（MATRIDERM）移植10例、原位缝合8例、皮片和人工脱细胞异体真皮（MATRIDERM）联合移植4例,皮片移植2例、局部皮瓣6例、邻位皮瓣5例进行修复和重建。结果：本组38例,除1例人工脱细胞异体真皮（MATRIDER）M移植创面边缘感染经换药治疗伤口II期愈合外,其余皮瓣和值皮均成活,供区和人工脱细胞异体真皮（MATRIDER）M移植创面均I期愈合。32例患者获随访1～3年,1例复发,复发病例为植皮治疗的鳞状细胞癌患者于术后2年复发,经再次手术扩大切除后采用皮瓣移位修复,随访1年未再复发;随访患者均存活良好,外形及功能满意。结论：头面部皮肤恶性肿瘤早期诊断、彻底切除、及时修复,杜绝复发及取得良好的外观和功能效果是治疗的关键所在,修复方法根据患者具体情况和头面部美学单位或亚单位原理遵循由简至繁的原则,尽可能兼顾缺损区域外形和功能的修复和重建。     

隆突性皮肤纤维肉瘤的广泛切除术

目的 探讨隆突性皮肤纤维肉瘤(dermatofibrosarcoma protuberans,DFSP)经广泛性切除术后的长期临床随访结果,并分析该病经多次手术切除复发后的生物学行为变化.方法 回顾性分析1978年2月至2002年12月收治的109例DFSP患者的临床资料,患者无瘤生存率采用x2检验.结果 所有患者采用广泛性切除术,99例(90.8%)完全切除,7例(6.4%)切缘阳性,另有3例(2.8%)切缘距肿瘤组织＜1 mm.46例原发组中,40例术后直接缝合,6例需游离植皮或转移皮瓣覆盖创面.术后5年无瘤生存率95.7%,10年随访未见远处转移.复发组有43例术后直接缝合,20例需游离植皮或转移皮瓣,5年无瘤生存率为81%,10年随访有4例出现肺转移.两组间5年无瘤生存率比较,P=0.025;10年远处转移率比较,P=0.032,差异均有统计学意义.结论 对于DFSP患者行距肿瘤边缘2.5～3.5 cm的广泛性切除术,可获得较好的局部控制.多次复发的患者,切除术后局部复发和转移率上升.     

Surgical treatment of renal cancer with vena cava extension

Fifty-four patients with renal cancer and vena cava tumour thrombus underwent radical nephrectomy and removal of the thrombus; the operative mortality rate was 9.3% (5 patients). The extent of the vena cava thrombus did not affect survival. Of 36 patients with no known pre-operative metastases and complete (29 patients) and incomplete (7 patients) removal of the vena cava tumour thrombus, the 5-year survival rate was 68 and 17%, respectively (P = 0.01). Thirteen patients (45%) who underwent complete removal of the vena cava tumour thrombus are alive and free of disease, with a mean follow-up of 51.2 months (range 4-144); three died without disease 110, 31 and 23 months after operation. The 2-year and 5-year survival rates of 18 patients with known pre-operative metastases was 37.5 and 12.5% respectively; 14 died between 1 and 27 months post-operatively (mean 11.6) of metastatic disease. Two of these 18 patients experienced long-term remission: one died of unrelated causes 151 months after operation; the other was lost to follow-up 219 months after operation, with no evidence of disease. Of 14 patients with positive regional nodes, the mean survival in those with metastases compared with those without metastases was 7.5 versus 15 months, respectively; only one patient survived at 14 months. Operative intervention in patients without metastatic disease (systemic or regional) and complete removal of the vena cava thrombus achieved a 5-year survival rate of 68%. Variables which significantly decreased survival and may be considered contraindications for operation were systemic metastasis, regional lymph node involvement and incomplete removal of the vena cava thrombus.     

低位直肠癌保肛术36例治疗体会

目的探讨低位直肠癌保肛术的手术方式选择。方法回顾性分析我院1998年1月~2008年1月施行低位直肠癌保肛手术36例的临床资料。结果本组无手术死亡病例。发生吻合口瘘1例,无吻合口狭窄发生,均治愈出院。术后平均随访5年,健在28例,5年生存率为77.8%。肿瘤局部复发4例,复发率为11%。结论对于低位直肠癌病人,严格掌握适应证、正确选择术式是保肛手术取得成功的关键。     

Chemotherapy and radiation therapy before transhiatal esophagectomy for esophageal carcinoma

Recent efforts to improve survival in patients with esophageal carcinoma have combined both systemic and local therapy. From October 1985 to October 1987, 43 patients with local-regional esophageal cancer (adenocarcinoma in 21, squamous cell in 22) were treated with cisplatin, vinblastine, and 5-fluorouracil chemotherapy concurrent with 4,500 cGy radiation therapy for 21 days before transhiatal esophagectomy 3 weeks later. Two patients died of chemotherapy/radiation therapy toxicity. Forty-one completed preoperative chemotherapy/radiation therapy. At operation, 2 patients had incurable metastatic disease; 39 underwent transhiatal esophagectomy. Eleven patients had no residual tumor in the resected specimen for a 27% (11 of 41) pathological complete response rate. Preoperative chemotherapy/radiation therapy resulted in no increased perioperative morbidity as compared with our historical controls. One patient died postoperatively of an unrecognized brain metastasis (2% operative morbidity). At a median follow-up of 27 months, 20 patients (47%) are alive and clinically disease-free and 21 have died, 19 from progression of their carcinoma. The median survival time for all 43 patients is 29 months (Kaplan-Meier estimate), and cumulative survival is 72% at 12 months, 60% at 24 months, and 46% at 36 months. All 11 patients with a complete response are alive at a median follow-up of 36 months, and all are disease-free. The 2-year survival of 60% of this group as compared with 32% in our earlier patients treated with transhiatal esophagectomy alone suggests that intensive combined modality therapy improves survival in these patients. A randomized prospective trial is now in progress.     

Metastatic cutaneous squamous cell carcinoma to the parotid: the role of surgery and adjuvant radiotherapy to achieve best outcome

Background: Australia has the highest incidence of cutaneous squamous cell carcinoma in the world. The majority of lesions occur in the head and neck with metastases to the parotid gland lymph nodes reflecting an uncommon, but aggressive, manifestation. Parotidectomy ± neck dissection followed by adjuvant radiotherapy should be considered as best practice. Methods: Between 1983 and 2000, seventy-four patients were treated for metastatic cutaneous squamous cell carcinoma to the parotid with surgery and adjuvant radiotherapy at Westmead Hospital, Sydney. Relevant data were extracted from patient files and a prospectively maintained database. Patterns of relapse and outcome were analysed. Results: Median age at diagnosis was 65 years (34−93 years) in 63 men and 11 women. Median follow-up duration was 41 months (12−188 months). All patients underwent parotidectomy with 52 undergoing a simultaneous neck dissection. Twelve patients required sacrifice of the facial nerve (4) or one or more branches (8). All received adjuvant radiotherapy to the parotid region with 56 also receiving radiotherapy to the ipsilateral neck. Despite treatment, 24% developed locoregional recurrence, with a median time to relapse of 7.5 months. The most common site for recurrence was the treated parotid region and upper neck. Most relapsed patients died. No variable independently predicted for locoregional recurrence on multivariate analysis. The 5-year absolute and cause-specific survival rates were 58% and 72%, respectively. Conclusion: Parotid gland lymph node metastases from cutaneous squamous cell carcinoma are associated with a high rate of recurrence and cause-specific mortality despite current best practice (surgery and high dose adjuvant radiotherapy). The role of more aggressive surgery, altered fractionation or chemotherapy to enhance locoregional control remains unclear.     

Primary lung cancer; assessment of the disclosed 5-year survival rate by the Internet website

The disclosed 5-year survival rate for lung cancer in the Internet website represents a various difference by each institution. The better inferiority of the survival has been listed in a table to compare with other institutions and has been reported in magazines and media with a lack of an enough inspection, i.e., with a sufficient considering of a risk adjustment such as patient's background, operative policy, postoperative adjuvant therapy, and statistical background. We report our outcome of the surgical treatment for primary lung cancer. Of 875 patients treated for lung cancer in our department for 23 years between January 1980 and December 2002, 115 patients containing of 42 cases in 1997 and of 48 ones in 1992 and of 25 ones in 1987 were selected and the accumulated survival analysis was treated by Kaplan-Meier method. Eighty males and 35 females were between 15 and 80-year-old (average 63.2 +/- 11.4). The pathological classification was adenocarcinoma (n=69), squamous cell carcinoma (n=32), and others (n=14). The operative procedures were pneumonectomy (n=14), bilobectomy (n=12), lobectomy (n=85), and wedge resection (n=4). The survival time was from 29 days to 182 months (median survival time was 1471+/- 1180 days, the averaged time was 49 months). The 5-year survival rate was 41.4 +/- 9.1% (n=25) in 1987, 35.6 +/- 6.2% (n=48) in 1992, and 56.0 +/- 7.0% (n=42) in 1987, respectively (log-rank test, p = 0.2555). The 10-year survival rate was 24.1 +/- 7.9% in 1987 and 8.5 +/- 3.6% in 1992, respectively. The 5-year survival rate was as follows: IA 81.0 +/- 8.6% (n=20), IB 73.7 +/- 10.1% (n=19), IIA 57.1 +/- 18.7% (n=7), IIB 55.6 +/- 16.6% (n=9), IIIA 28.6 +/- 7.6% (n=35), IIIB 15.4 +/- 10.0% (n=13), IV 16.7 +/- 10.8% (n=12), respectively. The 5-year survival rate was as follows: male 42.8 +/- 5.3% (n=80), female 63.2 +/- 7.3% (n=35), respectively (p = 0.0147). In regard to the histological classification, the 5-year survival rate was as follows: adenocarcinoma 47.2 +/- 5.9% (n=69), squamous cell carcinoma 50.8 +/- 8.9% (n=32), respectively (p = 0.9012). As a rule of the disclosure on the internet website, we report our survival data by accompanying with minimum parameters such as, patient's background, pathological types, gender, pathological stages, and mean survival rate with standard error. When we compare the 5-year survival rate with other institutes, in considering of a risk adjustment, we would carefully have to estimate the determined survival rate with a standard error.     

Adjuvant chemotherapy after surgery and radiation for stage III and IV head and neck cancer.

Twenty consecutive patients with Stage III and IV squamous head and neck cancer were treated with surgery, radiation, and adjuvant multiagent chemotherapy. Eleven other patients who were referred for local recurrent disease were treated with second surgery or radiation and also with adjuvant chemotherapy. The actuarial survival of these two groups of patients combined (N = 31) was 87% at 6 years. Four patients died of recurrent cancer (two in each group), six of unrelated causes during a 6-year follow-up. The side effects of adjuvant chemotherapy were mild to moderate and of short duration.     

Reappraisal of the role of radical radiotherapy and salvage cystectomy in the treatment of invasive (T2/T3) bladder cancer

One hundred and eighty-two patients with invasive (T2/T3) bladder cancer were treated by radical radiotherapy at the London Hospital between 1974 and December 1985. Cystectomy was reserved for patients whose tumours either did not respond completely to radiation or recurred later, provided they were fit for surgery and had not developed distant metastases. The overall corrected 5-year survival rate was 40%; 75 patients responded to radiation and did not relapse during the period of follow-up; 20 patients had an initial response to radiation but subsequently relapsed, with a 5-year survival rate following relapse of 20%. Of these, 11 patients had a cystectomy with a 5-year survival following relapse of 36%, whereas all 9 patients who did not have a cystectomy died within 3 years; 87 patients who did not respond to radiation had a 5-year survival rate of 18%. Of these, 22 patients underwent salvage cystectomy with a 5-year survival of 47%, whereas the 65 patients who did not have a cystectomy had a 5-year survival of 3%. These results justify a policy of radical radiotherapy and salvage cystectomy rather than elective cystectomy in the treatment of invasive bladder cancer.     

老龄肺癌的外科治疗分析

本文报告老龄肺癌38例，初诊误诊率47．4％。伴咯血者71．05％，伴肺外症状者39.47％。手术切除率78．9％。鳞状细胞癌占71％。本组无1例手术死亡，术后5年生存率37％。作者分析本症的临床特点，手术适应证和手术时机，并提出加强围术期治疗和护理，是提高手术成功的关键。     

Practical usefulness of lymphatic and connective tissue clearance for the carcinoma of the pancreas head.

We performed a retrospective review of 59 pancreatic resections for ductal carcinoma of the pancreas head performed between 1971 and 1983. In addition to pancreaticoduodenectomy, 37 consecutive patients (from 1971 to 1981) received lymphatic dissection adjacent to the pancreatic head (Group R1), whereas another 22 patients (from 1981 to 1983) received a wider range of lymphatic and soft tissue dissection, including the para-aortic region (Group R2). These groups did not differ with regard to operative mortality rate or background factors in the patients who tolerated operation. The 3-year cumulative survival rate was 13% in the R1 group vs. 38% in the R2 group (p less than 0.05). Almost all of the deaths from cancer recurrence occurred within 3 years after operation; the cumulative rate of death from local recurrence decreased from 67 to 16% (p less than 0.05) at 3 years. Among the patients with nodal involvement, there was no 3-year survivor in the R1 group, but four (27%) in the R2 group (p less than 0.05) survived. Among the patients whose tumor size exceeded 4 cm with retroperitoneal invasion, there was no 3-year survivor in either group and most patients died of distant metastasis. Extended clearance of regional lymph nodes and soft tissue appears to benefit patients with ductal carcinoma of the pancreatic head whose tumor size is less than 4 cm without severe invasion to the retroperitoneal space.     

Long-term results of radical prostatectomy

Between 1969 and March 1988, 257 patients underwent radical prostatectomy at the Department of Urology at the University of Würzburg, Medical School. The operative mortality was 0.8%. So far, 75 patients with prostate carcinoma, stage pT1-3 pNoMo, have been followed up for more than 10 years (mean 13 years). The 10-year survival rate was 68%. This is equivalent to the expected survival rate of males of comparable age. Only 14 of the 75 patients (18.6%) died of tumor progression after radical prostatectomy. Tumor recurrence was noted in 17 of the 75 (22.6%) patients analyzed within a 10-year follow-up period. In 4 of 9 patients with periprostatic tumor infiltration (stage pT3NoMo) tumor progression occurred. These data demonstrate that radical prostatectomy offers an excellent survival rate for patients with localized prostatic cancer and that this rate is identical to the expected survival rate for males in this age group.