按组织学特征治疗早期乳腺癌(T_1N_0M_0和T_2N_0M_0)

本文回顾分析纽约为 St.Vincent 医院医学中心在1965年～1967年经各型手术治疗的早期乳腺癌。在供分析的403例中,228例为 T_1N_0M_0(肿瘤直径<2cm,无淋巴结和远处转移),175例为 T_2N_0M_0(肿瘤2～5cm。无淋巴结侵犯:无转移)。其中365例为导管肿瘤,17例胶样癌,10例小叶癌,9例髓样癌及2例囊腺癌。     

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??Endoscopic and open operation for cN0 stage papillary thyroid carcinoma: An analysis of 164 cases LIU Yang*?? WANG Ping??WANG Yong??et al. * Department of Thyroid Surgery?? the First Affiliated Hospital of Zhengzhou University??Zhengzhou 450052??China
Corresponding author: WANG Ping??E-mail: wpycg@medmail.com.cn
Abstract Objective To explore the feasibility and efficacy of endoscopic operation for cN0 stage papillary thyroid carcinoma. Methods The data of 164 cases of cN0 stage papillary thyroid carcinoma aged 20 to 50 years old performed operation between April 2010 and July 2011 in the Second Affiliated Hospital of Zhejiang University were analyzed retrospectively. All the patients were divided into two group including 105 cases in traditional operation group and 59 cases in endoscopic operation group. The complications and the lymph node numbers of two groups were analyzed statistically. Results There was no significant difference in complications about voice hoarseness, hydroposia bucking and hypocalcemia between the two groups (P>0.05). There were 273 lymph nodes resected in endoscopic operation group (average 4.6 lymph nodes per case). There were 605 lymph nodes in traditional operation group ??average 5.8 lymph nodes per case??. There was no significant difference between the two groups (P>0.05). All the cases were followed up for 12 to 28 months with the mean of 19 month??during which no case had recurrent tumor. Conclusion Endoscopic operation for cN0 stage papillary thyroid carcinoma is safe and feasible??which has the good curative and cosmetic effects     

乳腺癌与Slit/R0b0信号通路关系的研究进展

乳腺癌是全球妇女最常见的恶性肿瘤之一,发病率攀升,且呈年轻化态势,为妇女恶性肿瘤死因的首位,倍受世界各国瞩目.     

临床T1aN0M0肺腺癌淋巴结转移预测因素分析

目的分析T1aN0M0肺腺癌患者淋巴结转移的危险因素。方法在上海市胸科医院2011年1月至2012年12月行连续手术切除的5 312例非小细胞肺癌患者中,选择273例临床分期为T1aN0M0肺腺癌的患者进行回顾性分析。根据CT检查结果分为纯磨玻璃影(GGO)、GGO带有实性成分(实性成分直径5mm)、部分实性结节(实性成分直径≥5mm)及纯实性结节。对相关的临床资料及病理特征进行单因素和多因素分析,寻找淋巴结转移的高危因素。结果入选的273例患者均行薄层CT扫描,其中103例(37.7%)为纯GGO,118例(43.2%)为GGO带有实性成分(实性成分直径5mm),13例(4.8%)为部分实性结节(实性成分直径≥5mm),39例(14.3%)为纯实性结节。共有18例(6.6%)患者有淋巴结转移,N1和N2淋巴结转移者分别为11例(6.5%)和7例(4.1%)。所有纯GGO及实性成分直径5mm的患者术后均无淋巴结转移。多因素分析显示T1a肺腺癌患者淋巴结转移的危险因素为有症状、实性成分直径≥5mm以及癌胚抗原(CEA)水平增高者(CEA5ng/ml)。多因素分析也显示纯实性结节的淋巴结转移因素为空气支气管征、肿瘤大小、有症状出现以及CEA水平增高者(95%CI:2.001~5.990,P=0.035;95%CI:1.000~3.980,P=0.021;95%CI:1.887~2.663,P=0.020;95%CI:1.514~8.498,P=0.013)。结论临床分期为T1aN0M0的肺腺癌患者,如果影像学表现为实性成分直径5mm或表现为纯GGO者无淋巴结转移,应避免淋巴结清扫。但是对于临床上纯实性结节或者实性部分直径5mm者,特别是CEA5ng/ml或者出现临床症状者,应该行系统性淋巴结清扫。     

椎间盘内注射0_2-0_3混合气体治疗腰椎间盘突出症

目的探究经皮穿刺盘内注射02-03混合气体治疗腰椎间盘突出症(LDH)的疗效。方法170例患者均有腰痛和/或下肢疼痛麻木的临床症状,经CT和/或MRI证实为LDH。在C臂机透视引导下采用16-18G穿刺针,经脊柱后外侧方入路穿刺达椎间盘中央,行盘内注射5￣15ml,03浓度为50μg/ml,术毕于神经节周围注射2%利多卡因2ml,地塞米松5mg,VitB12500μg/ml。结果治疗后3个月、6个月、12个月随访用改良的MacNab方法评价其治疗效果。优83例(48.82%),良41例(24.12%),差45例(26.47%),手术1例(0.59%),优良率为72.94%,失败率为27.06%。结论椎间盘内注射02-03混合气体是治疗LDH的一种安全、有效的新疗法。     

T_0乳腺癌的诊治体会

目的探讨T0乳腺癌的临床特点,提高T0乳腺癌的诊治水平。方法对部分高度怀疑腋窝淋巴结肿癌转移、经触诊和影像学检查未发现乳房内包块的患者分别行肿大腋窝淋巴结切除病理学检查、细针穿刺细胞学检查或术中快速冰冻切片病理学检查。11例提示为腺癌转移,行患侧改良乳腺癌根治手术。结果 34例细针穿刺细胞学检查6例提示腺癌转移,18例腋窝淋巴结切除病理学检查3例证实为腺癌转移,14例术中快速冰冻切片病理学检查,2例诊断为腺癌转移。术后常规病理学检查结果:腋窝淋巴结均有数目不等的腺癌转移,6例在患侧乳腺内找到微小原发癌灶,4例诊断为乳腺腺病,1例未发现异常。随访1～10 a,术后生存期>10 a者6例,3～5 a4例,<3 a1例,术后5 a内死亡的4例患者均死于肺、骨转移,1例死于对侧乳腺癌骨转移。结论 T0乳腺癌是经触诊和影像学检查未发现乳房内原发灶、以腋窝淋巴结转移为主要临床表现的特殊类型乳腺癌之一,临床罕见,极易误诊误治。对临床上仅有腋窝淋巴结肿大而无特殊乳房体征者,应尽快确定其病理性质并尽早治疗,以免延误病情。     

如何提高胰腺癌R0切除率

尽管自Whipple首次采用胰十二指肠切除手术治疗胰腺癌已经将近80年,胰腺癌的手术方式也已经有了许多重大的改进。但是,胰腺癌术后的高复发率及低生存率依然严重困扰着胰腺外科的发展。到目前为止,胰腺癌的5年生存率总体上仍然达不到5%。不能不说胰腺癌是所有癌症中最令人失望的癌肿。公认的看法是根治性手术切除是胰腺癌患     

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??Estimate of the criterion for R0 resection in primary hepatocellular carcinoma WU Li-qun, QIU Fa-bo, ZHANG Shun, et al. Department of Hepatobiliary Surgery, Affiliated Hospital of Medical College Qingdao University, Qingdao 266003, China
Corresponding author??WU Li-qun, E-mail??wulq5810@126.com
Abstract Objective To estimate the criterion for R0 resection of primary hepatocellular carcinoma (HCC). Methods The clinical data of 406 cases of primary HCC underwent hepatectomy from January 1998 to December 2007 in Department of Hepatobiliary Surgery, Affiliated Hospital of Medical College Qingdao University were analyzed retrospectively. The relationships between the clinical, operative and pathologic factors were analyzed. Results The factors which the median recurrence-free survival months were smaller than 6 months were considered non-R0 resection, included the vascular invasion, palliation resection, cutting edge pathologic residual tumor, lymph notes metastasis, serum AFP level continuing higher after operation or / and positive TACE (tumor dyeing on TACE within 1 month and a deposit of lipiodol on CT scan). There were 315 cases of R0 resection. Their recurrence-free survival was 84%, 67%, 42% and 30% (1, 2, 5 and 10 year) and overall survival was 97%, 86%, 56% and 35%. In 91 cases of non-R0 resection, the recurrence-free survival was 22%, 11% and 3% (1, 2 and 5 year) and overall survival was 48%, 26% and 10%. Conclusion The R0 criterion for HCC resection contains the vascular invasion, palliation resection, cutting edge pathologic residual tumor, lymph notes metastasis, serum AFP level continuing higher after resection or / and tumor dyeing on TACE within 1 month.     

T2N0M0期结直肠癌根治性术后的生存状况研究

探究外科治疗T2N0M0期结直肠癌患者的生存状况。回顾性分析2012年1月—2014年1月我院收治的108例T2N0M0期结直肠癌患者的临床资料,所有患者均行根治性手术,随访患者术后1年和3年的生存状况。单因素和Logistic多因素分析患者术后死亡相关因素。术后1年和3年生存率分别为94.46%和79.66%,其中腹腔转移、肺部转移、肝脏转移是患者术后死亡的主要原因。Logistic多因素分析显示,年龄≥60岁、病理类型为浸润型、低分化程度为T2N0M0期结直肠癌患者术后死亡的危险因素(P0.05)。T2N0M0期结直肠癌患者根治术后易发腹腔转移、肺部转移、肝脏转移,应加强对年龄≥60岁、病理类型为浸润型、低分化程度患者的管理,以提高生存率。     

cT1a～cN0M0期肺腺癌患者纵隔淋巴结转移规律

目的探讨cT1a～cN0M0肺腺癌纵隔淋巴结转移规律,从而为早期肺腺癌患者术中淋巴结清扫提供一定的理论依据。方法收集我院2017～2018年胸外科接受外科手术肺腺癌患者临床、影像、病理资料。研究共入组患者667例,其中男241例、女426例,年龄59(16,87)岁。纯磨玻璃结节(GGN)234例、GGN成分为主结节98例、实性成分为主结节199例、实性结节136例。术后发生N1淋巴结转移30例,发生N2淋巴结转移52例。依据有无纵隔淋巴结转移进行分组。结果单因素分析显示男性(P=0.014)、高癌胚抗原(CEA)水平(P0.001)、较大的结节最大径(P0.001)、较大的肿瘤实性成分比例(P0.001)、较小的肿瘤消失比例(P0.001)、实性结节(P0.001)、空洞征(P=0.005)、分叶征(P=0.002)、毛刺征(P=0.003)、胸膜凹陷征(P=0.001)、支气管征(P=0.025)、较大的病理组织(P0.001)、N1淋巴结转移(P0.001)、侵袭性病理成分(P0.001)、肺泡腔播散(P=0.001)、胸膜侵犯(P0.001)、脉管浸润(P0.001)是纵隔淋巴结转移的危险因素。多因素分析显示脉管浸润[比值比(odds ratio,OR)=6.9,95%CI 2.3～20.7,P=0.001)]、更大的肿瘤实性成分比例(OR=109.6,95%CI 3.8～3 124.3,P=0.006)、空洞征(OR=3.1,95%CI 1.1～8.3,P=0.028)、N1淋巴结转移(OR=15.7,95%CI 6.7～36.4,P0.001)是纵隔淋巴结转移的独立危险因素。结论对于cT1a～cN0M0期的肺腺癌,GGN及GGN为主型患者较少发生纵隔淋巴结转移。随着实性成分逐渐增加以及空洞征的存在,发生纵隔淋巴结转移的几率逐渐增加。因此对于不同影像学表现的患者可以考虑采用不同范围的淋巴结切除方式。     

仿生脉冲电磁场对0VX-0P大鼠骨密度与生物力学相关关系的影响

目的骨密度与骨的生物力学性能存在相关性，但某些治疗方法对骨密度及骨折发生率的影响并不一致，表明不同治疗方法可能对骨密度与骨的生物力学性能间的相关关系存在不同的影响。为此，本研究观察了仿生脉冲电磁场对去卵巢骨质疏松大鼠骨密度与生物力学关系的影响，并与雌激素进行了比较。方法6月龄雌性未孕Wistar大鼠160只，按体质量随机抽取分为以下4组：去卵巢组（OVX），去卵巢＋苯甲酸雌二醇组（E），假手术组（Sham），电磁场治疗组（EM）。OVX、EM、E组行双侧卵巢切除术，Sham组行假手术。术后第9W开始治疗：E组苯甲酸雌二醇肌肉注射，0．5mg／kg，1次，2W。EM组大鼠暴露于仿生脉冲电磁场治疗，1h／1次／d，OVX、Sham组不予以任何处理，作为对照组。开始治疗后6W、8W、10W、12W等时间点分别在麻醉下处死实验动物，腰6椎体、右侧股骨应用DEXA测定骨密度，并进行腰6椎体、右侧股骨生物力学指标的测定。结果股骨BMD（bone mineral densityBMD）与最大载荷、腰6椎体BMD与最大载荷之间均存在一种正向的线性关系。在股骨中，OVX较组相关曲线较Sham组相关曲线向右下方平移，E组则平移不明显，EM组则有左上方平移。在腰6椎体中，OVX、E组相关曲线向右下方平移不明显，EM组有左上方平移。结论仿生脉冲电磁场不但具有提高OVX-OP大鼠的BMD，同时改善了骨密度与生物力学性能的相关关系。     

Médiatisation et « greffe de visage » ou « à qui appartient la greffe de visage » ?

Mediatisation of a scientific event could be neither controlled, nor verifiable. The experience which has been lived through the first worldwide allotransplantation of composite tissues of the face confirms that the actors of a surgical innovation are not the owners. Because there is neither confidentiality nor possible patent. Curiously the scientific world, providing with a sharing ethic, which rightly privileges the free spreading of knowledge in the way that most people could benefit of it. Obviously it is made without denied controversy, for truth as purpose. This scientific word that way joins the media one, with a specific ethic of the duty of information, but also interested in mercantile preoccupations quick to cultivate controversy not to enlighten this truth but to better sell pictures or papers. Than the author should only sustain this instrumentation which could certainly flatter him, and from which he could used, but in reality that paralysed him a little to go on in serenity with his shadow worker way.     

腹腔镜肾肿瘤剜除术治疗T_(1a)N_0M_0期肾癌

目的:总结腹腔镜肾肿瘤剜除术治疗T_(1a)N_0M_0期肾癌的临床经验。方法:回顾性分析2006年10月~2012年10月接受腹腔镜保留肾单位手术(LNSS)的1 79例T_(1a)N_0M_0期肾癌患者临床资料,按手术方式分为A、B两组,A组为接受腹腔镜肾肿瘤剜除术(LTE)患者,共94例,B组为接受标准腹腔镜肾部分切除术(LPN)患行,共85例,对两组患者基本资料、围手术期情况、组织病理学结果及随访结果进行统计学分析。结果:A组、B组的手术时间、肾动脉阻断率及阻断时间之间比较差异无统计学意义(P0.05)。A组术中失血量及输血率、术后并发症发生率及术后住院时间均较B组下降,差异有统计学意义(P0.05)。术后病理证实A、B组切缘阳性分别有1例(1.1%)、3例(3.5%),癌组织累及但未穿透假包膜分别有22例(23.4%)、27例(31.8%),均差别无统计学意义(P0.05)。平均随访时间(33.5±20.9)个月,两组患者术后12个月eGFR水平较术前差异无统计学意义。A组1例(1.1%)出现同侧肾脏异位复发,1例(1.1%)出现肺转移;B组原位复发、同侧肾脏异位复发、肺转移各1例;两组间复发率、转移率差异无统计学意义(P0.05)。结论:LTE可获得与LPN相同的肿瘤学效果,有利于保留更多的正常肾组织,且并发症发生率较低,是治疗T_(1a)N_0M_0期肾癌有效的手段。