上颌窦癌术后即时修复的研究

上颌窦癌术后即刻修复 2 6例 ,其中上颌骨全切 12例 ,半侧及部分颌骨全切的 14例 ,共 2 6例 ,随诊时间 2～ 5年 ,不但早期恢复了癌症患者的咀嚼功能重建 ,也给患者心理上减轻一定的负担 ,获得满意效果。认为上颌窦癌术后即刻修复是行之有效的治疗方法     

乳腺切除术后即刻乳房再造术式的选择

乳腺切除术后即刻乳房再造与二期再造相比在术后效果、患者心理、住院时间以及所需费用等方面均具有明显优势。为乳腺癌术后患者选择一个合适的即刻乳房再造方式十分必要。本文对TRAM皮瓣、双蒂TRAM皮瓣、DIEP皮瓣、背阔肌肌皮瓣、扩张器/假体置入以及背阔肌肌皮瓣联合假体置入等各种即刻乳房再造术式的适应证与禁忌症进行综述。并从肿瘤学角度针对各种乳腺癌根治术如改良根治术、保留乳头、乳晕的乳腺切除术,以及保留皮肤的乳腺切除术、保乳手术后即刻乳房再造等术式的选择策略进行讨论。     

乳腺肿瘤术后即刻修复与重建的临床研究

目的:减少女性乳腺肿瘤术后局部畸形,提高患者生活质量。方法:2003年以来,我们多中心课题组通力合作,对23例乳腺肿瘤患者进行术后即刻修复与再造(其中良性肿瘤6例,囊性肉瘤1例,乳腺癌16例),分别采用水平双蒂巨乳缩小方法、背阔肌肌皮瓣带蒂转移、乳房假体植入、横形腹直肌肌皮瓣带蒂转移、腹壁下动脉穿支皮瓣吻合血管游离移植。手术前后进行心理问卷调查;比较住院时间及费用;观察对辅助治疗及复发的影响。结果:23例患者分别采用不同方法修复,除1例术后吻合口出现静脉栓塞外,余皮瓣全部成活,形态满意。随访2~18个月,无腹部薄弱或腹壁疝等并发症;患者术后显示较强的自信,恢复正常学习和工作。结论:乳腺肿瘤术后即刻修复与再造是一种安全可行的方法。适应症为良性乳腺肿瘤及有强烈乳房再造要求的Ⅰ、Ⅱ期乳腺癌患者;Ⅲ期以上乳腺癌患者,可权衡病人的全身状况,不是绝对禁忌症。应根据患者具体情况选择适合患者本人的方法进行乳房再造。     

The Effect of Patient and Surgical Characteristics on Renal Function After Partial Nephrectomy

Background

The purpose of the study was to identify patient and disease characteristics that have an adverse effect on renal function after partial nephrectomy.

术后即时放疗在治疗疤痕疙瘩中的临床价值

 我院在1991年5月～1994年1月对50例疤痕疙瘩进行手术及术后即时放疗综合治疗的临床研究。术后24小时内即开始接受放疗，照射使用浅层X线或高能电子束，剂量一般为2000～2600cGy/2～3周，随诊最长3年零9个月，复发1例占2%.结果表明该方法既不影响切口的愈合又能有效地防止复发，具有疗程短，复发率低，美容效果好等优点，治疗疤痕疙瘩是可行的。     

乳腺癌术后Ⅰ期乳房再造(附150例报告)

目的探讨乳腺癌根治术后即时乳房再造的肿瘤治疗和形体完美双重效果。方法对1999年1月至2005年7月病理证实为乳腺癌的150例患者[均为女性，年龄49±15岁，肿瘤大小（1．6±1．2）cm，腋窝未及淋巴结]行乳腺全切除（包括传统改良根治11例，保留乳房皮肤的改良根治12例，保留乳头、乳晕的改良根治127例）后，即时行乳房再造[Ⅰ期背阔肌皮瓣再造139例，下腹横形腹直肌皮瓣（TRAM）再造11例]。结果手术成功149例，失败1例（损伤血管），术后并发腹壁疝1例，乳房出现脂肪结节6例，脂肪液化3例，腹部切口延迟愈合3例，背部血肿28例，切口边缘局部皮肤坏死7例，移植物缺血坏死1例（再次手术切除），乳头坏死4例。本组随访到123例，随访率82％，平均随访时间36．6个月，发生腋窝淋巴结转移2例，骨转移1例，锁骨上淋巴结转移1例，死亡1例（因转移自杀），无局部复发，术后外形改变（按JCRT标准）：优、良、中、差分别为11．5％、49．3％、36．7％、2．6％。结论乳腺癌根治术后即时乳房再造联合辅助治疗对早中期乳腺癌是可行的，能达到治疗和美容效果。     

子宫腺肌瘤病灶切除辅助药物治疗临床疗效分析

目的:探讨病灶切除辅助药物治疗对子宫腺肌瘤的疗效.方法:对40例临床诊断为子宫腺肌瘤患者进行随机分组,实验组20例,对照组20例.对比分析经单纯药物治疗与病灶切除辅助药物治疗两种不同方法的临床效果.结果:术前临床表现结合阴道彩超及CA-125与手术后病理检验对子宫腺肌瘤的诊断有很好的吻合性.病灶切除辅助物治疗组患者痛经及月经过多的改善明显优于单纯药物治疗组(P＜0.05),前者无病灶期明显长于后者(P＜0.05).结论:临床结合阴道彩超及CA-125可以明显提高子宫腺肌瘤的术前诊断率.病灶切除辅助药物治疗能很好地缓解临床症状,避免单纯药物治疗停药后的病情返弹,延长无病灶时间.     

乳腺癌术后一期乳房再造

背景与目的：乳房再造使乳腺癌全乳切除患者重获完整的乳房外形。本文介绍乳腺癌术后应用带蒂背阔肌肌皮瓣联合或不联合假体和带蒂横向腹直肌肌皮瓣（TRAM）行一期乳房再造的经验，并探讨适合中国乳腺癌患者的乳房再造方式。方法：2000年1月-2005年7月，74例乳腺癌患者乳房切除后，应用背阔肌肌皮瓣或带蒂TRAM行一期乳房再造。结果：再造手术均取得成功，背阔肌肌皮瓣再造62例（83．8％），其中联合假体13例、带蒂TRAM再造12例、联合假体1例。经过2～66个月随访，局部区域复发率4．1％。患者满意度高，可接受度96％。而且这两种自体再造方式在是否需要联合假体上没有差别（P=0．440）。结论：乳腺癌术后一期乳房再造能同时满足肿瘤治疗和形体美容的要求，提高患者生活质量，背阔肌肌皮瓣再造对中国女性适用性好，值得推广。     

子宫腺肌瘤病灶切除辅助药物治疗临床疗效分析

目的:探讨病灶切除辅助药物治疗对子宫腺肌瘤的疗效。方法:对40例临床诊断为子宫腺肌瘤患者进行随机分组,实验组20例,对照组20例。对比分析经单纯药物治疗与病灶切除辅助药物治疗两种不同方法的临床效果。结果:术前临床表现结合阴道彩超及CA-125与手术后病理检验对子宫腺肌瘤的诊断有很好的吻合性。病灶切除辅助物治疗组患者痛经及月经过多的改善明显优于单纯药物治疗组(P<0.05),前者无病灶期明显长于后者(P<0.05)。结论:临床结合阴道彩超及CA-125可以明显提高子宫腺肌瘤的术前诊断率。病灶切除辅助药物治疗能很好地缓解临床症状,避免单纯药物治疗停药后的病情返弹,延长无病灶时间。     

Surgical Management of the Colorectal Cancer Patient with Simultaneous Liver and Lung Metastases

Although the liver and lung are the two most common sites of metastatic disease for colon and rectal cancer, management of simultaneous liver and lung metastases is ill-defined. The objective of this review is not only to review long-term outcomes after resection of simultaneous colorectal liver and lung metastases but also apply recent data regarding the (1) evolution of indeterminate pulmonary nodules discovered during staging evaluation of colorectal liver metastases, (2) impact of genetic mutations in colorectal cancer on disease outcomes, and (3) influence of lung metastases on overall survival outcomes to the management of patients with simultaneous colorectal liver and lung metastases.     

卡环式可摘义齿修复口底肿瘤术后牙列缺损的临床观察

目的 评价并比较卡环式可摘义齿对口底肿瘤术后牙列缺损和普通牙列缺损修复的效果.方法 于2007年1月至2014年6月,选择48例行保持下颌骨连续性的口底肿瘤切除术后牙列缺损患者(观察组)和48例普通牙列缺损患者(对照组),采用卡环式可摘义齿进行牙列缺损修复.定期随访并测定2组的咀嚼效率和基牙牙周指数,并进行满意度评价.结果 修复前观察组的咀嚼效率和牙龈指数均低于对照组,差异均有统计学意义(P＜0.05);菌斑指数也低于对照组,但差异无统计学意义(P＞0.05).修复后不同时期观察组的咀嚼效率、牙龈指数及菌斑指数均增高,且与对照组的差异均无统计学意义(P＞0.05).修复18个月后观察组的满意度高于对照组,但差异无统计学意义(P＞0.05).结论 卡环式可摘义齿能应用于口底肿瘤术后牙列缺损的修复.     

保留乳头乳晕复合体的乳房切除术并即刻假体植入乳房重建26例

目的 探讨保留乳头乳晕复合体(NAC)的乳房切除术并即刻假体植入乳房重建的疗效.方法 对26例乳腺癌患者实施保留NAC的乳房切除术并即刻假体植入乳房重建术,观察术后美容效果、并发症情况并进行随访.结果26例患者均手术成功.术后1个月按放射治疗联合中心(JCRT)标准评价美容效果,优良率88.5％(23/26),无严重并发症发生.术后随访3～48个月(中位随访时间26个月),所有病例均无局部复发及远处转移.结论 保留NAC的乳房切除术并即刻假体植入乳房重建术能够保证肿瘤根治原则,手术操作简单,具有良好的形体美容效果,疗效满意,值得进一步临床实践.     

Immediate in vivo target-specific cancer cell death after near infrared photoimmunotherapy

ABSTRACT: INTRODUCTION: Near infrared (NIR) photoimmunotherapy (PIT) is a new type of cancer treatment based on a monoclonal antibody (mAb)-NIR phthalocyanine dye, (IR700) conjugate. In vitro cancer-specific cell death occurs during NIR light exposure in cells previously incubated with mAb-IR700 conjugates. However, documenting rapid cell death in vivo is more difficult. Methods: A luciferase-transfected breast cancer cell (epidermal growth factor receptor+, MDA-MB-468luc cells) was produced and used for both in vitro and in vivo experiments for monitoring the cell killing effect of PIT. After validation of cytotoxicity with NIR exposure up to 8 J/cm2 in vitro, we employed an orthotopic breast cancer model of bilateral MDA-MB-468luc tumors in female athymic mice, which subsequently received a panitumumab-IR700 conjugate in vivo. One side was used as a control, while the other was treated with NIR light of dose ranging from 50 to 150 J/cm2. Bioluminescence imaging (BLI) was performed before and after PIT. Results: Dose-dependent cell killing and regrowth was successfully monitored by the BLI signal in vitro. Although tumor sizes were unchanged, BLI signals decreased by >95% immediately after PIT in vivo when light intensity was high (>100J/cm2), however, in mice receiving lower intensity NIR (50J/cm2), tumors recurred with gradually increasing BLI signal. Conclusion: PIT induced massive cell death of targeted tumor cells immediately after exposure of NIR light that was demonstrated with BLI in vivo.     

Estimating the Value of Surgical Clips for Target Volume Delineation in External Beam Partial Breast Radiotherapy

AimsTo investigate the role of surgical clips in defining the clinical target volume (CTV) for three-dimensional conformal external beam radiotherapy-partial breast irradiation (3D-CRT-PBI) using preoperative computed tomography scans.Materials and methodsA group of patients with early breast cancer underwent conservative surgery with placement of surgical titanium clips (at least three clips required). All patients had a treatment planning computed tomography simulation before (CT1) and after surgery (CT2). The two sets of images were co-registered with a match point registration. The relationship between the clips-based CTV for PBI delineated on CT2 and the initial tumour location on CT1 was studied, evaluating the percentage of intersection volume.ResultsTwenty-eight patients participated in this study. In total, 13 patients (46.4%) had an intersection volume ≥ 50% and 10 patients (35.7%) had complete intersection (intersection volume = 100%). An increased median intersection volume was observed in patients with more than six clips (P = 0.007) and in patients with a larger portion of breast volume covered by the PBI-CTV (CTV/BV; P = 0.010). Intersection volume increased with the number of clips, after adjustment for CTV/BV (linear coefficient = 5.1693; P = 0.043). Also, a maximum distance from the chest wall ≤0.7 cm and CTV/BV > 9.5% were found to be predictors of an intersection volume ≥50% (area under the curve 0.841; confidence interval 0.649–0.952; P < 0.0001; area under the curve 0.800; confidence interval 0.607–0.926; P = 0.0004) and of an intersection volume of 100% (area under the curve 0.776, confidence interval 0.573–0.916, P = 0.046; area under the curve 0.752, confidence interval 0.536–0.935; P = 0.032).ConclusionsTitanium clips are essential and six or more increase the accuracy of tumour bed delineation for PBI; also the primary tumour location as well as the percentage of volume of breast covered by PBI-CTV may influence the correct delineation of PBI-CTV.     

舌癌224例根治性手术后立即整复

本文报告我科1978年1月～1987年12月10年间224例舌癌联合根治术后应用各类组织瓣一期重建缺损的治疗经验。移植234块组织瓣的总成功率为94.0％。作者指出:游离前壁皮瓣手术简单,成功率高,是理想的半舌切除后舌再造的首选皮瓣。胸大肌肌皮瓣或背阔肌肌皮瓣能提供丰厚的组织,适用于全舌、全口底切除后的整复。肋骨背阔肌或肋骨胸大肌肌皮瓣则适用于全舌、口底和下领骨联合根治性切除术后缺损的立即整复。     

Surgical salvage of cancer of the oropharynx after chemoradiation

Advanced oropharyngeal squamous cell carcinoma is treated primarily with chemoradiation, with the goal of excellent disease control and preservation of swallowing and articulation functions of the oropharynx. Disease control rates generally are excellent; however, a significant number of patients do not achieve locoregional control of disease. The importance of human papillomavirus expression in predicting successful tumor response, locoregional control, and survival following chemoradiation is increasingly confirmed. Emerging is a clinical profile, viral expression, and genetic expression pattern that can predict success of chemoradiation and indicate which patients are at higher risk for locoregional failure necessitating surgical salvage. Successful surgical salvage depends on restaging at the time of recurrence and the time interval from chemoradiation to recurrence. Although surgical morbidity and mortality remain a challenge in patients undergoing salvage surgery of the oropharynx after radiation failure with or without chemotherapy, they may be mitigated by liberal application of regional and microvascular free flap reconstruction techniques.     

拓扑替康用于小细胞肺癌维持/巩固治疗和挽救治疗的疗效比较

背景与目的小细胞肺癌(small cell lung cancer,SCLC)作为治疗有效率和复发率都很高的疾病,如何减少其复发或延长缓解时间、改善总生存,一直是目前亟待解决的问题。本研究旨在探索拓扑替康(topotecan,TPT)用于SCLC维持/巩固治疗的临床获益。方法回顾性分析53例SCLC患者的治疗结果,按治疗方法分为两组:一线化疗取得缓解或稳定后用TPT维持或巩固的维持/巩固组和TPT用于二线或二线以后的挽救治疗组。用Log-rank法对总生存差别进行单因素分析比较,并行多因素Cox回归分析。结果维持/巩固组29例,挽救化疗组24例,客观有效率分别为51.7%和41.7%,中位生存时间分别为20个月和27个月(P=0.89)。Cox回归分析显示仅性别和分期是有统计学意义的预后因素。结论将TPT提前用于一线取得缓解或稳定的SCLC维持/巩固治疗能提高有效率,但未见生存优势。     

喉气管瓣修复下咽颈段食管癌术后缺损

修复下咽颈段食管癌术后缺损是一个复杂的问题。作者报道了采用喉气管瓣修复13例。累及食管上段的下咽癌、环后癌、梨状窝癌和颈段食管癌切除术后缺损及手术方法。其中环后癌3例，梨状窝癌5例，颈段食管癌3例，咽后壁癌2例。术后一期愈合9例，咽癌2例，吻合口狭窄2例。5年随访生存8例（61．5％）。证明采用喉气管瓣移植修复颈段食管缺损之方法简单，术后咽食管功能恢复好，不易狭窄。