三切口食管癌切除术中胃与结肠代食管术的疗效

我院自１９８０年１月～１９９０年１２月行经颈胸腹三切口手术治疗胸上、中段食管癌１８８例,术后病理证实均为鳞癌。其中胃代食管术１３０例,结肠代食管术５８例,作者对手术治疗效果及生活质量进行了回顾性对比分析。材料和方法一研究对象本组１８８例中,男１５１例...     

晚期食管癌在空肠代食管转流术中显微外科的应用

本文报告5例晚期食管癌采用显微外科技术,以空肠代食管转流吻合术解决病人经口进食的困难,改善营养状况,提高病人生活质量,为药物治疗创造条件。手术方法取近端空肠段50cm,经胸骨前或胸骨后隧道上提至颈部,空肠段上端的血管与颈部合适的动静脉吻合,空肠段下端的血管与胃网膜右动静脉吻合重建血供。空肠段上下两断端分别与颈部食管及胃吻合代食管。术后第3天患者可进流食,第10天进普食。第2周可进行化疗。随访1/2～1年取得良好近期效果。     

胃代食管术治疗下咽癌的可行性及其临床价值

背景与目的：由于下咽癌解剖部位的特殊性,传统仅作姑息性治疗.我们探讨下咽癌合并喉侵犯患者胃代食管术治疗下咽癌的可行性及其临床意义.方法：采用胃代食管术,并辅助放射治疗和适量化疗治疗42例下咽癌患者.手术范围：喉、咽切除,食管拔脱,下咽成形以及胃、口咽吻合术.放疗包括术前放疗和术后放疗.结果：无院内死亡,手术并发症3例,其中2例吻合口瘘,1例血胸,均治愈出院.3年生存率37.9%.结论：下咽癌手术切除率高,胃代食管术有明显的优势,采用下咽、喉切除胃代食管术加辅助放疗可有效的提高长期生存率,影响远期疗效的主要原因是局部复发.     

食管胃双原发癌临床病理分析

目的：探讨食管胃双原发癌临床病理特征、治疗及预后，提高临床诊治的警惕性和重视程度。方法：收集我院食管胃双原发癌24例，并结合文献资料进行临床病理特征分析。结果：食管胃双原发癌占同期标本1．69％。男性居多，60岁左右好发。食管以中段居多。鳞癌为主，胃以贲门居多。腺癌为主，双原发癌与癌症多中心起源有关。结论：男性中老年患者。出现上消化道症状时，要警惕双原发癌可能。     

食管贲门癌切除术后并发食管胃大动脉瘘18例分析

 目的 探讨食管癌贲门癌术后发生食管胃大动脉瘘的病因、诊断治疗方法与预防措施。方法 对18例术后食管胃大动脉瘘的临床资料进行回顾性分析。结果 其中食管癌14例（食管中段癌7例，下段癌7例）、贲门癌4例。食管胃弓上吻合术的7例（其中2例胸顶吻合），食管胃弓下吻合术的11例（其中4例弓窝吻合）。手术至出血发生时间最短的11 d，最长的93 d。1例再次手术行瘘修补术后生存18 d。18例全部死亡。结论 食管贲门癌应采用手术治疗，但手术方法值得探讨。避免吻合口瘘和食管胃消化性溃疡穿孔才能预防食管胃大动脉瘘的发生。     

经食管床胃代食管术中缝合纵隔胸膜的效果观察

目的：减少经食管床胃代食管术后的并发症。方法：将100例胸段食管癌切除变食管后胃经食管床提到颈部吻合，其中58例缝合纵隔胸膜固定胃（缝合组），42例不缝合纵隔胸膜（对照组）。术后观察有无胸闷、气促、呕吐等症状，拍胸部X片了解胸胃的位置及大小，随访有无“胸胃综合征”的表现。术后3个月做肺功能检查并与术前对比。结果：缝合组暂时性胸胃排空障碍1例，保守治疗缓解，全部病例X胸片示胸胃无移位，无“胸胃综合征”发生，手术前后肺功能无明显变化。对照组术后早期出现胸胃排空障碍5例，4例保守治疗好转，1例胃扭转再次手术治愈。X胸片示胸胃不同程度移位34例，“胸胃综合征”6例，23例肺活量和最大通气量比术前下降10%-15%。结论：经食管床胃代食管术中缝合纵隔胸膜可明显减少因胸胃移位而产生的术后并发症。     

结肠代食管术12例临床分析

目的 探讨结肠代食管术在消化道重建中的应用价值.方法 12例中,8例为食管癌术后吻合口复发,3例为食管癌既往有胃大部切除病史,1例为食管癌术后吻合口狭窄放置支架后吻合口气管瘘.9例采用横结肠加部分降结肠代食管,左结肠动脉为供血血管,顺蠕动吻合;3例采用横结肠加部分升结肠代食管,中结肠动脉为供血血管,逆蠕动吻合.结果 全...     

食管癌同期并发食管胃贲门双原发癌的诊断和治疗

本文报告1984年4月至1995年11月手术治疗食管癌或贲门癌1259例,经病理证实食管癌同期并发食管胃贲门原发癌22例,发生率占1.75％(22/1259)。癌分布以食管--食管5例,食管--贲门9例,食管--胃8例。本文结合文献对食管胃贲门双原发癌的发病率,诊断标准,诊断方法,病因学及治疗进行了讨论,作者认为,由于术前漏诊率高,应提高对该病的警惕,术中常规探查食管胃,并尽可能一次手术切除。     

胸内结肠代食管术治疗中晚期食管癌24例报告

结肠代食管术在1911年由Kelling首创,五十年代广泛应用于临床,多数用于治疗良性病变。1955年Mahoney和Sherman首次报导经右胸入路行结肠代食管术。由于并发症和死亡率高,以及胃代食管的应用,作者明显减少。多数认为结肠代食管术后消化道功能     

右胸,腹两切口结肠代食管术在食管癌手术中的应用

右胸、腹两切口结肠代食管术在食管癌手术中的应用江苏省肿瘤医院（南京市２１０００９）倪庆增冯纯伟刘建良在食管癌的外科治疗中，结肠代食管的术式已被广泛应用，手术途径和方式比较多，但经右胸、腹两切口做结肠代食管、结肠－食管右胸内吻合手术，国内文献尚未见报道...     

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.